Although skin biopsy and the “presence of deep dermal mixed infiltrate with abundant neutrophils surrounding eccrine sweat glands” is considered the preferred method for diagnosing palmoplantar eccrine hidradenitis (PEH), Paola Piccini, MD, and her colleagues at the University of Florence (Italy) caution that biopsy frequently is not needed.
In the days prior to the appearance of erythematous and painful nodules on the soles of his feet, a healthy 8-year-old boy sustained “thermal and mechanical trauma playing football and cycling,” that made walking difficult. The week prior to the injury, he had complained of diarrhea in the absence of fever.
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Given results of testing and the patient’s overall good health, he received a diagnosis of PEH. Dr. Piccini and her colleagues chose not to biopsy the nodules because they typically resolve on their own within a few weeks. Instead, he was prescribed pain relievers and bed rest. Within 2 weeks, the nodules were completely healed, and no further relapse was reported, the authors noted in the Journal of Pediatrics.
All previous case studies cited in the literature reported complete resolution without treatment within 4 weeks, said Dr. Piccini and her colleagues. They added that correct diagnosis is key to avoiding inappropriate medical treatments given the benign course of PEH.
Common presenting risk factors tend to include local thermal and mechanical trauma plus intense physical activity and recent infection. It is these risk factors that cause rupture of the eccrine gland and resulting infiltration of neutrophils to the site.
Conditions that share common symptoms with PEH include erythema multiforme, nodular erythema, cellulitis, and viral infections.
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SOURCE: Piccini, P et al. J. Pediatr. 2018. doi: 10.1016/j.peds.2018.03.017.