Correspondence

Neutrophilic Dermatosis versus Neutrophilic Eccrine Hidradenitis

N Engl J Med 1999; 340:1371April 29, 1999

Article

To the Editor:

In the Images in Clinical Medicine in the December 3 issue,1 the history and pathologic picture are not consistent with the diagnosis of acute febrile neutrophilic dermatosis but are typical of neutrophilic eccrine hidradenitis, a condition frequently seen in patients receiving chemotherapy.2 The important distinction is the presence of neutrophils around eccrine sweat glands deep within the dermis. The response of the patient shown in the Image to intravenous corticosteroids is not specific. Neutrophilic eccrine hidradenitis remits spontaneously but may recur during subsequent courses of chemotherapy.

Paul R. Gross, M.D.
220 S. 8th St., Philadelphia, PA 19107

David Margolis, M.D.
Hospital of the University of Pennsylvania, Philadelphia, PA 19104

2 References

1. 1

   Starobinski M, Salomon D. Acute febrile neutrophilic dermatosis in acute myelogenous leukemia. N Engl J Med 1998;339:1687-1687
   Full Text | Web of Science | Medline

2. 2

   Margolis DJ, Gross PR. Neutrophilic eccrine hidradenitis: a case report and review of the literature. Cutis 1991;48:198-200
   Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: Gross and Margolis aptly point out that some features of our case were consistent with a diagnosis of neutrophilic eccrine hidradenitis.1 This entity is part of a group of neutrophilic dermatoses that also includes Sweet's syndrome and pyoderma gangrenosum. In our patient, the diagnosis of acute neutrophilic dermatosis (Sweet's syndrome) was based on the appearance of polymorphic, tender, infiltrated papulonodules, as well as sterile pustules, and on the histologic evidence of full-thickness dermal invasion by neutrophils. These findings meet the criteria for the diagnosis of acute neutrophilic dermatosis.2 The additional involvement of the adnexae supports the diagnosis of neutrophilic eccrine hidradenitis, and it may be that this entity is part of a continuous spectrum of neutrophilic dermatoses.3 This could explain the features of both conditions in our patient. Our patient suffered a recurrence of neutrophilic dermatosis when he was given chemotherapy for the relapse of his myelomonocytic leukemia but not when receiving consolidation chemotherapy while the disease was in complete remission.

Michel Starobinski, M.D.
Denis Salomon, M.D.
Hôpitaux Universitaires de Genève, CH-1211 Geneva 14, Switzerland

3 References

1. 1

   Harrist TJ, Fine JD, Berman RS, Murphy GF, Mihm MC Jr. Neutrophilic eccrine hidradenitis: a distinctive type of neutrophilic dermatosis associated with myelogenous leukemia and chemotherapy. Arch Dermatol 1982;118:263-266
   CrossRef | Web of Science | Medline

2. 2

   Fett DL, Gibson LE, Su WP. Sweet's syndrome: systemic signs and symptoms and associated disorders. Mayo Clin Proc 1995;70:234-240
   CrossRef | Web of Science | Medline

3. 3

   Vignon-Pennamen MD, Wallach D. Cutaneous manifestations of neutrophilic disease: a study of seven cases. Dermatologica 1991;183:255-264
   CrossRef | Medline

Citing Articles (3)

Citing Articles

1. 1

   Iwei Yeh, Evan George, Philip Fleckman. (2011) Eccrine hidradenitis sine neutrophils: a toxic response to chemotherapy. Journal of Cutaneous Pathology 38:11, 905-910
   CrossRef

2. 2

   T.E.C. Nijsten, L. Meuleman, J. Lambert. (2002) Chronic pruritic neutrophilic eccrine hidradenitis in a patient with Behcet's disease. British Journal of Dermatology 147:4, 797-800
   CrossRef

3. 3

   Gaston Roustan, Clara Salas, Rafael Cabrera, Angel Simón. (2001) Neutrophilic eccrine hidradenitis unassociated with chemotherapy in a patient with acute myelogenous leukemia. International Journal of Dermatology 40:2, 144-147
   CrossRef