RHEUMATOID NEUTROPHILIC DERMATITIS

Background: Rheumatoid neutrophilic dermatitis (RND) is a recently rec ognized, rare cutaneous manifestation of rheumatoid arthritis. It occu rs in patients with severe rheumatoid arthritis and is typically asymp tomatic. Rheumatoid neutrophilic dermatitis was originally described b y Ackerman in 1978. Since that time, 8 patients with this disease have been described in the literature. Observations: We report 2 cases of RND. Findings of skin biopsy specimens from both patients revealed cha racteristic signs of dermal leukocytosis and leukocytoclasia without v asculitis. The pathogenesis of the neutrophilic infiltrate is unclear. Processes that may play a role in the pathogenesis of RND include imm une complex activations, cell adhesion and migration, and cytokine rel ease.Conclusions: Rheumatoid neutrophilic dermatitis falls into the sp ectrum of neutrophilic vascular reactions described by Jorizzo and Dan iels. Although early reports suggest that prominent leukocytoclasia is not a feature of RND, our findings confirm the observations of Lowe e t al that leukocytoclasia can be seen in RND and may be striking. It i s important for dermatologists to be aware of this rare manifestation of rheumatoid arthritis.