Laboratory Studies

A CBC count should be performed for all patients found to have neutrophilic eccrine hidradenitis (NEH) by skin biopsy who have not been previously diagnosed with a malignancy.

Procedures

A punch biopsy of a representative lesion should be performed.

Histologic Findings

Routine biopsy specimens reveal a dense neutrophilic infiltrate within and around eccrine glands, with necrosis of eccrine epithelial cells. Some severely neutropenic patients may have a paucity or absence of neutrophils histologically, but the necrosis of eccrine glands is evident. Apocrine gland involvement, squamous syringometaplasia, dermal hemorrhage, dermal edema, epidermal spongiosis, basilar vacuolization, focal keratinocyte necrosis, mucin deposits, and mild, superficial panniculitis may be observed. Associated leukocytoclastic vasculitis has been reported.^[40]Immunohistochemical staining from a healthy adult patient with recurrent summertime generalized neutrophilic eccrine hidradenitis (NEH) showed decreased expression of dermcidin on the secretory portion of the eccrine glands.^[31]

Cases revealing histologic features of both acute febrile neutrophilic dermatosis (Sweet syndrome) and neutrophilic eccrine hidradenitis have been reported.^[41]

See the histological image below.

Neutrophilic infiltrate on hematoxylin and eosin stain (100X). Courtesy of Jeffrey P. Callen, MD, and Vilma Fabre, MD.

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Treatment & Management

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. [QxMD MEDLINE Link].
Nelson CA, Stephen S, Ashchyan HJ, James WD, Micheletti RG, Rosenbach M. Neutrophilic dermatoses: Pathogenesis, Sweet syndrome, neutrophilic eccrine hidradenitis, and Behçet disease. J Am Acad Dermatol. 2018 Dec. 79 (6):987-1006. [QxMD MEDLINE Link].
Bolognia JL, Cooper DL, Glusac EJ. Toxic erythema of chemotherapy: a useful clinical term. J Am Acad Dermatol. 2008 Sep. 59(3):524-9. [QxMD MEDLINE Link].
Bishnoi A, Daroach M, Aggarwal D, Radotra BD, Panda P, Parsad D. Ticagrelor induced neutrophilic eccrine hidradenitis: a unique adverse effect of a new antiplatelet drug. Postgrad Med J. 2019 May. 95 (1123):279-280. [QxMD MEDLINE Link].
Puar N, Scheele A, Perez Marques F, Panicker J. Neutrophilic eccrine hidradenitis secondary to pegfilgrastim in a patient with synovial sarcoma. Clin Case Rep. 2019 Mar. 7 (3):533-536. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Barrera-Godínez A, Méndez-Flores S, Gatica-Torres M, et al. Not all that glitters is COVID-19: a case series demonstrating the need for histopathology when skin findings accompany SARS-CoV-2 infection. J Eur Acad Dermatol Venereol. 2021 May 20. [QxMD MEDLINE Link].
Feraru G, Dodiuk-Gad R, Krausz J, Ziv M. Infliximab-induced neutrophilic eccrine hidradenitis in a patient with hidradenitis suppurativa. Dermatol Ther. 2020 Nov. 33 (6):e13900. [QxMD MEDLINE Link].
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. 2005 Jun. 52 (6):963-6. [QxMD MEDLINE Link].
Cohen PR. Neutrophilic dermatoses occurring in oncology patients. Int J Dermatol. 2007 Jan. 46(1):106-11. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Bachmeyer C, Chaibi P, Aractingi S. Neutrophilic eccrine hidradenitis induced by granulocyte colony-stimulating factor. Br J Dermatol. 1998 Aug. 139(2):354-5. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Bilic M, Mutasim DF. Neutrophilic eccrine hidradenitis in a patient with Behçet's disease. Cutis. 2001 Aug. 68(2):107-11. [QxMD MEDLINE Link].
Mendiratta V, Sanke S, Chander R. Neutrophilic Eccrine Hidradenitis in a Child with Chronic Granulomatous Disease. Indian J Dermatol. 2016 Nov-Dec. 61 (6):683-684. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Herms F, Franck N, Kramkimel N, Fichel F, Delaval L, Laurent-Roussel S, et al. Neutrophilic eccrine hidradenitis in 2 patients treated with BRAF inhibitors: a new cutaneous adverse event. Br J Dermatol. 2016 Dec 22. [QxMD MEDLINE Link].
Oscoz-Jaime S, Mitxelena-Eceiza J, Córdoba-Iturriagagoitia A. Neutrophilic eccrine hidradenitis in a patient treated with highly activity antiretroviral therapy. Med Clin (Barc). 2017 Jan 20. 148 (2):93-94. [QxMD MEDLINE Link].
Schmutz JL. [Neutrophilic eccrine hidradenitis and azathioprine hypersensitivity syndrome]. Ann Dermatol Venereol. 2014 Nov. 141 (11):738-9. [QxMD MEDLINE Link].
da Silva Sousa AC, Guedes Pereira RVA, Menezes NMBVN, Furtado AMC, Baptista AM. Neutrophilic eccrine hidradenitis in a patient with FOLFOX chemotherapy. Acta Dermatovenerol Alp Pannonica Adriat. 2018 Dec. 27 (4):207-209. [QxMD MEDLINE Link].
Bachmeyer C, Aractingi S. Neutrophilic eccrine hidradenitis. Clin Dermatol. 2000 May-Jun. 18(3):319-30. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
Headley CM, Ioffreda MD, Zaenglein AL. Neutrophilic eccrine hidradenitis: a case report of an unusual annular presentation. Cutis. 2005 Feb. 75(2):93-7. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Bardenstein DS, Haluschak J, Gerson S, Zaim MT. Neutrophilic eccrine hidradenitis simulating orbital cellulitis. Arch Ophthalmol. 1994 Nov. 112(11):1460-3. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Katayama S, Iwata H, Nomura Y, Nakamura A, Yamaguchi T, Hishimura N, et al. Case of miliaria rubra histologically showing neutrophilic eccrine hidradenitis due to hyperhidrosis induced by a catecholamine-producing neuroblastoma. J Dermatol. 2020 Mar. 47 (3):e92-e93. [QxMD MEDLINE Link].
Heo JY, Park TH, Kim WI, Yoon SY, Cho MK, Kim S. Case of neutrophilic eccrine hidradenitis resembling acanthosis nigricans in a patient with acute myeloid leukemia associated with azacitidine and sorafenib. J Dermatol. 2021 Apr. 48 (4):e155-e156. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Wlodek C, Bhatt N, Kennedy C. Two neutrophilic dermatoses captured simultaneously on histology. Dermatol Pract Concept. 2016 Jul 31. 6 (3):55-7. [QxMD MEDLINE Link].
Sanmartín O, Beato C, Suh-Oh HJ, Aragón I, España A, Majem M, et al. Clinical Management of Cutaneous Adverse Events in Patients on Chemotherapy: A National Consensus Statement by the Spanish Academy of Dermatology and Venereology and the Spanish Society of Medical Oncology. Actas Dermosifiliogr. 2019 Jul - Aug. 110 (6):448-459. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].

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Courtesy of Jeffrey P. Callen, MD.
Neutrophilic infiltrate on hematoxylin and eosin stain (100X). Courtesy of Jeffrey P. Callen, MD, and Vilma Fabre, MD.