NEUTROPHILIC DERMATOSIS (PUSTULAR VASCULITIS) OF THE DORSAL HANDS

By Gary M. White, MD


Neutrophilic dermatosis of the dorsal hands

Neutrophilic dermatosis (pustular vasculitis) of the dorsal hands is a variant of Sweet's Syndrome. Pyoderma gangrenosum has some similar clinical features.

Clinical

The patient presents with pustular or ulcerative plaques and nodules or hemorrhagic bulla on the dorsal hands and/or fingers. Often, the patient is suspected of having a cutaneous infection, but antibiotic therapy is ineffective. Skin biopsy shows a dense dermal neutrophilic infiltrates with leukocytoclasis and fibrinoid vascular necrosis. Cutaneous cultures by definition yield negative findings. In one series of 7 patients, possible systemic associations included bowel disorders and a urinary tract infection. A low grade fever may be present.

Treatment

Prednisone rapidly reverses the process and should be started once infection has been excluded and the diagnosis established. Cyclosporin is an alternative. Topical clobetasol ointment is helpful as an adjunct to systemic therapy. See Sweet's Syndrome for further discussion of treatment options.

Additional Pictures

Neutrophilic dermatosis of the dorsal hands Neutrophilic dermatosis of the dorsal hands

Neutrophilic dermatosis of the dorsal hands

References

Neutrophilic dermatosis of the dorsal hands in an elderly man Dermatology Online Journal 2016;22(2)

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