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Dermatology Online Journal

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Neutrophilic dermatosis of the dorsal hands in an elderly man


recently diagnosed with stage II lung adenocarcinoma, who presented to the clinic with a 14-day history of painful macules that progressed to bullae on the dorsal surface of his hands; decreased range of motion was noted. Examination revealed bilateral small, tender violaceous vesicopustules admixed with larger tense hemorrhagic pus-filled bullae on the dorsal aspect of his hands. Biopsy demonstrated changes consistent with neutrophilic dermatosis of the dorsal hands. The patient had been diagnosed with ulcerative colitis in the 1970s, although the condition was asymptomatic at the time of presentation. Treatment with prednisone 60 mg daily resulted in significant improvement by the next day. This regimen was continued for two weeks and was followed by a 6-week steroid taper. After a review of the approximate 75 cases currently reported, we also discuss the recurrence rate of NDDH of approximately 10%.

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