Neutrophilic dermatosis of the dorsal hands: Pustular vasculitis revisited

The Relationship Between Neutrophilic Dermatosis of the Dorsal Hands and Sweet Syndrome

“…The relationship of NDDH to pustular vasculitis, acute febrile neutrophilic dermatosis (Sweet syndrome), and pyoderma gangrenosum (PG) remains undecided. The presentation of violaceous papulonodules on the radial aspects of the dorsal hands was originally noted by Strutton et al, 1 and Galaria et al 2 proposed the term neutrophilic dermatosis of the dorsal hands for this disease. Others have since reported cases and offered insights into the categorization of this entity.…”

A Case of Neutrophilic Dermatosis of the Dorsal Hands with Concomitant Involvement of the Lips

“…The histology of NDDH shows prominent papillary dermal edema and a dense diffuse infiltration of mature neutrophils throughout the upper dermis 3 . Swollen endothelial cells, dilated small blood vessels and fragmented neutrophil nuclei can also be present 4 .…”

“…NDDH is a rare, localized variant of SS, and this was first described by Galaria et al 3 in 2000. The pathogenesis of SS may be multifactorial and it remains to be definitively determined 4 .…”

“…A septic process, a hypersensitivity reaction, leukotactic mechanisms and cytokines have all been postulated to contribute to the pathogenesis of SS 4 . Clinically, NDDH is characterized by tender, erythematous plaques, pustules and bullae that are generally limited to the dorsal hands and fingers 3 . This is usually limited to the dorsal hands, and often with a predilection for the lateral aspect of the hand between the thumb and index finger 5 .…”

“…Allergic contact dermatitis is an eczematous dermatitis that presents as severe pruritus that develops in regions exposed to allergen, and allergic contact dermatitis shows spongiotic dermatitis histologically 8 . Cellulitis or erysipelas is excluded according to the negative tissue cultures and stains and a lack of response to antibiotics 3 . Atypical pyoderma gangrenosum, also known as vesiculobullous PG, presents with chronic hemorrhagic bullous lesions that ulcerate superficially and are usually seen in patients with leukemia or polycythemia vera 7 .…”