Neutrophilic Dermatoses: A Case Series of Unusual Adverse Effects with Commonly Administered Drugs

Abstract

Neutrophilic Dermatoses (NDs) are inflammatory conditions characterised by sterile neutrophilic infiltrates on histopathology. Multiple clinical presentations can occur in a single patient with ND. The location of the neutrophilic infiltrate (in the skin’s superficial, deeper, or subcutaneous layers), the clinical features, and the duration of the disease help to identify ND. Robert Douglas Sweet introduced the term neutrophilic dermatoses in 1964 to describe febrile neutrophilic dermatoses, now known as Sweet syndrome. The major conditions in this group include Pyoderma Gangrenosum (PG), Sweet Syndrome (SS), subcorneal pustular dermatoses, Generalised Pustular Psoriasis (GPP), and Inflammatory Bowel Disease (IBD)-associated neutrophilic dermatoses. The present case series described five female patients, aged 32 to 85, who developed painful, red, pus-filled skin lesions after taking common medications such as aceclofenac, diclofenac, and isotretinoin. The cases included Neutrophilic Eccrine Hidradenitis (NEH), Sweet syndrome, and PG, with symptoms such as fever, sore throat, and arthralgia. Skin biopsies confirmed the diagnoses, showing inflammatory changes, dermal oedema, and features such as vascular injury. Blood tests consistently showed neutrophilia and elevated inflammatory markers {Erythrocyte Sedimentation Rate (ESR) and C-Reactive Protein (CRP)}. Management consisted of stopping the suspected offending medications and initiating corticosteroid therapy, which led to improvement in symptoms. This case series highlights the importance of promptly identifying drug-induced neutrophilic disorders to avoid misdiagnosis, inappropriate treatment, and potential complications. Heightened awareness among clinicians is essential to facilitate timely diagnosis and effective management of these rare yet significant dermatological reactions. Hence, the case series aimed to summarise therapeutic innovations related to the principal neutrophilic dermatoses.

Keywords

• autoinflammatory
• pyoderma gangrenosum
• sweet syndrome