Neutrophilic Eccrine Hidradenitis Clinical Presentation

Updated: Jun 22, 2021
  • Author: Joseph C Pierson, MD; Chief Editor: Dirk M Elston, MD  more...
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Most reported cases of neutrophilic eccrine hidradenitis (NEH) have been in patients with acute myelogenous leukemia (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 (both children [30] and adults [31] ) have developed papules and plaques of idiopathic neutrophilic eccrine hidradenitis, especially 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 typically occurs in healthy children; however, one child in remission after acute lymphoblastic leukemia developed generalized extension. [32]


Physical Examination

The cutaneous lesions of neutrophilic eccrine hidradenitis (NEH) 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, [33] and sclerodermoid changes [34] have also been noted. Tenderness may be elicited. The trunk or limbs are most often involved. Neutrophilic eccrine hidradenitis simulating orbital cellulitis, [35] facial cellulitis, [36] symmetrical ear swelling, [37] miliaria rubra, [38] and acanthosis nigricans [39] have been documented.

See the image below.

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