Neutrophilic dermatosis of the dorsal hands: Pustular vasculitis revisited

An entity termed "pustular vasculitis of the hands" was recently described. Patients with this condition presented with low-grade fevers and erythemat ous plaques, pustules, and bullae limited to the dorsal hands and fingers, which were characterized histologically by a dense neutrophilic infiltrate and leukocytoclastic vasculitis. We describe patients with a similar clinic al presentation, but who lacked vasculitis on biopsy findings. We describe 3 otherwise asymptomatic patients with hemorrhagic bullae, plaques, and pus tules solely on the dorsal hands. Biopsy specimens showed a neutrophilic in filtrate and leukocytoclasis, but no necrotizing vasculitis, and were remin iscent of Sweet's neutrophilic dermatoses. In our patients, corticosteroids or dapsone led to clearing of the lesions, and small maintenance doses of dapsone prevented their recurrence. Our 3 patients had clinical lesions sim ilar to those termed pustular vasculitis of the hands, but which lacked leu kocytoclastic vasculitis on biopsy findings. Because of histologic findings and a therapeutic response more characteristic of Sweet's syndrome, we pro pose the term neutrophilic dermatosis of the dorsal hands. In addition, low -dose dapsone is proposed as a possible first-line therapy in this conditio n, especially in those with recurrent disease.