eMedicine Specialties > Dermatology > Diseases of the Adnexa
Neutrophilic Eccrine Hidradenitis: Treatment & Medication
Updated: Aug 31, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
Many neutrophilic eccrine hidradenitis (NEH) patients are asymptomatic and do not require therapy for the self-limited eruption. Some patients may seek relief of pain and/or fever.
Consultations
The patient's primary care provider should be informed of the possible implications of this rare disorder. If the patient has been previously diagnosed with a malignancy, the treating hematologist or oncologist should be notified.
Medication
Pain relief is sometimes necessary in neutrophilic eccrine hidradenitis (NEH). Nonsteroidal anti-inflammatory drugs (NSAIDs) appear to be the simplest intervention and decrease associated fever. Systemic corticosteroids have not been universally effective in neutrophilic eccrine hidradenitis and confer more immunologic risks to the patient undergoing chemotherapy for treatment of malignancy. An individual with idiopathic neutrophilic eccrine hidradenitis was successfully treated with colchicine.21
Nonsteroidal anti-inflammatory drugs
Have analgesic and antipyretic activities. Inhibit cyclo-oxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, including inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions.
Ibuprofen (Ibuprin, Advil, Motrin)
DOC for mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
Adult
400-800 mg PO tid; not to exceed 3.2 g/d
Pediatric
10 mg/kg PO q6-8h; not to exceed 40 mg/kg
Coadministration with aspirin increases risk of serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently; concurrent use of NSAIDs and cyclosporine may increase cyclosporine levels, nephrotoxicity, and increased plasma creatinine concentrations; concurrent administration of lithium and NSAIDs may result in elevated lithium serum levels leading to lithium toxicity
Documented hypersensitivity; peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, or high risk of bleeding
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in dehydration, CHF, hypertension, and decreased renal and hepatic function; prolonged bleeding may be exaggerated in patients with underlying hemostatic defects; caution in anticoagulation abnormalities or during anticoagulant therapy; GI toxicity (eg, bleeding, ulceration, perforation) can occur in patients treated with long-term administration of NSAIDs
Ketoprofen (Oruvail, Orudis)
For relief of mild to moderate pain and inflammation.
Initially, small dosages are indicated in patients who are small and/or elderly and in those with renal or liver disease. Doses >75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe patient for response.
Adult
25-50 mg PO q6-8h prn; not to exceed 300 mg/d
Pediatric
3 months to 12 years: 0.1-1 mg/kg PO q6-8h
>12 years: Administer as in adults
Coadministration with aspirin increases risk of serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, ACE inhibitors, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently; antihypertensive effects of calcium channel blockers may be antagonized by concomitant administration of NSAIDs (avoid); also avoid NSAIDs in patients receiving tacrolimus immunosuppression, particularly in patients with liver dysfunction; concurrent use of NSAIDs and cyclosporine may increase cyclosporine levels, nephrotoxicity, and plasma creatinine concentrations; concurrent administration of lithium and NSAIDs may result in elevated lithium serum levels leading to lithium toxicity
Documented hypersensitivity; treatment of peri-operative pain in setting of coronary artery bypass graft (CABG) surgery; patients who have experienced asthma, urticaria, or allergic-type reactions after taking aspirin or other NSAIDs
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Caution in CHF, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy; avoid use of NSAIDs in patients receiving tacrolimus immunosuppression, particularly in patients with liver dysfunction
Naproxen (Anaprox, Naprelan, Naprosyn)
For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which results in a decrease of prostaglandin synthesis.
Adult
500 mg PO followed by 250 mg q6-8h; not to exceed 1.25 g/d
Pediatric
<2 years: Not established
>2 years: 2.5 mg/kg/dose PO; not to exceed 10 mg/kg/d
Coadministration with aspirin increases risk of serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently; concurrent use of NSAIDs and cyclosporine may increase cyclosporine levels, nephrotoxicity, and increased plasma creatinine concentrations; concurrent administration of lithium and NSAIDs may result in elevated lithium serum levels leading to lithium toxicity
Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug
Flurbiprofen (Ansaid)
May inhibit cyclo-oxygenase enzyme, which in turn inhibits prostaglandin biosynthesis. These effects may result in analgesic, antipyretic, and anti-inflammatory activities.
Adult
200-300 mg/d PO divided bid/qid
Pediatric
Not established
Coadministration with aspirin increases risk of serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, ACE inhibitors, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently; antihypertensive effects of calcium channel blockers may be antagonized by concomitant administration of NSAIDs (avoid); also avoid NSAIDs in patients receiving tacrolimus immunosuppression, particularly in patients with liver dysfunction; concurrent use of NSAIDs and cyclosporine may increase cyclosporine levels, nephrotoxicity, and increased plasma creatinine concentrations; concurrent administration of lithium and NSAIDs may result in elevated lithium serum levels leading to lithium toxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion, risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug
More on Neutrophilic Eccrine Hidradenitis |
| Overview: Neutrophilic Eccrine Hidradenitis |
| Differential Diagnoses & Workup: Neutrophilic Eccrine Hidradenitis |
 Treatment & Medication: Neutrophilic Eccrine Hidradenitis |
| Follow-up: Neutrophilic Eccrine Hidradenitis |
| Multimedia: Neutrophilic Eccrine Hidradenitis |
| References |
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References
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Further Reading
Keywords
neutrophilic eccrine hidradenitis, NEH, acute myelogenous leukemia, AML, chemotherapy-associated eccrine hidradenitis, drug-associated eccrine hidradenitis, infectious eccrine hidradenitis, neutrophilic dermatoses, chemotherapy, intradermal bleomycin injections, Sweet syndrome, atypical pyoderma gangrenosum, toxic erythema of chemotherapy, eccrine squamous syringometaplasia, idiopathic palmoplantar eccrine hidradenitis
