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Author: Dr Stanley Leong, Dermatology and Paediatric Registrar, Christchurch, July, 2023. Reviewing dermatologist: Dr Ian Coulson (2023)
Edited by the DermNet content department
A 47-year old man with a recent acute myeloid leukaemia relapse presented with multiple purple lesions on the anterior chest and forearms. The lesions were not itchy or tender.
On examination, multiple similar purple lesions with a peripheral erythematous rim and a haemorrhagic crust at the centre were seen.
Sweet syndrome (acute febrile neutrophilic dermatosis). It is a type of neutrophilic dermatosis.
Sweet syndrome usually has an acute onset of erythematous, oedematous plum coloured papules and plaques that are tender but not pruritic, with the face and trunk being the common areas to be affected. Lesions may occur in the mouth and conjunctivitis and episcleritis are well reported. There is often peripheral blood neutrophilia and fever.
A dense neutrophilic dermal infiltrate with disintegration of neutrophils producing nuclear dust. There should not be inflammatory changes in the blood vessels, which distinguishes it from a leukocytoclastic vasculitis.
The exact cause for neutrophilic dermatosis is unknown.
Sweet syndrome can be caused by underlying disorders such as:
In mild disease, neutrophilic dermatosis may respond to topical corticosteroids.
In moderate-to-severe disease, the treatment options are: