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 location. 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 asymptomatic, 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 have a benign medical history and have had recent 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 to a level that is toxic to the secretory cells of the gland, resulting in cell necrosis. The neutrophilic inflammation is poorly understood. Only theories exist on the pathogenesis of non chemotherapyinduced neutrophilic eccrine hidradenitis; the true pathogenesis is unknown.
Histology: The histological evaluation requires a punch biopsy or excisional biopsy to evaluate the eccrine glands. A shave biopsy is usually inadequate. There is a striking amount of neutrophilic inflammation in and around the eccrine apparatus. The eccrine glands show varying degrees of necrosis. No vasculitis is present.
Treatment: Treatment is supportive. Underlying infections need to be treated adequately. The main goals are pain control and prevention of secondary infection. If the patient’s neutrophilic eccrine hidradenitis is caused to a chemotherapeutic agent, a change in the chemotherapy regimen can be considered. If the patient’s chemotherapy cannot be changed, topical corticosteroids and nonsteroidal anti inflammatory agents may be used. If this is unsuccessful, dapsone and colchicine may be considered because of their antineutrophilic effects. Oral steroids have been used with variable success. No placebo-controlled studies have been performed for this condition.