A 92-year-old man with no medical history of interest was seen at our dermatology department for rapidly progressive lesions that appeared on the hands in the absence of any trauma. The lesions began as 2 violaceous papules on the back of the right hand and the dorsum of the third finger of the same hand, and in less than 2 weeks developed into 2 edematous plaques of approximately 7 cm and 3 cm in diameter, respectively, with central ulceration, a violaceous border, and a friable base. One week after the appearance of these lesions a new hard, nonulcerated, friable painful nodule appeared on the back of the left hand (Fig. 1).

Figure 1

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Culture and a skin punch biopsy were performed and empirical intravenous antibiotic treatment was initiated while awaiting the results of the microbiological studies. The culture was negative and the biopsy showed a dense neutrophilic infiltrate beneath a moderately hyperplasic epithelium. Based on these findings the patient was diagnosed with neutrophilic dermatosis of the dorsal hands and was treated with oral prednisone (0.5 mg/kg/d). The lesions improved considerably within 2 weeks of beginning treatment.

To rule out other associated processes, the patient underwent a full laboratory work-up including a blood smear and an autoimmunity study, computed tomography of the thorax, abdomen, and pelvis, and a colonoscopy, none of which revealed any pathological findings of interest.

Neutrophilic dermatosis of the dorsal hands is an inflammatory disease related to Sweet syndrome, and can be associated with other processes such as tumors (mainly hematological), autoimmune diseases, infections, and inflammatory bowel disease. Skin biopsy is essential for diagnosis and culture is useful, as this condition is frequently confused with an infectious disease. The first line of treatment consists of systemic corticosteroids, although in refractory cases other treatments such as dapsone have been administered, with good response.