Erythematous plaques on the bilateral dorsal hands

Neutrophilic dermatosis of the dorsal hands is a rare cutaneous disorder characterized by the sudden onset of painful, haemorrhagic, and pustular bullae with violaceous rims on the dorsal aspects of the hands. Here we present a 61-year old male with a 1-week history of tender, haemorrhagic, and pustular bullae on both dorsal hands, evolving into ulcerative plaques with haemorrhagic crusting over 5 days. A 4 mm lesional punch biopsy revealed a diffuse dermal infiltrate of numerous neutrophils intermixed with lymphocytes and histiocytes, along with epidermal spongiosis and neutrophilic exocytosis. No leukocytoclastic vasculitis was identified. The provided images document the progression of this rare inflammatory process. Understanding such cases is crucial for accurate diagnosis and management.