Rheumatoid neutrophilic dermatitis M06.8

Author: Prof. Dr. med. Peter Altmeyer

All authors of this article

Last updated on: 21.09.2022

Dieser Artikel auf Deutsch

Synonym(s)

Neutrophilic rheumatoid dermatitis; Neutrophil rheumatoid dermatitis; Rheumatoid neutrophilic dermatitis; RND

History
This section has been translated automatically.

Ackerman, 1978

Definition
This section has been translated automatically.

Very rare neutrophilic dermatosis (trunk and extremity exanthema with papules, plaques, pustules) in patients with severe forms of seropositive primary chronic polyarthritis (rheumatoid arthritis). Rheumatoid arthritis usually occurs well before the skin symptoms (7-8 years).

Notice. The entity of this disease is still controversial.

In particular, neutrophilic rheumatoid dermatitis must be distinguished from the adult form of Still's syndrome or, more likely, it is identical with it.

Occurrence/Epidemiology
This section has been translated automatically.

Very rare. So far, only single case reports are published in the literature.

Age at manifestation averages 57.4 years.

w:m=2:1;

Etiopathogenesis
This section has been translated automatically.

Unsolved. Inflammatory "neutrophilic vascular reactions" are suspected, which are associated with neutrophilic infiltrates and dermal vascular changes.

Manifestation
This section has been translated automatically.

Occurs in adults after the 40th LJ. Women are 3-4 times more frequently affected than men.

Localization
This section has been translated automatically.

Hips, on the extensor sides of the upper and lower extremities (preferably lower legs and forearms, preferably near the joints).

Clinical features
This section has been translated automatically.

Mostly persistent, symmetrically distributed, rather sharply circumscribed, 0.5-1.5 cm, reddish-purple plaques and papules of moderately coarse consistency. Less common are vesicles, pustules, or ulcers. Less commonly, subepithelial blistering occurs.

Laboratory
This section has been translated automatically.

Relative and absolute neutrophil leukocytosis in the blood count; rheumatoid factor highly positive, anti-CCP-Ac significantly increased. BSG and CRP increase. Case studies with seronegative rheumatoid factor have also been described in the literature.

Histology
This section has been translated automatically.

Dense, interstitial or periadnexal accentuated, dermal neutrophilic infiltrate with leukocytoclasia but without signs of vasculitis. Neutrophilic granulocytes are also located along the dermo-epidermal junctional zone. Focal epitheliotropy with spongiotic vesiculation of pustule formation is possible. Also abscess-like condensations of neutrophilic granulocytes . The adjacent subcutaneous adipose tissue may be involved (septal panniculitis).

Therapy
This section has been translated automatically.

Symptomatic antiphlogistic external and internal therapy with glucocorticoids in combination with methotrexate (15-20mg/week s.c.).

Alternative: Dapsone or colchicine

Literature
This section has been translated automatically.

  1. Ackerman AB (1978) Histologic diagnosis of inflammatory skin disease: a method by pattern analysis. Lea & Feiber, Philadelphia, pp. 449-45.
  2. Below J et al (2015) Rheumatoid neutrophilic dermatitis. Dermatologist 66: 228-230
  3. Brown TS et al (2001) Rheumatoid neutrophilic dermatitis in a woman with seronegative rheumatoid arthritis. J Am Acad Dermatol 45: 596-600.
  4. Gay-Crosier F et al (2000) Rheumatoid neutrophilic dermatitis/sweet's syndrome in a patient with seronegative rheumatoid arthritis. Dermatology 201: 185-187
  5. Lazarov A et al (2002) Rheumatoid neutrophilic dermatitis: an initial dermatological manifestation of seronegative rheumatoid arthritis. J Eur Acad Dermatol Venereol 16: 74-76.
  6. Lu CI et al (2004) A bullous neutrophilic dermatosis in a patient with severe rheumatoid arthritis and monoclonal IgA gammopathy. J Am Acad Dermatol 51(2 Suppl): 94-96.
  7. Nakamura T et al (2011) Cutaneous nodules in patients with rheumatoid arthritis: a case report and review of literatures. ClinRheumatol
    30:719-722
  8. Yamamoto T et al (2003) Rheumatoid neutrophilic dermatitis, rheumatoid papules, and rheumatoid nodules in a patient with seronegative rheumatoid arthritis. J Am Acad Dermatol 48: 634-635
  9. Youn CS et al (2000) Colchicine treatment in a patient with neutrophilic dermatosis associated with rheumatoid arthritis. J Dermatol 27: 782-787
  10. Yoshida Y et al (2003) Rheumatoid neutrophilic dermatitis. J Dermatol 30: 255-256
  11. Żuk G et al (2019) Rheumatoid neutrophilic dermatitis. Reumatologia 57:350-353.

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

Authors

Last updated on: 21.09.2022