Erythematous papules in a patient with rheumatoid arthritis. Rheumatoid neutrophilic dermatitis (RND)

Rheumatoid neutrophilic dermatitis

“…No mucosal or nail involvement was described, except in two cases in which aphthous ulcers and mild nail bed erythema were presented in association with onset and worsening of concomitant RA 20,44 . Considering the evolution in terms of type of lesions and extension, crusted erosions, postinflammatory hyperpigmentation and secondary spreading to the trunk were mainly reported 22,23,25,28,29,33,35,38,40,45 . One case of atrophic scarring after ulceration also occured, 30 as well as concomitant palpable purpura of the lower extremities in the absence of vasculitis 19 .…”

“…20,44 Considering the evolution in terms of type of lesions and extension, crusted erosions, postinflammatory hyperpigmentation and secondary spreading to the trunk were mainly reported. 22,23,25,28,29,33,35,38,40,45 One case of atrophic scarring after ulceration also occured, 30 as well as concomitant palpable purpura of the lower extremities in the absence of vasculitis. 19 RND was predominantly asymptomatic (55.5%), although a subset of patients reported the presence of pain (26%) and itch (18.5%).…”

“…Of the remaining patients who exhibited positive outcomes, it was challenging to identify clinical and nonclinical features in common. 10,17,37,38,50 Regarding systemic treatments, steroids represented a therapeutic pillar with prednisone 5,[14][15][16][19][20][21]24,27,[31][32][33]35,51 over methyl-/ prednisolone 13,28,34,44,46,47,52 followed by dapsone 3,11,13,18,40,42,43,49 and colchicine 24,44,52 in terms of prevalence. Data about the duration of systemic therapies were reported in 17 cases: steroids were administered for a minimum of half a month 21,28,31 and a maximum of 10 months.…”

Management of neutrophilic dermatoses

“…Some individual case reports suggest that RND improves with treatment of the underlying rheumatoid arthritis (173,174). Individual patients have been reported to respond to oral and topical corticosteroids, dapsone (100 mg/day), hydroxychloroquine, sulphamethoxypyridamine (500 mg twice daily), and cyclophosphamide (169)(170)(171)(173)(174)(175)(176)(177)(178).…”

Rheumatoid Neutrophilic Dermatitis as Presenting Sign of Seronegative Arthritis

“…It manifests as symmetric erythematous papules, plaques and nodules and urticarial lesions over the trunk, shoulders, neck and extensor surfaces of the extremities (4,9). Annular, vesicular or ulcerative lesions are less common (5,7). There have only been 4 cases of RND associated with seronegative RA (11 -14).…”