Paparone Philip P, Paparone Paige A, Senyatso Refilwe Y
Infectious Disease Specialists Inc, Galloway, NJ; email:
Touro College of Osteopathic Medicine, New York, NY.
Wounds. 2013 Jun;25(6):148-52.
Neutrophilic dermatosis of the dorsal hands (NDDH) is a rare condition often misdiagnosed as a localized cutaneous infection. A type of neutrophilic dermatosis, NDDH is considered to be a subset of Sweet's syndrome and is similar to pyoderma gangrenosum. The authors report 2 cases of male patients who presented with persistent ulcerative skin lesions. In both cases, biopsy revealed neutrophilic infiltration consistent with NDDH. Patient 1 had been unsuccessfully treated with antibiotics. Lesion biopsy showed epidermal hyperplasia with spongiosis and overlying scale crust, as well as dense neutrophilic infiltration of the underlying dermis. Periodic acid-Schiff (PAS) stain was negative for fungal and yeast organisms. A biopsy of a lesion from patient 2 indicated focal parakeratosis, perivascular inflammatory cell infiltrate, and scarring. Both patients were prescribed oral and/or topical corticosteroids and the condition resolved in 1-2 months. The clinical presentation, histological features, and excellent response to corticosteroid treatment are consistent with diagnosis of NDDH. Delayed recognition of neutrophilic dermatosis and treatment of secondary infection resulted in delayed treatment. Improved recognition of neutrophilic dermatoses is important for optimal management of NDDH. .
手背嗜中性皮病（NDDH）是一种罕见病症，常被误诊为局部皮肤感染。作为嗜中性皮病的一种类型，NDDH被认为是Sweet综合征的一个亚型，与坏疽性脓皮病相似。作者报告了2例出现持续性溃疡性皮肤病变的男性患者。在这两个病例中，活检均显示符合NDDH的嗜中性粒细胞浸润。患者1使用抗生素治疗无效。病变活检显示表皮增生伴海绵形成及上层鳞屑痂，以及真皮深层密集的嗜中性粒细胞浸润。过碘酸希夫（PAS）染色显示真菌和酵母生物体呈阴性。患者2病变的活检显示灶性角化不全、血管周围炎性细胞浸润和瘢痕形成。两名患者均接受了口服和/或外用皮质类固醇治疗，病情在1 - 2个月内得到缓解。临床表现、组织学特征以及对皮质类固醇治疗的良好反应均符合NDDH的诊断。对嗜中性皮病的识别延迟以及对继发感染的治疗导致了治疗延误。提高对嗜中性皮病的认识对于NDDH的最佳管理至关重要。
