Neutrophilic Dermatoses: Challenging Cases

Anthony Fernandez, MD, PhD, delved into perplexing case studies of neutrophilic dermatoses (NDs), spotlighting their unusual clinical symptoms and atypical laboratory findings during his Fall Dermatology Week 2023 session, “Neutrophilic Dermatoses; Challenging Clinico-Pathologic Cases.”

Dr Fernandez serves as director of medical dermatology, W.D. Steck chair of clinical dermatology, and co-medical director of continuing medical education at the Cleveland Clinic and the Cleveland Clinic Lerner College of Medicine in Westlake, Ohio. The learning objectives of his presentation included imparting a comprehensive understanding of the typical and atypical presentations of NDs, insights into underlying disease associations, familiarity with diagnostic criteria, and a grasp of various treatment approaches for both NDs and their associated conditions.

Addressing the enigmatic realm of NDs, a group of autoinflammatory diseases marked by the infiltration of neutrophils in the skin layers, Dr Fernandez stated, “This condition often presents challenges due to potential extracutaneous involvement, making diagnosis and treatment intricate.”

“Pyoderma gangrenosum (PG) may be a challenging diagnosis, but recently developed diagnostic criteria can be helpful,” he noted in his key takeaways. “PG-like ulcers can be seen in antineutrophil cytoplasmic antibody-associated vasculitides.”

“Neutrophilic urticarial dermatosis has relatively specific histologic features and is most commonly seen in the setting of Schnitzler syndrome, adult-onset Still disease, and systemic lupus erythematosus,” Dr Fernandez concluded. “VEXAS syndrome is a newly described auto-inflammatory syndrome with prominent cutaneous involvement, and recent research suggests it may be more common than previously thought.”

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Reference
Fernandez A. Neutrophilic dermatoses; challenging clinico-pathologic cases. Presented at: Dermatology Week; September 20–23, 2023; Virtual.