Neutrophilic dermatosis of the dorsal hand

Neutrophilic dermatosis of the dorsal hands (NDDH) is a rare condition often misdiagnosed as a localized cutaneous infection. A type of neutrophilic dermatosis, NDDH is considered to be a subset of Sweet's syndrome and is similar to pyoderma gangrenosum. The authors report 2 cases of male patients who presented with persistent ulcerative skin lesions. In both cases, biopsy revealed neutrophilic infiltration consistent with NDDH. Patient 1 had been unsuccessfully treated with antibiotics. Lesion biopsy showed epidermal hyperplasia with spongiosis and overlying scale crust, as well as dense neutrophilic infiltration of the underlying dermis. Periodic acid-Schiff (PAS) stain was negative for fungal and yeast organisms. A biopsy of a lesion from patient 2 indicated focal parakeratosis, perivascular inflammatory cell infiltrate, and scarring. Both patients were prescribed oral and/or topical corticosteroids and the condition resolved in 1-2 months. The clinical presentation, histological features, and excellent response to corticosteroid treatment are consistent with diagnosis of NDDH. Delayed recognition of neutrophilic dermatosis and treatment of secondary infection resulted in delayed treatment. Improved recognition of neutrophilic dermatoses is important for optimal management of NDDH. .