Updates in Neutrophilic Dermatoses

Mita Patel, MD, co-chair of the IAS 2018 meeting, updated attendees on neutrophilic dermatoses. Dr Patel is director, Hidradenitis Suppurativa and Neutrophilic Dermatoses Clinic; assistant program director, Dermatology and Rheumatology Fellowship; assistant professor in Dermatology, Harvard Medical School; associate physician, Department of Dermatology, Brigham and Women’s Hospital in Boston, Massachusetts.

The neutrophilic dermatoses are a heterogeneous group of dermatologic disorders united by the presence of non-infectious inflammatory skin lesions that are histologically dominated by infiltrating neutrophils.
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“The dermatologic layer of infiltration determines the classification and clinical manifestations of these conditions, which often co-present with systemic autoimmune disorders or hematologic malignancies. Significant overlap between the neutrophilic dermatoses complicates their identification and subsequent management, requiring a thorough understanding of the similarities and differences between disorders,” she said.

 The exact etiology of neutrophilic dermatosis is unclear. “However, it is an abnormality in the innate immune system, possibly secondary to inappropriate levels of IL-1, the master cytokine of inflammation,” Dr Patel noted. “Neutrophilic dermatoses may occur alone or in association with an underlying systemic condition, including blood disorders (leukemia, monoclonal gammopathy, myelodysplastic syndrome); digestive diseases (ulcerative colitis, Crohn disease); autoimmune diseases (rheumatoid arthritis, systemic lupus erythematosus, Grave disease, Hashimoto thyroiditis); or infections (HIV, hepatitis B, among others).”

The category of neutrophilic dermatoses includes Sweet syndrome, pyoderma gangrenosum, palisaded neutrophilic granulomatous dermatitis, subcorneal pustulosis, leukocytoclastic vasculitis, palmoplantar pustulosis, neutrophilic urticaria, and hidradenitis suppurativa.

Dr Patel discussed the clinical aspects that define the major neutrophilic dermatoses, and provided an update on the latest diagnostic criteria, treatment options, and prognoses management plans associated with each disorder. She then reviewed 5 cases.