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Year : 2015  |  Volume : 6  |  Issue : 5  |  Page : 361-362  

Neutrophilic dermatosis of the dorsal hands: A rare unilateral presentation


Department of Dermatology, Dr. P.N. Behl's Skin Institute and School of Dermatology, New Delhi, India

Date of Web Publication4-Sep-2015

Correspondence Address:
Sarvesh S Thatte
Department of Dermatology, Dr. PN Behl’s Skin Institute and School of Dermatology, N Block, Greater Kailash 1, Zamrudpur, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2229-5178.164490

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How to cite this article:
Thatte SS, Aggarwal A. Neutrophilic dermatosis of the dorsal hands: A rare unilateral presentation. Indian Dermatol Online J 2015;6:361-2

How to cite this URL:
Thatte SS, Aggarwal A. Neutrophilic dermatosis of the dorsal hands: A rare unilateral presentation. Indian Dermatol Online J [serial online] 2015 [cited 2019 Dec 6];6:361-2. Available from: http://www.idoj.in/text.asp?2015/6/5/361/164490

Sir,

Neutrophilic dermatosis of the dorsal hands (NDDH) refers to a localized variant of Sweet syndrome when the clinical lesions are predominantly restricted to the dorsal aspect of the hands and are similar to those of Sweet syndrome in morphology. Cutaneous pathergy occurs when skin lesions appear at sites of trauma.[1] Herein we report a case of unilateral presentation of NDDH following insect bite.

A 50-year-old married woman presented at our outpatient department with moderately swollen, painful red colored area with burning sensation over dorsum of left hand of three weeks duration following an insect bite. The patient took treatment from a private practitioner for two weeks without any relief. She denied any history of itching, recent change of medications or intake of new medications, any loss of sensation, or any other skin lesions on body.

On cutaneous examination, a well-defined erythematous and markedly edematous lesion measuring 5 × 6 cm was present over the dorsum of left hand with central clearing and raised erythematous, edematous, infiltrated, and irregular margin with surrounding erythema. A fine collarette of scales was present in area of central clearing. Few erythematous, edematous, and infiltrated papules were present near the margin [Figure 1]. Deep dermal tenderness was positive. Differential diagnoses of persistent insect bite reaction, erysipelas, and NDDH were considered.
Figure 1: A well-defined erythematous and edematous lesion with central clearing and raised erythematous, edematous, infiltrated, and irregular margin

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A biopsy was taken from margin of the lesion, which revealed diffuse and dense neutrophilic infiltrate in papillary dermis extending to reticular dermis along with papillary dermal edema [Figure 2]. Based on clinical and histopathological findings final diagnosis of NDDH following insect bite was made.
Figure 2: Papillary dermal edema with dense neutrophilic infiltrate (hematoxylin and eosin ×10)

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Patient was started on tablet prednisolone 5 mg three times a day for 10 days with dramatic improvement [Figure 3].
Figure 3: Excellent response following oral steroids

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In NDDH, lesions are morphologically similar to Sweet syndrome and predominantly restricted to the dorsal aspect of the hands that rapidly resolve after systemic corticosteroids and/or dapsone therapy is initiated.[1] Cutaneous pathergy, is a dermatosis-associated feature and occurs when skin lesions appear at sites of cutaneous trauma such as biopsies, injection sites, intravenous catheter placement, venepuncture, insect bites, and cat scratches.[1]

Baz et al. reported a case of NDDH that was associated with sarcoidoisis and hepatitis C.[2] Boye et al. reported three cases of NDDH without any localized or systemic triggering factor.[3] DiCaudoand Connolly reported seven cases of NDDH among which bowel disorders and urinary tract infection were considered as possible systemic association.[4] Byun et al. reported a case of NDDH with lip involvement without any systemic feature.[5]

In our case, lesion was present unilaterally over the dorsum of left hand, without any systemic association and occurred at the site of insect bite, which suggests the cutaneous pathergy associated with the dermatosis.

Unilateral presentation of NDDH following insect bite is rarely encountered in day-to-day practice.

 
   References Top

1.
Cohen PR, Honigsmann H, Kurzrock R. Acute Febrile Neutrophilic Dermatosis (Sweet syndrome) In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolf K, editors. Fitzpatrick's Dermatology in General Medicine. 8th ed. New York: McGraw-Hill; 2012. p. 362-371.  Back to cited text no. 1
    
2.
Baz K, Yazici AC, Kaya TI, Ikizoglu G, Ulubas B, Apa DD, et al. Neutrophilic dermatosis of the hands (localized Sweet's syndrome) in association with chronic hepatitis C and sarcoidosis. Clin Exp Dermatol 2003;28:377-9.  Back to cited text no. 2
    
3.
Boye T, Terrier JP, Guennoc B, Fournier B, Carsuzaa F. Neutrophilic dermatosis of the hands. A localized subset of Sweet's syndrome: 3 cases. Ann Dermatol Venereol 2005;132:883-5.  Back to cited text no. 3
    
4.
DiCaudo DJ, Connolly SM. Neutrophilic dermatosis (pustular vasculitis) of the dorsal hands: A report of 7 cases and review of the literature. Arch Dermatol 2002;138:361-5.  Back to cited text no. 4
    
5.
Byun JW, Hong WK, Song HJ, Han SH, Lee HS, Choi GS, et al. A case of neutrophilic dermatosis of the dorsal hands with concomitant involvement of the lips. Ann Dermatol 2010;22:106-9.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


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