Palmoplantar Hidradenitis

Background

This rare condition is characterized by recurrent tender and erythematous nodules occurring predominately on the soles. Children are usually affected and most commonly they are healthy. With the onset of the nodules, a low grade fever may ensue. Spontaneous resolution within a few days is the rule. However, about 50% of these lesions recur.

OUTLINE

Epidemiology

Pathogenesis

Gross Appearance and Clinical Variants

Histopathological Features and Variants

Differential Diagnosis

Prognosis and Treatment

Commonly Used Terms

EPIDEMIOLOGY CHARACTERIZATION

INCIDENCE Rare

AGE RANGE-MEDIAN Childhood
Mean 6 years (Range 1.5-15 years)

PATHOGENESIS CHARACTERIZATION

COLD

Plantar hidradenitis in children induced by exposure to wet footwear.

Naimer SA, Zvulunov A, Ben-Amitai D, Landau M.

Goosh Katif Health Center, Hof Gaza, Israel.
Pediatr Emerg Care 2000 Jun;16(3):182-3 Abstract quote
Painful erythematous papules and nodules involving either the palms of the hands, or, more commonly, the soles of the feet, characterize palmoplantar eccrine hidradenitis or palmoplantar hidradenitis (PH). The younger pediatric population is predominately affected.

Histologically, the eccrine gland apparatus is the target of inflammatory neutrophilic infiltrates. This entity has been reported under a variety of names, including traumatic plantar urticaria, neutrophilic eccrine hidradenitis, plantar erythema nodosum, and idiopathic recurrent palmoplantar hidradenitis. All are essentially the same process, described in different forms. Despite the growing number of reported cases, the pathogenesis remains obscure.

We present four children with PH of the soles of the feet, who shared a common recent history of exposure to cold, damp, footwear. The temporal relationship between exposure to dampness and cold and the appearance of the skin lesions suggest a possible pathogenetic mechanism.

GROSS APPEARANCE/
CLINICAL VARIANTS CHARACTERIZATION

GENERAL

Idiopathic recurrent palmoplantar hidradenitis in children. Report of 22 cases.

Simon M Jr, Cremer H, von den Driesch P.

Department of Dermatology, University of Erlangen-Nurnberg, Erlangen, Germany.
Arch Dermatol 1998 Jan;134(1):76-9 Abstract quote
BACKGROUND: Idiopathic recurrent palmoplantar hidradenitis (IRPH) is characterized by tender erythematous plaques and nodules on the soles and, less often, the palms of young patients. To date, 10 cases of IRPH have been documented in the literature.

OBSERVATIONS: We describe 22 pediatric patients with characteristic cutaneous and histologic findings of IRPH. Their mean age was 6 years (age range, 1.5-15 years). The onset of the disease clustered in 2 peaks, in autumn and spring. All patients had complete resolution of their lesions within 3 weeks, in 16 cases without any treatment. Ten of the 22 patients experienced more than 1 episode of IRPH.

CONCLUSIONS: Our study represents the largest number of cases of IRPH collected to date. Based on our data, the clinical picture is so characteristic that a histopathologic examination may not be necessary in every case. We suggest that there is a seasonality in the occurrence of this always benign and limited disease.

Palmoplantar eccrine hidradenitis: three new cases and review.

Landau M, Metzker A, Gat A, Ben-Amitai D, Brenner S.

Department of Dermatology, Tel Aviv-Elias Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.
Pediatr Dermatol 1998 Mar-Apr;15(2):97-102 Abstract quote
Palmoplantar eccrine hidradenitis (PEH) is characterized by painful erythematous papules and nodules of abrupt onset on the soles of young individuals.

The histologic hallmark is a predominant neutrophilic infiltrate surrounding the eccrine gland apparatus. A total of 28 cases have been published since 1988, with a broad variation in the age of patients, symptomatology, associated diseases, clinical course, and histologic features. These different histologic pictures have resulted in several names for this entity, including idiopathic plantar hidradenitis, neutrophilic eccrine hidradenitis, recurrent palmoplantar hidradenitis in children, and idiopathic palmoplantar hidradenitis.

We present three cases of this disorder and review the literature on the varying symptomatology, clinical course, and histology that have led to the myriad of names for this disease.

Idiopathic palmoplantar eccrine hidradenitis in children.

Ben-Amitai D, Hodak E, Landau M, Metzker A, Feinmesser M, David M.

Sackler Faculty of Medicine, Tel Aviv University, Israel.

Eur J Pediatr 2001 Mar;160(3):189-91 Abstract quote
Idiopathic palmoplantar eccrine hidradenitis (IPPH) is a recently described disorder characterized by painful erythematous plantar nodules and in three cases, showed a typical neutrophilic infiltrate around and within the eccrine sweat apparatus.

Five cases of IPPH on the soles of the feet in healthy children are reported. The disorder presented after intense physical activity in four cases. The course was benign and self-limiting. Complete bed rest for several days without any medical therapy led to alleviation of the pain and disappearance of all the lesions.

Conclusion. Idiopathic palmoplantar eccrine hidradenitis may be more common than reported. Paediatricians should be aware of it in order to avoid unnecessary diagnostic tests and treatments.

VARIANTS

PUSTULAR

Pustular idiopathic recurrent palmoplantar hidradenitis: An unusual clinical feature.

Hernandez-Martin A, Pinedo F, Perez-Lescure J.

Units of Dermatology, Fundacion Hospital General Yague Ourense, Pathology, and Pediatrics, Fundacion Hospital Alcorcon, Madrid.
J Am Acad Dermatol 2002 Nov;47(5 Suppl):S263-5 Abstract quote
A 12-year-old boy had painful lesions on both soles. He had had a similar episode several months before that resolved spontaneously.

Physical examination showed erythematous, extremely tender nodules on both plantar surfaces and the toes. The second and third left toes had small pustules on top of the nodules. There was no palmar involvement. The clinical features, pathologic findings, and self-limited course suggested recurrent palmoplantar hidradenitis. This distinctive entity of unknown origin appears during childhood and is characterized histologically by a neutrophilic infiltrate affecting the eccrine glands.

We report the case of a patient with unusual clinical features.

HISTOLOGICAL TYPES CHARACTERIZATION

GENERAL

Idiopathic plantar hidradenitis: a neutrophilic eccrine hidradenitis occurring primarily in children.

Stahr BJ, Cooper PH, Caputo RV.

Department of Pathology, Emory University, Atlanta, GA.
J Cutan Pathol 1994 Aug;21(4):289-96 Abstract quote
Neutrophilic eccrine hidradenitis (NEH) has been described in a variety of clinical settings but is most often seen in leukemic patients receiving chemotherapy.

We have recently encountered 6 healthy individuals, of whom 5 were children, who developed NEH localized to the feet. The patients were from 9 to 21 years of age. The presenting complaint was rapid development of tenderness of the feet with varying degrees of morbidity. At clinical evaluation, tender, erythematous papules and nodules were confined to the feet, primarily the plantar surfaces.

The major differential diagnoses were erythema nodosum and vasculitis. Laboratory studies were non-contributory. Histologically, the findings were generally similar to those of NEH with certain exceptions, most notably the absence of syringosquamous metaplasia and the presence, in most cases, of neutrophilic abscesses in eccrine coils. Inflammatory and degenerative changes involved primarily the eccrine duct (coiled and dermal), and tended to spare the secretory apparatus. Stains for microorganisms were negative.

There were brief recurrences in some of the patients, but those followed over time have remained well. We suggest the term idiopathic plantar hidradenitis for this condition.

Idiopathic palmoplantar hidradenitis.

Buezo GF, Requena L, Fraga Fernandez J, Garcia Diez A, Fernandez Herrera JM.

Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain

Am J Dermatopathol 1996 Aug;18(4):413-6 Abstract quote
Idiopathic plantar hidradenitis (IPH) is a recently described condition primarily affecting healthy children who develop tender lesions localized to the plantar or lateral aspects of the feet with histologic findings similar to those seen in neutrophilic eccrine hidradenitis (NEH), although with certain notable exceptions including the absence of syringosquamous metaplasia and the presence, in most cases, of neutrophilic abscesses adjacent to eccrine coils.

Since its original description, three additional patients have been reported, one with palmoplantar lesions, extending the disease's clinical spectrum to include palmar as well as plantar surfaces.

We report on a healthy 8-year-old girl with tender, erythematous nodules on palms and soles and review the literature on this subject.

DIFFERENTIAL DIAGNOSIS KEY DIFFERENTIATING FEATURES

NEUTROPHILIC ECCRINE HIDRADENITIS

PROGNOSIS AND TREATMENT CHARACTERIZATION

PROGNOSTIC FACTORS

RECURRENCE

Recurrent palmoplantar hidradenitis in children.

Rabinowitz LG, Cintra ML, Hood AF, Esterly NB.

Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.
Arch Dermatol 1995 Jul;131(7):817-20 Abstract quote
BACKGROUND: There are several reports of tender, erythematous plantar nodules occurring in pediatric patients. Despite similar morphological features, the histologic findings in these lesions have been quite diverse. A new entity called idiopathic plantar hidradenitis (also termed neutrophilic eccrine hidradenitis in children), which is characterized by tender, red nodules on the feet and unique histopathologic features, was recently described.

OBSERVATIONS: We describe two children with these unusual cutaneous lesions and histopathologic findings and compare them with patients with idiopathic plantar hidradenitis. Our patients, in contrast to those with idiopathic plantar hidradenitis, had involvement of the palms as well as the soles. Both children had self-limited recurrent lesions; in one child, the lesions were associated with low-grade fever. Biopsy specimen findings in both cases demonstrated dense neutrophilic infiltrates localized to the eccrine units.

CONCLUSIONS: Our patients had clinical and histologic findings similar to those recently reported as idiopathic plantar hidradenitis (neutrophilic eccrine hidradenitis in children). Because palms and soles can be affected and the lesions typically recur, we suggest that this condition be referred to as recurrent palmoplantar hidradenitis.

TREATMENT

Henry JB. Clinical Diagnosis and Management by Laboratory Methods. Twentieth Edition. WB Saunders. 2001.
Weedon D. Weedon's Skin Pathology. Second Edition. Churchill Livingstone. 2002.
Fitzpatrick's Dermatology in General Medicine. 5th Edition. McGraw-Hill. 1999.

Commonly Used Terms

Skin Rash

Last Updated 11/18/2002

GROSS APPEARANCE/ CLINICAL VARIANTS	CHARACTERIZATION
GENERAL
Idiopathic recurrent palmoplantar hidradenitis in children. Report of 22 cases. Simon M Jr, Cremer H, von den Driesch P. Department of Dermatology, University of Erlangen-Nurnberg, Erlangen, Germany.	Arch Dermatol 1998 Jan;134(1):76-9 Abstract quote BACKGROUND: Idiopathic recurrent palmoplantar hidradenitis (IRPH) is characterized by tender erythematous plaques and nodules on the soles and, less often, the palms of young patients. To date, 10 cases of IRPH have been documented in the literature. OBSERVATIONS: We describe 22 pediatric patients with characteristic cutaneous and histologic findings of IRPH. Their mean age was 6 years (age range, 1.5-15 years). The onset of the disease clustered in 2 peaks, in autumn and spring. All patients had complete resolution of their lesions within 3 weeks, in 16 cases without any treatment. Ten of the 22 patients experienced more than 1 episode of IRPH. CONCLUSIONS: Our study represents the largest number of cases of IRPH collected to date. Based on our data, the clinical picture is so characteristic that a histopathologic examination may not be necessary in every case. We suggest that there is a seasonality in the occurrence of this always benign and limited disease.
Palmoplantar eccrine hidradenitis: three new cases and review. Landau M, Metzker A, Gat A, Ben-Amitai D, Brenner S. Department of Dermatology, Tel Aviv-Elias Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.	Pediatr Dermatol 1998 Mar-Apr;15(2):97-102 Abstract quote Palmoplantar eccrine hidradenitis (PEH) is characterized by painful erythematous papules and nodules of abrupt onset on the soles of young individuals. The histologic hallmark is a predominant neutrophilic infiltrate surrounding the eccrine gland apparatus. A total of 28 cases have been published since 1988, with a broad variation in the age of patients, symptomatology, associated diseases, clinical course, and histologic features. These different histologic pictures have resulted in several names for this entity, including idiopathic plantar hidradenitis, neutrophilic eccrine hidradenitis, recurrent palmoplantar hidradenitis in children, and idiopathic palmoplantar hidradenitis. We present three cases of this disorder and review the literature on the varying symptomatology, clinical course, and histology that have led to the myriad of names for this disease.
Idiopathic palmoplantar eccrine hidradenitis in children. Ben-Amitai D, Hodak E, Landau M, Metzker A, Feinmesser M, David M. Sackler Faculty of Medicine, Tel Aviv University, Israel.	Eur J Pediatr 2001 Mar;160(3):189-91 Abstract quote Idiopathic palmoplantar eccrine hidradenitis (IPPH) is a recently described disorder characterized by painful erythematous plantar nodules and in three cases, showed a typical neutrophilic infiltrate around and within the eccrine sweat apparatus. Five cases of IPPH on the soles of the feet in healthy children are reported. The disorder presented after intense physical activity in four cases. The course was benign and self-limiting. Complete bed rest for several days without any medical therapy led to alleviation of the pain and disappearance of all the lesions. Conclusion. Idiopathic palmoplantar eccrine hidradenitis may be more common than reported. Paediatricians should be aware of it in order to avoid unnecessary diagnostic tests and treatments.
VARIANTS
PUSTULAR
Pustular idiopathic recurrent palmoplantar hidradenitis: An unusual clinical feature. Hernandez-Martin A, Pinedo F, Perez-Lescure J. Units of Dermatology, Fundacion Hospital General Yague Ourense, Pathology, and Pediatrics, Fundacion Hospital Alcorcon, Madrid.	J Am Acad Dermatol 2002 Nov;47(5 Suppl):S263-5 Abstract quote A 12-year-old boy had painful lesions on both soles. He had had a similar episode several months before that resolved spontaneously. Physical examination showed erythematous, extremely tender nodules on both plantar surfaces and the toes. The second and third left toes had small pustules on top of the nodules. There was no palmar involvement. The clinical features, pathologic findings, and self-limited course suggested recurrent palmoplantar hidradenitis. This distinctive entity of unknown origin appears during childhood and is characterized histologically by a neutrophilic infiltrate affecting the eccrine glands. We report the case of a patient with unusual clinical features.

HISTOLOGICAL TYPES	CHARACTERIZATION
GENERAL
Idiopathic plantar hidradenitis: a neutrophilic eccrine hidradenitis occurring primarily in children. Stahr BJ, Cooper PH, Caputo RV. Department of Pathology, Emory University, Atlanta, GA.	J Cutan Pathol 1994 Aug;21(4):289-96 Abstract quote Neutrophilic eccrine hidradenitis (NEH) has been described in a variety of clinical settings but is most often seen in leukemic patients receiving chemotherapy. We have recently encountered 6 healthy individuals, of whom 5 were children, who developed NEH localized to the feet. The patients were from 9 to 21 years of age. The presenting complaint was rapid development of tenderness of the feet with varying degrees of morbidity. At clinical evaluation, tender, erythematous papules and nodules were confined to the feet, primarily the plantar surfaces. The major differential diagnoses were erythema nodosum and vasculitis. Laboratory studies were non-contributory. Histologically, the findings were generally similar to those of NEH with certain exceptions, most notably the absence of syringosquamous metaplasia and the presence, in most cases, of neutrophilic abscesses in eccrine coils. Inflammatory and degenerative changes involved primarily the eccrine duct (coiled and dermal), and tended to spare the secretory apparatus. Stains for microorganisms were negative. There were brief recurrences in some of the patients, but those followed over time have remained well. We suggest the term idiopathic plantar hidradenitis for this condition.
Idiopathic palmoplantar hidradenitis. Buezo GF, Requena L, Fraga Fernandez J, Garcia Diez A, Fernandez Herrera JM. Department of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain	Am J Dermatopathol 1996 Aug;18(4):413-6 Abstract quote Idiopathic plantar hidradenitis (IPH) is a recently described condition primarily affecting healthy children who develop tender lesions localized to the plantar or lateral aspects of the feet with histologic findings similar to those seen in neutrophilic eccrine hidradenitis (NEH), although with certain notable exceptions including the absence of syringosquamous metaplasia and the presence, in most cases, of neutrophilic abscesses adjacent to eccrine coils. Since its original description, three additional patients have been reported, one with palmoplantar lesions, extending the disease's clinical spectrum to include palmar as well as plantar surfaces. We report on a healthy 8-year-old girl with tender, erythematous nodules on palms and soles and review the literature on this subject.

Epidemiology
Pathogenesis
Gross Appearance and Clinical Variants
Histopathological Features and Variants
Differential Diagnosis
Prognosis and Treatment
Commonly Used Terms

EPIDEMIOLOGY	CHARACTERIZATION
INCIDENCE	Rare
AGE RANGE-MEDIAN	Childhood Mean 6 years (Range 1.5-15 years)

DIFFERENTIAL DIAGNOSIS	KEY DIFFERENTIATING FEATURES
NEUTROPHILIC ECCRINE HIDRADENITIS

PROGNOSIS AND TREATMENT	CHARACTERIZATION
PROGNOSTIC FACTORS
RECURRENCE
Recurrent palmoplantar hidradenitis in children. Rabinowitz LG, Cintra ML, Hood AF, Esterly NB. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA.	Arch Dermatol 1995 Jul;131(7):817-20 Abstract quote BACKGROUND: There are several reports of tender, erythematous plantar nodules occurring in pediatric patients. Despite similar morphological features, the histologic findings in these lesions have been quite diverse. A new entity called idiopathic plantar hidradenitis (also termed neutrophilic eccrine hidradenitis in children), which is characterized by tender, red nodules on the feet and unique histopathologic features, was recently described. OBSERVATIONS: We describe two children with these unusual cutaneous lesions and histopathologic findings and compare them with patients with idiopathic plantar hidradenitis. Our patients, in contrast to those with idiopathic plantar hidradenitis, had involvement of the palms as well as the soles. Both children had self-limited recurrent lesions; in one child, the lesions were associated with low-grade fever. Biopsy specimen findings in both cases demonstrated dense neutrophilic infiltrates localized to the eccrine units. CONCLUSIONS: Our patients had clinical and histologic findings similar to those recently reported as idiopathic plantar hidradenitis (neutrophilic eccrine hidradenitis in children). Because palms and soles can be affected and the lesions typically recur, we suggest that this condition be referred to as recurrent palmoplantar hidradenitis.
TREATMENT