Medscape is available in 5 Language Editions – Choose your Edition here.


Neutrophilic Eccrine Hidradenitis Clinical Presentation

  • Author: Joseph C Pierson, MD; Chief Editor: Dirk M Elston, MD  more...
Updated: Oct 13, 2015


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. Some healthy patients, children,[11] and adults,[12] have developed generalized urticarial-like papules and plaques of idiopathic neutrophilic eccrine hidradenitis in the summertime.

Regardless of the clinical setting, patients with neutrophilic eccrine hidradenitis develop skin lesions and frequently report fever. Half the patients are asymptomatic, but pain and tenderness are not uncommon. The palmoplantar variant of neutrophilic eccrine hidradenitis occurs in healthy children; however, one child in remission after acute lymphoblastic leukemia developed generalized extension.[13]



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,[14] and sclerodermoid changes[15] have also been noted. Tenderness may be elicited. The trunk or limbs are most often involved. Neutrophilic eccrine hidradenitis simulating orbital cellulitis,[16] facial cellulitis,[17] and symmetrical ear swelling[18] have been documented.

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


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.[19] 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[9] ; with acetaminophen[20] ; with granulocyte colony-stimulating factor[7] ; with cyclophosphamide therapy for lupus[21] ; with methotrexate therapy for actinic reticuloid[22] ; with carbamazepine usage[23] ; with cetuximab treatment[24] ; in azathioprine hypersensitivity syndrome[25] ; and with HIV, Serratia, Enterobacter,Nocardia, Staphylococcus, Streptococcus, and Mycobacterium chelonae[26] infections.

Contributor Information and Disclosures

Joseph C Pierson, MD Dermatology Residency Program Director, University of Vermont College of Medicine

Joseph C Pierson, MD is a member of the following medical societies: Association of Professors of Dermatology, New England Dermatological Society, American Academy of Dermatology

Disclosure: Nothing to disclose.


Christine C Tam, MD Managing Member, Certified Dermatologists

Christine C Tam, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

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

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

Disclosure: Nothing to disclose.

Warren R Heymann, MD Head, Division of Dermatology, Professor, Department of Internal Medicine, Rutgers New Jersey Medical School

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

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

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

Disclosure: Nothing to disclose.

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

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

  3. Cohen PR. Neutrophilic dermatoses occurring in oncology patients. Int J Dermatol. 2007 Jan. 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. 1993 Jun. 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. 2003 May. 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. 1998 Jul. 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. 1998 Aug. 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. 2005 Aug-Sep. 132(8-9 Pt 1):686-8. [Medline].

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

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

  11. Andreu-Barasoain M, Calzado L, Salamanca J, Nuño A, Gamo R, Gomez de la Fuente E, et al. Generalized idiopathic neutrophilic eccrine hidradenitis in a 7-month-old child. J Am Acad Dermatol. 2012 Oct. 67(4):e133-4. [Medline].

  12. Kambayashi Y, Fujimura T, Yamasaki K, Aiba S. Therapy-resistant, spontaneously remitting generalized neutrophilic eccrine hidradenitis in a healthy patient decreases the expression of dermcidin in affected eccrine glands. Case Rep Dermatol. 2011 Sep. 3(3):228-34. [Medline]. [Full Text].

  13. Salik D, Kolivras A, Sass U, Huybrechts S, Dangoisse C. [Palmoplantar neutrophilic eccrine hidradenitis with general extension in a child in remission after acute lymphoblastic leukemia]. Ann Dermatol Venereol. 2014 Apr. 141 (4):285-9. [Medline].

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

  15. 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].

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

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

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

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

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

  21. 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].

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

  23. Bhanu P, Santosh KV, Gondi S, Manjunath KG, Rajendaran SC, Raj N. Neutrophilic eccrine hidradenitis: a new culprit-carbamazepine. Indian J Pharmacol. 2013 Jan-Feb. 45 (1):91-2. [Medline].

  24. Turan H, Kaya E, Gurlevik Z, Erdem H, Oktay M. Neutrophilic eccrine hidradenitis induced by cetuximab. Cutan Ocul Toxicol. 2012 Jun. 31 (2):148-50. [Medline].

  25. Schmutz JL. [Neutrophilic eccrine hidradenitis and azathioprine hypersensitivity syndrome]. Ann Dermatol Venereol. 2014 Nov. 141 (11):738-9. [Medline].

  26. Bassas-Vila J, Fernández-Figueras MT, Romaní J, Ferrándiz C. Infectious eccrine hidradenitis: a report of 3 cases and a review of the literature. Actas Dermosifiliogr. 2014 Mar. 105 (2):e7-12. [Medline].

  27. Grillo E, Vano-Galvan S, Gonzalez C, Pedro J. Letter: Neutrophilic eccrine hidroadenitis with atypical findings. Dermatol Online J. 2011 Sep 15. 17(9):14. [Medline].

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

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

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

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 © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.