Neutrophilic dermatosis of the hands (NDH) is a recently described condition that resembles and, in fact, may represent a variant of Sweet syndrome confined to the hands [1]. NDH is characterized by erythematous, edematous plaques with a violaceous border occurring on the dorsal area of the hands. Vesicles, central necrosis, and ulceration can be prominent features. Associated clinical findings include pathergy, fever, and peripheral neutrophilia. Histopathology reveals a dense neutrophilic dermal infiltrate, often with subepidermal edema and occasionally leukocytoclastic vasculitis.A 57-year-old man sought consultation at an outside institution because of a 1-month history of progressive purplish discoloration of his left second digit (Image 1), with associated fever and malaise. Despite negative cultures, the affected digit was amputated because of concern about infectious gangrene. After amputation, the violaceous border continued to expand due to pathergy, and the patient presented to our institution for a second opinion (Image 2). A diagnosis of NDH was made after clinical examination Image 1. Deep-red, edematous, violaceous plaque on the digit before amputation.Image 2. Violaceous plaque surrounding amputation site.Image 3. A and B, Histopathology of amputated digit revealing intraepidermal edema and diffuse dermal neutrophilia (hematoxylin-eosin, original magnification 310 and 340, respectively).
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