Recurrent bilaterally symmetrical bullous sweet′s syndrome: A rare and confusing entity

Abstract

A rare presentation of Sweet's syndrome (SS) (acute febrile neutrophilic dermatosis) is being reported in a 28-year-old man from India. I report a rare presentation of SS that consisted of bilaterally symmetrical, bullous lesions on both forearms with a seasonal recurrence. A thorough work-up for the usual conditions predisposing to or leading to SS did not throw any light on the etiology. After failing treatment with prednisolone alone we added indomethacin, and he responded to the combination in a matter of days with complete clearance of lesions.

Erythema and bullae on the face and hands of a farm worker

“…Spongiosis may be present and be more prominent in bullous SS . Interestingly, haematological malignancy and atypical features of haemorrhage and ulceration are more frequent in bullous SS, although these features were not detected in our patient …”

“…Atypical SS subtypes include ulcerative, papular and nodular, and bullous. The latter is a rare variant (> 60 reported cases) in which neutrophilic bullae predominate in a distribution similar to that of classic SS . Dorsal hand involvement in bullous SS is an uncommon but shared feature seen also in atypical pyoderma gangrenosum (PG) and neutrophilic dermatosis of the dorsal hands (NDDH), thereby making these entities difficult to distinguish clinically.…”

“…Without treatment, cutaneous SS lesions often remit, but may recur . Standard treatment is oral corticosteroids, which leads to resolution of most cases.…”

“…The presence of atypical features, including ulcers, haemorrhage and dorsal hand involvement, may lead to consideration of other aetiologies, such as atypical PG and NDDH . Diagnosis of the bullous SS variant is therefore aided by recognition of the atypical clinical presentation, together with the corresponding histopathological features and elevated levels of inflammatory markers on laboratory examination …”

Exploring the link between cadmium and psoriasis in a nationally representative sample

“…reported epidermis, papillary dermis and serum zinc concentration was decreased in patient with psoriasis 41 . Zinc supplement, oral 42 or topical use 43 had been proved to improve the condition of psoriasis.…”