Palmoplantar Eccrine Hidradenitis: Seven New Cases

Abstract

Palmoplantar eccrine hidradenitis is a self-limited disease characterized by painful erythematous papules and nodules of abrupt onset on the soles, and less frequently on the palms, of young individuals in good health. We describe seven children, four girls and three boys, between 4 and 12 years of age, with characteristic cutaneous and histopathologic findings of palmoplantar eccrine hidradenitis. All patients had complete resolution of their lesions within 2-4 weeks without treatment, however, one child experienced recurrences. All skin biopsy specimens showed a deep dermal mixed infiltrate with abundant neutrophils surrounding eccrine sweat glands, the histologic hallmark of the disease. Palmoplantar eccrine hidradenitis is a distinct clinical entity in which physical activity, excessive sweating, and prolonged wetness are possible triggering factors. The regression of the lesions is usually rapid, with complete clearance after 1 month, although there may be recurrent episodes.

Neutrophilic Dermatoses in Children

“…Children with idiopathic palmoplantar hidradenitis develop tender erythematous plaques and nodules on the palms or, less commonly, the soles with acute onset, often after cold exposure, local trauma, physical activity, or prolonged wetness ⁄ sweating (68)(69)(70)(71)(72)(73)(74)(75)(76). No associated medication or underlying disease can be identified and patients are afebrile.…”

“…In a minority of patients, lesions recur. Younger children may be predisposed because of the immaturity of their eccrine glands (68)(69)(70)(71)(72)(73)(74)(75)(76). Several series described seasonality to cases, with peaks in the spring, summer, or autumn.…”

“…Neutrophilic eccrine hidradenitis (NEH) is a self‐limited eruption of urticaria‐like edematous erythematous papules, and plaques (66,67). Neutrophilic eccrine hidradenitis occurs in a classical malignancy‐associated variant (66,67), an idiopathic palmoplantar pediatric variant (68–76) and a pseudomonas‐associated variant (77). In the classical variant, lesions are tender, abrupt in onset, affect the face, arms, palms, and soles (66,67) in the last two to four weeks but frequently recur.…”

Palmar Eccrine Hidradenitis Secondary to Trauma from Computer Gaming in an Adolescent After Bone Marrow Transplantation

“…Reported mostly in athletes exposed to repeated trauma, especially on the palms and soles , it has been described after gaming on a PlayStation (Sony, Tokyo, Japan) for several days . The density of eccrine glands at these sites, coupled with alterations in these glands caused by a combination of intense physical activity, sweating, and occlusion, has been postulated to be causative .…”

Painful nodules on the soles in a 9-year-old boy

“…The nodules usually appear after intense physical activity and are so painful that they lead to a walking impairment. 3 The pathogenesis of PEH remains obscure; physical activity and hyperhidrosis may play a role by occluding the ducts of eccrine glands and activating the inflammatory response. 4 It is important to recognise this condition to avoid unnecessary therapy with antibiotic and anti-inflammatory drugs.…”