Hemorrhagic Bullae on the Hands—Diagnosis

The laboratory findings showed a white blood cell count of 13 640 cells/μL (reference range, 3280-9290 cells/μL), with a neutrophil count of 9600 cells/μL (reference range, 1300-7000 cells/μL) (to convert white blood cell and neutrophil counts to ×10⁹/L, multiply by 0.001) and an erythrocyte sedimentation rate of 46 mm/h (reference range, 0-10 mm/h). The skin biopsy revealed compact orthokeratosis, epidermal spongiosis, and a prominent dermal neutrophilic infiltrate with prominent edema and extravasation of red blood cells into the papillary dermis. There was no evidence of leukocytoclastic vasculitis. These findings are consistent with “neutrophilic dermatosis of the dorsal hands” (NDDH).