What is the pathophysiology of neutrophilic eccrine hidradenitis (NEH)?

Updated: Jun 22, 2021
  • Author: Joseph C Pierson, MD; Chief Editor: Dirk M Elston, MD  more...
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The mechanism(s) of neutrophilic eccrine hidradenitis (NEH) is unknown, although neutrophilic eccrine hidradenitis pathologic changes observed with intradermal bleomycin injections support a direct toxic effect of chemotherapy. More than 70% of oncology patients who develop neutrophilic eccrine hidradenitis do so after their first course of chemotherapy. [10] Cases linked to chemotherapeutic agents have developed at a wide range of 2 days to 2 years after initiation. Some patients experience recurrences of the cutaneous eruption upon reintroduction of the chemotherapeutic regimens. A diagnosis of toxic erythema of chemotherapy has been proposed for this group of disorders, to emphasize the overlapping clinical and histological features with similar eruptions. [3]

Reports of neutrophilic eccrine hidradenitis heralding the onset of both AML [11] and chronic myelogenous leukemia, [12] the relapse of AML, [13] and being induced by granulocyte colony-stimulating factor [14] suggest that the condition is in the spectrum of other neutrophilic dermatoses that have been observed in patients with cancer: erythema elevatum diutinum, intraepidermal immunoglobulin A (IgA) pustulosis, pyoderma gangrenosum, subcorneal pustular dermatosis, Sweet syndrome (and it localized variant, neutrophilic dermatosis/pustular vasculitis of the dorsal hand), and vasculitis. The inflammatory infiltrate of mature polymorphonuclear leukocytes is the unifying characteristic of this group of conditions. [10]

Cases of neutrophilic eccrine hidradenitis in otherwise healthy individuals, [15] occurring with a variety of nonchemotherapeutic agents, in Behçet disease, [16] in chronic granulomatous disease, [17] and in the setting of various infections suggest it could simply be an altered inflammatory response to nonspecific stimuli. Neutrophilic eccrine hidradenitis in young children may be triggered by thermal damage of eccrine glands. [9]

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