Neutrophilic dermatosis of the dorsal of the hands: Acral sweet syndrome?

A 47-year-old white man, with antecedents of alcoholism and diabetes mellitus, complained of pain and edema on his left knee. Seven days later vesicobullous lesions appeared over the erythematous base on the hands and right leg. Papular and purpuric lesions were also found on the dorsal of the patient’s hands. Aspiration of joint fluid on the left knee was performed. The complete blood count revealed the following results: hemoglobin 7.5 g/dl; hematocrit 22.4%; leukocytes 19,730/ mm 3 with 68% neutrophils; hepatitis B and C serology were negative; and three blood and two joint fluid cultures in aerobic and anaerobic media gave negative results. Neoplasia and autoimmune diseases were ruled out. Five days later, cutaneous lesions were localized predominantly on the dorsal of the hands (Figs 1 and 2). Dermatohistopathology revealed epidermis with acanthosis, intraepidermal and subcorneal microabscesses; areas of diffuse infiltrate of mature neutrophils in the dermis with leukocytoclastic vasculitis, and hemorrhage, mainly in the subepidermal area (Fig. 3). During 1 month the patient did not present any systemic manifestations, and the skin lesions underwent spontaneous regression.