Longitudinal Presentation and Management of Neutrophilic Dermatosis of the Dorsal Hand: A Case Report Over Six Visits

Neutrophilic dermatosis of the dorsal hands (NDDH) is a rare, challenging condition characterized by its acute febrile onset, neutrophilic dermal infiltrate seen on histology, and frequent association with hematologic disorders. This case report presents a longitudinal follow-up of NDDH in an 80-year-old male with significant comorbid conditions, including atrial fibrillation, chronic systolic heart failure, venous insufficiency, and gastroesophageal reflux disease. Over six clinic visits, we document the patient's clinical progression, highlighting key changes in presentation, diagnostic findings, and the multifaceted approach to management, including the use of systemic and topical therapies. Notably, the treatment strategy was adapted in response to diagnostic tests revealing methicillin-resistant Staphylococcus aureus (MRSA) and Group B Streptococcus (GBS), complicating the patient's condition. Despite the challenges posed by the patient's comorbidities, which limited the use of certain medications, the patient showed significant improvement with a treatment approach primarily involving topical and systemic steroids. The observed improvement emphasizes the effectiveness of modifying therapy based on lesion regression and the patient's overall condition. This case underscores the critical need for accurate diagnosis, the complexities of managing NDDH in patients with multiple health conditions, and the value of adaptability in treatment plans. Through this detailed longitudinal case study, we contribute insights into the progression and management of NDDH, emphasizing the need for ongoing research and a flexible approach to treatment.