Neutrophilic Eccrine Hidradenitis Clinical Presentation

  • Author: Joseph C Pierson, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 18, 2011
 

History

Most reported cases of neutrophilic eccrine hidradenitis (NEH) have been in patients with AML who are undergoing chemotherapy, frequently with cytarabine. Granulocytopenia may be found in such cases. Other malignancy and chemotherapy associations exist. As noted previously, cases have been documented in AML and chronic myelogenous leukemia patients who were not on chemotherapy. Some otherwise healthy individuals have inexplicably developed biopsy-proven lesions of neutrophilic eccrine hidradenitis. Regardless of the clinical setting, patients with neutrophilic eccrine hidradenitis develop skin lesions and frequently report fever. Half of the patients are asymptomatic, but pain and tenderness are not uncommon.

Next

Physical

The cutaneous lesions of neutrophilic eccrine hidradenitis are protean. Neutrophilic eccrine hidradenitis lesions may be solitary or multiple. Erythematous or purpuric macules, papules, nodules, or plaques are described most frequently. Hyperpigmented plaques, annular lesions,[15] and sclerodermoid changes[16] have also been noted. Tenderness may be elicited. The trunk or limbs are most often involved. Neutrophilic eccrine hidradenitis simulating orbital cellulitis,[17] facial cellulitis,[18] and symmetrical ear swelling[19] have been documented. A child with self-limited generalized patches and papules of NEH has been described.[20]

Courtesy of Jeffrey P. Callen, MD. Courtesy of Jeffrey P. Callen, MD.
Previous
Next

Causes

The cause of neutrophilic eccrine hidradenitis is unknown. A direct toxic effect of chemotherapy and a paraneoplastic mechanism have both been proposed to explain neutrophilic eccrine hidradenitis in the context of malignancy. Cases of neutrophilic eccrine hidradenitis resolving after withdrawal of chemotherapy and recurring upon reinstitution of the same regimen favor the former. Also supporting a direct toxic drug response is a study showing that the intradermal injection of bleomycin can yield local neutrophilic eccrine hidradenitis changes.[21] However, skin lesions arising after chemotherapy have developed anywhere from 2 days to 2 years later. A diagnosis of toxic erythema of chemotherapy has been proposed for this group of disorders, to emphasize the overlapping clinical and histologic features with similar eruptions.[2]

Favoring a paraneoplastic process are case reports of neutrophilic eccrine hidradenitis heralding the onset of both AML[4] and chronic myelogenous leukemia[5] and the relapse of AML.[6] Neutrophilic eccrine hidradenitis has also been observed in otherwise healthy individuals[8] ; in Behçet disease[12] ; with acetaminophen[9] ; with granulocyte colony-stimulating factor[7] ; with cyclophosphamide therapy for lupus[10] ; with methotrexate therapy for actinic reticuloid[11] ; and with HIV, Serratia, Enterobacter,Nocardia, Staphylococcus, Streptococcus, and Pseudomonas infections.

Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Joseph C Pierson, MD  Consulting Staff, Department of Dermatology, Guthrie Army Clinic, Ft Drum, NY

Joseph C Pierson, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Christine C Tam, MD  Staff Physician, Dermatology Office of David A Spott, MD

Christine C Tam, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Warren R Heymann, MD  Head, Division of Dermatology, Professor, Department of Internal Medicine, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Warren R Heymann, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  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. Apr 1982;118(4):263-6. [Medline].

  2. Bolognia JL, Cooper DL, Glusac EJ. Toxic erythema of chemotherapy: a useful clinical term. J Am Acad Dermatol. Sep 2008;59(3):524-9. [Medline].

  3. Cohen PR. Neutrophilic dermatoses occurring in oncology patients. Int J Dermatol. Jan 2007;46(1):106-11. [Medline].

  4. Pierson JC, Helm TN, Taylor JS, Elston DM, Tuthill RJ. Neutrophilic eccrine hidradenitis heralding the onset of acute myelogenous leukemia. Arch Dermatol. Jun 1993;129(6):791-2. [Medline].

  5. Gomez Vazquez M, Peteiro C, Toribio J. Neutrophilic eccrine hidradenitis heralding the onset of chronic myelogenous leukaemia. J Eur Acad Dermatol Venereol. May 2003;17(3):328-30. [Medline].

  6. Saada V, Aractingi S, Leblond V, Marinho E, Frances C, Chosidow O. [Neutrophilic eccrine hidradenitis associated with relapse of acute myeloblastic leukemia]. Ann Dermatol Venereol. Jul 1998;125(6-7):420-2. [Medline].

  7. Bachmeyer C, Chaibi P, Aractingi S. Neutrophilic eccrine hidradenitis induced by granulocyte colony-stimulating factor. Br J Dermatol. Aug 1998;139(2):354-5. [Medline].

  8. Morice A, Penven K, Comoz F, Cribier B, Dompmartin A, Leroy D. [Neutrophilic eccrine hidradenitis in a healthy patient]. Ann Dermatol Venereol. Aug-Sep 2005;132(8-9 Pt 1):686-8. [Medline].

  9. EL Sayed F, Ammoury A, Chababi M, Dhaybi R, Bazex J. Neutrophilic eccrine hidradenitis to acetaminophen. J Eur Acad Dermatol Venereol. Nov 2006;20(10):1338-40. [Medline].

  10. Lienesch DW, Mutasim DF, Singh RR. Neutrophilic eccrine hidradenitis mimicking cutaneous vasculitis in a lupus patient: a complication of cyclophosphamide. Lupus. 2003;12(9):707-9. [Medline].

  11. Tojo M, Iwatsuki K, Furukawa H, Takahashi M, Kaneko F. Neutrophilic eccrine hidradenitis in actinic reticuloid syndrome. Eur J Dermatol. Mar-Apr 2002;12(2):198-200. [Medline].

  12. Bilic M, Mutasim DF. Neutrophilic eccrine hidradenitis in a patient with Behçet's disease. Cutis. Aug 2001;68(2):107-11. [Medline].

  13. Shih IH, Huang YH, Yang CH, Yang LC, Hong HS. Childhood neutrophilic eccrine hidradenitis: a clinicopathologic and immunohistochemical study of 10 patients. J Am Acad Dermatol. Jun 2005;52(6):963-6. [Medline].

  14. Bachmeyer C, Aractingi S. Neutrophilic eccrine hidradenitis. Clin Dermatol. May-Jun 2000;18(3):319-30. [Medline].

  15. Headley CM, Ioffreda MD, Zaenglein AL. Neutrophilic eccrine hidradenitis: a case report of an unusual annular presentation. Cutis. Feb 2005;75(2):93-7. [Medline].

  16. Yasukawa K, Kato N, Aikawa K, Kodama K, Hamasaka A, Hata H. Neutrophilic eccrine hidradenitis with sclerodermoid change heralding the relapse of acute myelogenous leukemia: is this a paraneoplastic phenomenon?. Dermatology. 2007;215(3):261-4. [Medline].

  17. Bardenstein DS, Haluschak J, Gerson S, Zaim MT. Neutrophilic eccrine hidradenitis simulating orbital cellulitis. Arch Ophthalmol. Nov 1994;112(11):1460-3. [Medline].

  18. Srivastava M, Scharf S, Meehan SA, Polsky D. Neutrophilic eccrine hidradenitis masquerading as facial cellulitis. J Am Acad Dermatol. Apr 2007;56(4):693-6. [Medline].

  19. Ostlere LS, Wells J, Stevens HP, Prentice G, Rustin MH. Neutrophilic eccrine hidradenitis with an unusual presentation. Br J Dermatol. Jun 1993;128(6):696-8. [Medline].

  20. Lee WJ, Kim CH, Chang SE, Lee MW, Choi JH, Moon KC, et al. Generalized idiopathic neutrophilic eccrine hidradenitis in childhood. Int J Dermatol. Jan 2010;49(1):75-8. [Medline].

  21. Templeton SF, Solomon AR, Swerlick RA. Intradermal bleomycin injections into normal human skin. A histopathologic and immunopathologic study. Arch Dermatol. May 1994;130(5):577-83. [Medline].

  22. Belot V, Perrinaud A, Corven C, de Muret A, Lorette G, Machet L. [Adult idiopathic neutrophilic eccrine hidradenitis treated with colchicine]. Presse Med. Oct 2006;35(10 Pt 1):1475-8. [Medline].

  23. Shear NH, Knowles SR, Shapiro L, Poldre P. Dapsone in prevention of recurrent neutrophilic eccrine hidradenitis. J Am Acad Dermatol. Nov 1996;35(5 Pt 2):819-22. [Medline].

  24. Antonovich DD, Berke A, Grant-Kels JM, Fung M. Infectious eccrine hidradenitis caused by Nocardia. J Am Acad Dermatol. Feb 2004;50(2):315-8. [Medline].

  25. Bernstein EF, Spielvogel RL, Topolsky DL. Recurrent neutrophilic eccrine hidradenitis. Br J Dermatol. Nov 1992;127(5):529-33. [Medline].

  26. Laffitte E, Hohl D, Panizzon RG. [Pseudomonas eccrine hidradenitis in a child revealing acute lymphoblastic leukemia]. Ann Dermatol Venereol. Nov 2004;131(11):975-8. [Medline].

  27. Takai T, Matsunaga A. A case of neutrophilic eccrine hidradenitis associated with streptococcal infectious endocarditis. Dermatology. 2006;212(2):203-5. [Medline].

 
Previous
Next
 
Courtesy of Jeffrey P. Callen, MD.
Neutrophilic infiltrate on hematoxylin and eosin stain (100X). Courtesy of Jeffrey P. Callen, MD, and Vilma Fabre, MD.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.