Neutrophilic dermatosis of the hands: Presentation of eight cases and review of the literature

Abstract

Pustular dermatosis of the dorsal hands is a peculiar variant of Sweet's syndrome described by Strutton et al. Nevertheless, not all authors accept this entity. We present a retrospective study of eight cases of neutrophilic vasculitis of the hands. Three patients presented with lesions only on the dorsal hands, three with lesions on the palmar surface and two with lesions on the dorsal and palmar surfaces of the hands. The patients with lesions on the dorsal surface presented a pustular aspect, and the histopathological examination revealed a high degree of vascular damage with presence of vasculitis and, in one case, with fibrinoid necrosis. Therefore, the term pustular vasculitis of the dorsal hands introduced by Strutton et al. should probably be conserved. Our cases may have demonstrated a peculiar clinicopathological disease with its own entity.

Pustular vasculitis

“…The majority of cases described in the literature predominantly involve the dorsal hands1 3 and may subsequently spread to involve the lower limbs; however, our case demonstrates a rare case where primary involvement of the lower limbs was present with secondary involvement at the dorsum of the hands. The mean age of onset is 68.75 years 3.…”

“…We present a rare case of pustular cutaneous vasulitis, which describes a heterogeneous group of disorders characterised by papules, haemorrhagic plaque pustules on purpuric bases2 and bullous lesions 3…”

“…The mean age of onset is 68.75 years 3. Fever, pathergy4 and peripheral neutrophilia can be present, but are not necessary to make the diagnosis 3.…”

“…The mean age of onset is 68.75 years 3. Fever, pathergy4 and peripheral neutrophilia can be present, but are not necessary to make the diagnosis 3. The lesions are often intensely painful, often disproportional to the lesion size4 and ulceration is a common feature 4 5.…”

“…The lesions share a histopathological appearance demonstrating neutrophilic dermatosis and leukocytoclastic vasculitis 2 3…”