Page 137 - The Netter Collection of Medical Illustrations - Integumentary System_ Volume 4 ( PDFDrive )

Plate 4-52 Rashes

Slightly tender, pink-red macules and papules on the palms
and soles caused by inflammation of the eccrine sweat
glands. Palms and soles are the most frequent site of
involvement, likely due to the high density of eccrine glands.

NEUTROPHILIC ECCRINE
HIDRADENITIS

Neutrophilic eccrine hidradenitis is also known by
other names, such as palmoplantar eccrine hidradenitis
and idiopathic recurrent plantar hidradenitis. These
names imply that it is seen only on the palms and soles.
Neutrophilic eccrine hidradenitis is a more accepted
term, because it includes all cases independent of loca-
tion. This peculiar and uncommon rash can be seen
anywhere on the body where eccrine glands are present.
The palms and soles have a higher density of eccrine
glands than other regions do, and this may be one
reason why the disease is seen more frequently in this
location. This condition has been frequently described
in patients with leukemia who are undergoing chemo-
therapy. It has been reported to occur in other clinical
settings, including human immunodeficiency virus
infection, bacterial infections, other malignancies, and
use of medications other than chemotherapeutics, as
well as in patients with no other associations.
Clinical Findings: Clinically, neutrophilic eccrine
hidradenitis manifests in a myriad of ways. It usually
occurs in association with an underlying predisposing
condition such as those listed previously. Patients
develop the sudden onset of tender red papules and
nodules with minimal to no ulceration. The papules
blanch when pressed. The palms and soles are the areas
most frequently involved, but this condition can occur
anywhere on the body. The lesions may be asymptom-
atic, slightly tender, painful, or pruritic. The differential
diagnosis includes hot foot syndrome, which is caused
by pseudomonal bacterial infections. This condition
typically affects the foot, and it can be associated with
a folliculitis, such as hot tub folliculitis. Patients usually Low power. A neutrophilic infiltrate surrounds the dermal High power. Neutrophils infiltrating
have a benign medical history and have had recent eccrine glands. the eccrine ductal apparatus
exposure to a hot tub or swimming pool.
Pathogenesis: Chemotherapy-induced neutrophilic
eccrine hidradenitis is believed to occur secondary to
accumulation of the chemotherapeutic agent within the eccrine glands. A shave biopsy is usually inadequate. hidradenitis is caused to a chemotherapeutic agent, a
eccrine glands to a level that is toxic to the secretory There is a striking amount of neutrophilic inflamma- change in the chemotherapy regimen can be consid-
cells of the gland, resulting in cell necrosis. The neu- tion in and around the eccrine apparatus. The eccrine ered. If the patient’s chemotherapy cannot be changed,
trophilic inflammation is poorly understood. Only glands show varying degrees of necrosis. No vasculitis topical corticosteroids and nonsteroidal antiinflamma-
theories exist on the pathogenesis of non–chemotherapy- is present. tory agents may be used. If this is unsuccessful, dapsone
induced neutrophilic eccrine hidradenitis; the true Treatment: Treatment is supportive. Underlying and colchicine may be considered because of their anti-
pathogenesis is unknown. infections need to be treated adequately. The main neutrophilic effects. Oral steroids have been used with
Histology: The histological evaluation requires a goals are pain control and prevention of secondary variable success. No placebo-controlled studies have
punch biopsy or excisional biopsy to evaluate the infection. If the patient’s neutrophilic eccrine been performed for this condition.

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