Neutrophilic eccrine hidradenitis in non‐small cell lung cancer

Abstract

A 75-year-old man was treated for non-small cell lung cancer (NSCLC) (stage IIIb) with three-cycle chemotherapy (cisplatin and paclitaxel) for 3 weeks. No skin lesions were observed during the first and second chemotherapy cycles. After the third chemotherapy cycle, he developed slightly pruritic skin eruptions on the anterior chest. He was treated for 1 month with topical steroid without improvement, and was referred to our dermatologic department.Skin examination revealed slightly elevated, dusky, erythematous, edematous patches on the anterior chest in a bilateral distribution (Fig. 1).Histologic examination of a biopsy specimen taken from the cutaneous lesions showed a neutrophilic infiltrate surrounding the secretory eccrine glands. The epithelial cells of the eccrine ducts and coils were not affected. There was a mild superficial perivascular infiltrate of mainly lymphocytes. These changes were consistent with a diagnosis of neutrophilic eccrine hidradenitis (Fig. 2).He was treated with dapsone, 50 mg /day, and methylprednisolone, 8 mg /day, for 2 weeks, and his skin lesions improved. Two months later the erythematous eruptions recurred on the chest, back, and extremities without the use of any chemotherapeutic agent, and were treated effectively with the same drugs.

Diseases of cutaneous appendages

“…1491,[1527][1528][1529][1530] The first reports concerned patients with acute myelogenous leukemia receiving cytarabine therapy, 1527,1531 but other cancers [1532][1533][1534][1535][1536] and other chemotherapeutic agents 1533,1537 have now been implicated, as has granulocyte colony-stimulating factor (G-CSF). 1491,[1527][1528][1529][1530] The first reports concerned patients with acute myelogenous leukemia receiving cytarabine therapy, 1527,1531 but other cancers [1532][1533][1534][1535][1536] and other chemotherapeutic agents 1533,1537 have now been implicated, as has granulocyte colony-stimulating factor (G-CSF).…”

Neutrophilic dermatoses occurring in oncology patients

“…Neutrophilic dermatoses may develop in patients with cancer 1 . Lee et al 2 . described an oncology patient with neutrophilic eccrine dermatosis, reviewed the features of this condition, and discussed the postulated pathogenesis for this disorder, including the possibility that “neutrophilic eccrine hidradenitis is, as with Sweet's syndrome, a part of the spectrum of neutrophilic dermatoses.” In this article, in addition to describing another cancer patient with neutrophilic eccrine hidradenitis, the characteristics of neutrophilic eccrine hidradenitis and Sweet's syndrome are compared, and examples of multiple neutrophilic dermatoses occurring either concurrently or sequentially in the same individual are summarized.…”

“…In patients who have an underlying malignancy, neutrophilic dermatoses occur as a paraneoplastic syndrome, an antineoplastic therapy‐related disorder, or, less commonly, as an idiopathic condition 1 . The neutrophilic dermatosis usually presents as a single condition, such as in the man with lung cancer reported by Lee et al 2 . His recurrent neutrophilic eccrine hidradenitis initially appeared following the third course of chemotherapy and subsequently recurred (in the absence of any additional chemotherapy) 6 weeks after the dermatosis‐related treatment had been stopped.…”

“…Lee et al . 's patient with neutrophilic eccrine hidradenitis showed several unique features: 2 he had non‐small cell lung cancer and had received antitumor treatment with agents that either had not been reported (paclitaxel) or had seldom been observed (cisplatinum) to precede the appearance of neutrophilic eccrine hidradenitis. In addition, his dermatosis initially appeared after his third course of cancer therapy, in contrast with more than 70% of oncology patients who develop neutrophilic eccrine hidradenitis following their first course of chemotherapy.…”

“… § AML is the most common NEH‐associated malignancy (> 67%); other hematologic malignancies include CLL, CML, ALL, Hodgkin's disease, and non‐Hodgkin's lymphoma. NEH‐associated solid tumors include testicular carcinoma, Wilms’ tumor (nephroblastoma), breast carcinoma, lung carcinoma, osteosarcoma, and esophageal carcinoma 2,12,22–25 …”