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neutrophilic dermatosis
Includes:
- Sweet's syndrome
- pyoderma gangrenosum
Etiology:
- associated with
- myeloid leukemia
- myelofibrosis
- myelodysplastic syndrome
- refractory anemia
- chemotherapy
- filgrastim
- sargramostim
- all-trans retinoic acid
- thalidomide
- lenalidomide
- bortezomib
- penicillin for tonsillitis [3]
* 80-90% without underlying malignancy
Pathology:
- pathergy
- skin biopsy: dense neutrophilic infiltrate
Clinical manifestations:
- painful bullous lesions with a blue-gray border
- distribution: hands, arms, face
- painful lesions on the lip & soft palate
* images [3]
Laboratory:
- complete blood count: WBC: 32K/uL, 88% neutrophils (case report) [3]
Management:
- oral glucocorticoids
- oral cyclosporine
- wound care
* prognosis: may take > 1 years for all lesions to heal [3]
Specific
iododerma
pyoderma gangrenosum
Sweet's syndrome; acute febrile neutrophilic dermatosis
General
paraneoplastic dermatosis
References
- Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18.
American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.
- Dabade TS, Davis MD.
Diagnosis and treatment of the neutrophilic dermatoses
(pyoderma gangrenosum, Sweet's syndrome).
Dermatol Ther. 2011 Mar-Apr;24(2):273-84
PMID: 21410617
- Moon JH, Huynh J
Images in Clinical Medicine: Pathergy in Neutrophilic Dermatosis.
N Engl J Med 2021; 384:271, JAn 21
https://www.nejm.org/doi/full/10.1056/NEJMicm1901738