Rheumatoid neutrophilic dermatitis explained

Specialty:Dermatology

Rheumatoid neutrophilic dermatitis, also known as rheumatoid neutrophilic dermatosis,[1] is a cutaneous condition associated with rheumatoid arthritis.[2]

Signs and symptoms

Rheumatoid neutrophilic dermatitis occurs more frequently in patients with severe, persistent seropositive arthritis; it presents clinically as erythematous papules, nodules, plaques, or lesions resembling urticaria without any accompanying symptoms.[3] [4] [5] Less common conditions include annular lesions, blisters, ulcers, and vesicles.[6] [7] Skin lesions are typically symmetrical, but they can occasionally be distributed asymmetrically.[8] [9] Dorsal surfaces of hands and arms are preferred sites, with an emphasis on the extensor surfaces of extremities and joints.[10] [11] [12]

Diagnosis

Histopathological findings include normal epidermis, that may show hyperkeratosis, parakeratosis,[13] focal ulceration with scaly crust,[14] or spongiosis with intraepidermal blistering,[15]

Treatment

Treatments include topical steroids,[16] cyclophosphamide,[17] dapsone,[13] and hydroxychloroquine.[14]

Outlook

Lesion resolution can happen on its own or as the rheumatoid arthritis progresses, but lesions usually recur when the condition gets worse. Although most lesions heal without leaving scars, hyperpigmentation may linger for a while.[18]

See also

Further reading

Notes and References

  1. James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. Page 180. .
  2. Book: Rapini, Ronald P. . Bolognia, Jean L. . Jorizzo, Joseph L. . Dermatology: 2-Volume Set . Mosby . St. Louis . 2007 . 978-1-4160-2999-1 .
  3. Xue . Yun . Cohen . Jeffrey M. . Wright . Natalie A. . Merola . Joseph F. . Skin Signs of Rheumatoid Arthritis and its Therapy-Induced Cutaneous Side Effects . American Journal of Clinical Dermatology . Springer Science and Business Media LLC . 17 . 2 . December 9, 2015 . 1175-0561 . 10.1007/s40257-015-0167-z . 147–162. 26649439 . 42706531 .
  4. Ziemer . Mirjana . Müller . Anne-Katrin . Hein . Gert . Oelzner . Peter . Elsner . Peter . Incidence and classification of cutaneous manifestations in rheumatoid arthritis . JDDG: Journal der Deutschen Dermatologischen Gesellschaft . Wiley . 14 . 12 . November 25, 2016 . 1610-0379 . 10.1111/ddg.12680 . 1237–1246. 27886444 . 3424646 .
  5. Hata . Tissa . Kavanaugh . Arthur . Rheumatoid arthritis in dermatology . Clinics in Dermatology . Elsevier BV . 24 . 5 . 2006 . 0738-081X . 10.1016/j.clindermatol.2006.07.008 . 430–437. 16966022 .
  6. Fujio . Yumi . Funakoshi . Takeru . Nakayama . Kaori . Amagai . Masayuki . Ohyama . Manabu . Rheumatoid neutrophilic dermatosis with tense blister formation: A case report and review of the literature . Australasian Journal of Dermatology . Wiley . 55 . 1 . October 25, 2012 . 0004-8380 . 10.1111/j.1440-0960.2012.00963.x . e12–e14. 23094684 . 39668337 .
  7. Filosa . Alessandra . Filosa . Giorgio . Neutrophilic dermatoses: a broad spectrum of disease . Italian Journal of Dermatology and Venereology . Edizioni Minerva Medica . 153 . 2 . 2018 . 265–272 . 2784-8671 . 10.23736/s0392-0488.18.05841-8 . 29368857 .
  8. Brown . Timothy S. . Fearneyhough . Paul K. . Burruss . Jyoti B. . Callen . Jeffrey P. . Rheumatoid neutrophilic dermatitis in a woman with seronegative rheumatoid arthritis . Journal of the American Academy of Dermatology . Elsevier BV . 45 . 4 . 2001 . 0190-9622 . 10.1067/mjd.2001.119031 . 596–600. 11568753 .
  9. Chua-Aguilera . Carolyn Jean . Möller . Burkhard . Yawalkar . Nikhil . Skin Manifestations of Rheumatoid Arthritis, Juvenile Idiopathic Arthritis, and Spondyloarthritides . Clinical Reviews in Allergy & Immunology . Springer Science and Business Media LLC . 53 . 3 . July 27, 2017 . 1080-0549 . 10.1007/s12016-017-8632-5 . 371–393. 28752373 . 43240243 .
  10. DeFaria . Doreen . Kroumpouzos . George . Rheumatoid Neutrophilic Dermatitis as Presenting Sign of Seronegative Arthritis . Acta Dermato-Venereologica . Medical Journals Sweden AB . 84 . 3 . May 1, 2004 . 0001-5555 . 10.1080/00015550310007724 . 236–237. 15202847 . free .
  11. Ashchyan . Hovik J. . Nelson . Caroline A. . Stephen . Sasha . James . William D. . Micheletti . Robert G. . Rosenbach . Misha . Neutrophilic dermatoses . Journal of the American Academy of Dermatology . Elsevier BV . 79 . 6 . 2018 . 0190-9622 . 10.1016/j.jaad.2017.11.063 . 1009–1022. 29653213 . 4896415 .
  12. Caucanas . Marie . Heylen . Alain . Rolland . Florence . Müller . Gebhard . Olemans . Catherine . Sass . Ursulla . Vanhooteghem . Olivier . Associated pyoderma gangrenosum, erythema elevatum diutinum, and Sweet's syndrome: the concept of neutrophilic disease . International Journal of Dermatology . Wiley . 52 . 10 . September 23, 2013 . 0011-9059 . 10.1111/j.1365-4632.2011.05415.x . 1185–1188. 24073904 . 8539323 .
  13. Bouffard . D. . Long-standing verrucous lesion. Chromomycosis . Archives of Dermatology . American Medical Association (AMA) . 131 . 10 . October 1, 1995 . 0003-987X . 10.1001/archderm.131.10.1195b . 1195b–1196. 7574838 .
  14. Sánchez . Jorge L. . Cruz . Alma . Rheumatoid neutrophilic dermatitis . Journal of the American Academy of Dermatology . Elsevier BV . 22 . 5 . 1990 . 0190-9622 . 10.1016/0190-9622(90)70127-4 . 922–925. 2335586 .
  15. Lowe . Lori . Kornfeld . Bruce . Clayman . Joseph . Golitz . Loren E. . Rheumatoid neutrophilic dermatitis . Journal of Cutaneous Pathology . Wiley . 19 . 1 . 1992 . 0303-6987 . 10.1111/j.1600-0560.1992.tb01558.x . 48–53. 1556266 . 31454442 .
  16. Hirota . T K . Keough . G C . David-Bajar . K . McCollough . M L . Rheumatoid neutrophilic dermatitis . Cutis . October 1997 . 60 . 4 . 203–205 . 9347237.
  17. Mashek . Helen A. . Rheumatoid Neutrophilic Dermatitis . Archives of Dermatology . 133 . 6 . 1997-06-01 . 757–760 . 0003-987X . 10.1001/archderm.1997.03890420097013 . 9197831 .
  18. Lazarov . A . Mor . A . Cordoba . M . Mekori . Ya . Rheumatoid neutrophilic dermatitis: an initial dermatological manifestation of seronegative rheumatoid arthritis . Journal of the European Academy of Dermatology and Venereology . 16 . 1 . 2002 . 0926-9959 . 10.1046/j.1468-3083.2002.00401.x . 74–76. 11952297 . 30236685 .

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