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.

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.

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