Rheumatoid neutrophilic dermatitis.

Rheumatoid neutrophilic dermatitis is a rare entity reported to occur in association with severe rheumatoid arthritis. Three patients with seropositive rheumatoid arthritis and rheumatoid neutrophilic dermatitis are described. Clinically, the eruption is characterized by symmetric erythematous papules, plaques, and rarely vesicles on extensor skin surfaces. Light microscopy reveals a dermal neutrophilic infiltrate without vasculitis. Spongiotic intraepidermal blisters, subepidermal bullae, or papillary neutrophilic microabscesses may be seen. The histologic differential diagnosis includes the other dermatoses in which neutrophils predominate. Rheumatoid neutrophilic dermatitis is one of several neutrophilic dermatoses seen in association with rheumatoid arthritis, suggesting that it may be part of a spectrum of neutrophilic cutaneous reaction patterns in a predisposed host.