Bullous Rheumatoid Neutrophilic Dermatosis-A Systematic Review of 28 Cases

Area of Science:

• Dermatology
• Rheumatology
• Pathology

Background:

• Rheumatoid neutrophilic dermatosis (RND) is a rare extra-articular manifestation of rheumatoid arthritis (RA).
• A rare vesiculobullous subtype of RND can mimic autoimmune blistering diseases.
• This subtype primarily affects patients with seropositive and active RA.

Purpose of the Study:

• To systematically review the clinical, histopathological, immunopathological, and therapeutic features of vesiculobullous RND.
• To consolidate current knowledge on this rare dermatosis.
• To aid in the diagnosis and management of RND.

Main Methods:

• Systematic literature review following PRISMA 2020 guidelines.
• Searched PubMed, MEDLINE, and Google Scholar databases up to December 2025.
• Included case reports and series with extractable patient data; analyzed 28 non-duplicate cases.

Main Results:

• The mean age of patients was 60.8 years, with a female predominance (1:2.5 ratio) and a majority of Asian descent (67.9%).
• Lesions commonly affected lower legs (64.3%), palms/soles (41.7%), and thighs (35.7%).
• Histopathology showed dense neutrophilic infiltrate and subepidermal blisters; direct immunofluorescence and autoimmune bullous disease serology were negative.

Conclusions:

• This review is the most comprehensive synthesis of the bullous/vesiculobullous RND subtype.
• Key diagnostic features include neutrophil-predominant histopathology and negative direct immunofluorescence.
• Dapsone and corticosteroids are effective treatments, often combined with RA-specific therapies.