Neutrophilic dermatosis of the dorsal hands

Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Acad Dermatol


We report a case of a 78-year-old white gentleman who presented with a three to four week history of lesions on the dorsal aspect of his bilateral hands. The areas were associated with edema, pruritus and pain. Physical exam revealed edematous hemorrhagic plaques with focal areas of ulceration, predominantly on bilateral dorsal hands. Punch biopsy of a plaque on his left dorsal hand showed a diffuse neutrophilic infiltrate with areas of leukocytoclasis. In addition, there was hemorrhage and endothelial swelling with neutrophils noted within vessel walls. Tissue culture was obtained with a negative gram stain. Fungal culture was also negative and acid-fast bacilli were not present. The patient was treated with prednisone 80 mg daily, approximately 1 mg/kg with substantial improvement in edema, pruritus and pain. Neutrophilic dermatosis of the dorsal hands (NDDH) is a rare, localized variant of Sweet's syndrome first described in 1996. This condition has been observed in patients with myelodysplasia, leukemia, inflammatory bowel disease, sarcoidosis, lymphoma and hepatitis C. Presentation of this condition varies greatly including, but not limited to, violaceous edematous or ulcerated plaques with bullous or hemorrhagic lesions also being described. Fever, neutrophilic leukocytosis and elevated sedimentation rate have been reported in one-third of patients. Treatment is similar to Sweet's syndrome with first line therapy considered to be systemic corticosteroids. Dapsone, colchicine, azathioprine, tetracyclines, and cyclosporine have also been reported as treatment options.




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