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the authors report a patient with a stereotypical clinical picture of NDDH&#44; in which cocaine abuse seemed to be the trigger&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 46-year-old man with a previous history of type 1 diabetes mellitus&#44; atrial fibrillation&#44; dyslipidemia&#44; and Graves-Basedow disease presented with a 5-days history of cutaneous lesions on the dorsal aspect of his hands&#44; associated with thoracic pain&#44; mild cough&#44; and expectoration that had appeared simultaneously&#46; The patient did not present fever nor other acute symptoms&#46; He had not started taking new medications but recognized frequent use of cocaine for 8 months&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Chest radiography revealed right costophrenic angle blunting related to pleural effusion&#46; In this sense&#44; a diagnosis of atypical pneumonia was made and therefore treatment with amoxicillin-clavulanate and subsequently with azithromycin was indicated&#46; Nevertheless&#44; the patient showed no improvement&#46; Thoracoabdominal Computed Tomography &#40;TC&#41; verified a diffuse bilateral infiltrate suggestive of small airway inflammatory disease and a discrete pleural effusion&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Serum biochemistry showed glycemic decompensation &#40;299&#160;mg&#47;dL and HbA1C&#160;&#61;&#160;10&#46;6&#37;&#41; and elevated acute phase reactants &#40;Erythrocyte Sedimentation Rate &#8211; ESR&#160;&#61;&#160;58&#160;mm&#59; C-Reactive Protein &#8211; CRP&#160;&#61;&#160;4&#46;55&#160;mg&#47;dL&#41;&#46; Complete blood count revealed leukocytosis &#40;14&#160;mil&#47;mm<span class="elsevierStyleSup">3</span>&#41; and neutrophilia &#40;10&#46;4&#160;mil&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#46; Tumor markers and serum blood electrophoresis were within normal limits&#46; Autoimmunity tests &#40;including Antinuclear Antibodies &#91;ANAs&#93; and Extractable Nuclear antigen Antibodies &#91;ENAs&#93;&#41;&#44; serological tests for human immunodeficiency virus&#44; hepatitis B and C virus and respiratory tract infections &#40;including <span class="elsevierStyleItalic">Chlamydia</span><span class="elsevierStyleItalic">pneumoniae</span>&#44; Legionella&#44; <span class="elsevierStyleItalic">Mycoplasma</span><span class="elsevierStyleItalic">pneumoniae</span>&#44; Coxiella&#44; and Respiratory Syncytial Virus&#41; were negative&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Dermatological examination revealed bilateral erythematous-violaceous edematous plaques&#44; partially ulcerated&#44; and pustules coalescing in hemorrhagic bullous lesions on the dorsal aspect of his hands &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Fig&#46; 1 and 2</a>&#41;&#46; Histopathological examination showed acanthosis with subcorneal neutrophilic blister formation and a dense dermal interstitial inflammatory infiltrate predominantly composed of neutrophils &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Fig&#46; 3 and 4</a>&#41;&#46; In addition&#44; karyorrhexis&#44; erythrocyte extravasation&#44; and subepidermal edema were present&#46; A swab culture from skin bullae did not identify pathogenic microorganisms&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The patient was treated with oral prednisone 30&#160;mg daily in a slow-tapering regimen for 8 weeks&#44; along with topical betamethasone&#47;gentamicin cream&#46; Steroid therapy induced a dramatic response of both cutaneous lesions and thoracic pain&#46; Moreover&#44; the patient achieved to stop using cocaine since hospitalization to this day&#46; During 1-year follow-up&#44; no recurrence of the cutaneous lesions was observed&#44; and the patient remained completely asymptomatic&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">NDDH is currently considered an uncommon&#44; localized variant of SS&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Clinically&#44; NDDH is characterized by erythematous-violaceous plaques and nodules&#44; frequently ulcerated&#44; predominantly involving the dorsal hands&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This disorder has a predilection for the radial aspect of the hands and is generally bilateral&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The localized distribution&#44; clinical features and neutrophilic infiltration often lead to the initial diagnosis of cutaneous infection&#46; However&#44; the lesions do not respond to antibiotics and cultures are negative&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Blood analysis usually reveals leukocytosis&#44; neutrophilia and elevated ESR&#46; Nevertheless&#44; these findings are less common than in classical SS&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Most cases of classic SS are idiopathic&#46; Nevertheless&#44; as in classical SS&#44; there is a significant association between NDDH and systemic disease&#46; In this sense&#44; hematological disorders &#40;mainly myelodysplastic syndrome and plasma cell dyscrasias&#41;&#44; solid organ tumors&#44; inflammatory bowel disease&#44; and recent infections have been reported as triggers&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> For this reason&#44; it is of paramount importance to perform a thorough physical examination and request complementary tests to rule out underlying systemic disease&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Pulmonary involvement in classic SS is rare&#46; Skin lesions and pulmonary involvement are generally concomitant&#44; being the most common symptoms of dyspnea and cough&#46; Radiologic findings range from unilateral or bilateral interstitial infiltrates to lung opacities&#44; with or without pleural effusion&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> When performed&#44; cytological examination or biopsy can reveal a high proportion of neutrophils with negative cultures&#46; In the present study&#8217;s case&#44; these investigations were not performed because of the mild symptoms and its rapid improvement with steroids&#46; To the authors&#8217; best knowledge&#44; there are no previous reports of suspected pulmonary involvement in NDDH&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Histologically&#44; NDDH is characterized by a dense dermal neutrophilic infiltrate with associated dermal edema&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; findings of leukocytoclastic vasculitis are more frequent than in classic SS&#46; These findings are probably secondary to endothelial damage and are not necessary to make the diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5&#44;7</span></a> Direct immunofluorescence is typically negative&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although the spontaneous resolution has been rarely described&#44; patients with NDDH usually receive active treatment&#46; Although systemic corticosteroids are the mainstay of treatment&#44; many patients benefit from the use of a steroid-sparing systemic agent in order to prevent recurrences&#44; mainly dapsone&#46; Other alternative drugs are colchicine&#44; tetracycline or potassium iodide&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Mucocutaneous manifestations of cocaine abuse have been recently reviewed&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Cocaine-induced vasculopathy is a well-described phenomenon that manifests as purpuric plaques predominantly involving the ears&#44; nose and other facial regions&#46; This purpuric eruption is related to microvascular thrombosis with or without leukocytoclastic vasculitis&#46; Levamisole&#44; a cocaine adulterant&#44; has been identified as a trigger for the autoimmune response linked to this phenomenon&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Regarding neutrophilic dermatoses&#44; Pyoderma Gangrenosum &#40;PG&#41; secondary to chronic cocaine use is well documented and tends to present with multiple lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Indeed&#44; the strongest evidence for drug-induced PG concerns cocaine&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The histologic examination may show vasculitic changes as a distinctive but no constant finding&#46; It is not well known whether levamisole can be the pathogenic culprit behind cocaine-related PG&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Jeong et al&#46; propose that levamisole is possibly implicated in the pathogenesis of cocaine-induced PG because of the similarity in the serologic profile of both entities&#46; In this sense&#44; p-ANCA &#40;perinuclear antineutrophil cytoplasmic antibody&#41; and antiphospholipid antibodies are frequently elevated in both vasculopathic levamisole toxicity and PG&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Considering that neutrophilic dermatoses are frequently considered a continuum and there is a significant overlap between these disorders&#44; it is reasonable to hypothesize that levamisole-adultered cocaine could be involved in the genesis of other neutrophilic cutaneous diseases&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In conclusion&#44; the authors report a patient with NDDH&#44; in which cocaine abuse was identified as a possible trigger&#46; Cocaine use withdrawal along with appropriate acute phase treatment led to a prolonged time without recurrences and need for maintenance therapy&#46; As far as the authors know&#44; the relationship between cocaine and NDDH has not been previously reported&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#8217; contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Marcial &#193;lvarez-Salafranca&#58; Approval of the final version of the manuscript&#59; composition of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; participation in the design of the study&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Mar Garc&#237;a-Garc&#237;a&#58; Approval of the final version of the manuscript&#59; composition of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; participation in the design of the study&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Bego&#241;a de Escalante Yang&#252;ela&#58; Approval of the final version of the manuscript&#59; composition of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; participation in the design of the study&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Neutrophilic dermatoses encompass a wide spectrum of diseases characterized by a dense infiltration mainly composed of neutrophils&#46; Neutrophilic dermatosis of the dorsal hands is currently considered a localized variant of Sweet syndrome&#46; Cocaine abuse has been related to a wide range of mucocutaneous manifestations&#44; including neutrophilic dermatoses such as pyoderma gangrenosum&#46; The authors of this study present a patient with neutrophilic dermatosis of the dorsal hands&#44; in which cocaine abuse was identified as a probable trigger&#46;</p></span>"
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Case Report
Neutrophilic dermatosis of the dorsal hands related to cocaine abuse
Marcial Álvarez-Salafrancaa,
Corresponding author
malvarezs@salud.aragon.es

Corresponding author.
, Mar García-Garcíab, Begoña de Escalante Yangüelac
a Department of Dermatology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Department of Pathology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
c Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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the authors report a patient with a stereotypical clinical picture of NDDH&#44; in which cocaine abuse seemed to be the trigger&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 46-year-old man with a previous history of type 1 diabetes mellitus&#44; atrial fibrillation&#44; dyslipidemia&#44; and Graves-Basedow disease presented with a 5-days history of cutaneous lesions on the dorsal aspect of his hands&#44; associated with thoracic pain&#44; mild cough&#44; and expectoration that had appeared simultaneously&#46; The patient did not present fever nor other acute symptoms&#46; He had not started taking new medications but recognized frequent use of cocaine for 8 months&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Chest radiography revealed right costophrenic angle blunting related to pleural effusion&#46; In this sense&#44; a diagnosis of atypical pneumonia was made and therefore treatment with amoxicillin-clavulanate and subsequently with azithromycin was indicated&#46; Nevertheless&#44; the patient showed no improvement&#46; Thoracoabdominal Computed Tomography &#40;TC&#41; verified a diffuse bilateral infiltrate suggestive of small airway inflammatory disease and a discrete pleural effusion&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Serum biochemistry showed glycemic decompensation &#40;299&#160;mg&#47;dL and HbA1C&#160;&#61;&#160;10&#46;6&#37;&#41; and elevated acute phase reactants &#40;Erythrocyte Sedimentation Rate &#8211; ESR&#160;&#61;&#160;58&#160;mm&#59; C-Reactive Protein &#8211; CRP&#160;&#61;&#160;4&#46;55&#160;mg&#47;dL&#41;&#46; Complete blood count revealed leukocytosis &#40;14&#160;mil&#47;mm<span class="elsevierStyleSup">3</span>&#41; and neutrophilia &#40;10&#46;4&#160;mil&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#46; Tumor markers and serum blood electrophoresis were within normal limits&#46; Autoimmunity tests &#40;including Antinuclear Antibodies &#91;ANAs&#93; and Extractable Nuclear antigen Antibodies &#91;ENAs&#93;&#41;&#44; serological tests for human immunodeficiency virus&#44; hepatitis B and C virus and respiratory tract infections &#40;including <span class="elsevierStyleItalic">Chlamydia</span><span class="elsevierStyleItalic">pneumoniae</span>&#44; Legionella&#44; <span class="elsevierStyleItalic">Mycoplasma</span><span class="elsevierStyleItalic">pneumoniae</span>&#44; Coxiella&#44; and Respiratory Syncytial Virus&#41; were negative&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Dermatological examination revealed bilateral erythematous-violaceous edematous plaques&#44; partially ulcerated&#44; and pustules coalescing in hemorrhagic bullous lesions on the dorsal aspect of his hands &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Fig&#46; 1 and 2</a>&#41;&#46; Histopathological examination showed acanthosis with subcorneal neutrophilic blister formation and a dense dermal interstitial inflammatory infiltrate predominantly composed of neutrophils &#40;<a class="elsevierStyleCrossRefs" href="#fig0015">Fig&#46; 3 and 4</a>&#41;&#46; In addition&#44; karyorrhexis&#44; erythrocyte extravasation&#44; and subepidermal edema were present&#46; A swab culture from skin bullae did not identify pathogenic microorganisms&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The patient was treated with oral prednisone 30&#160;mg daily in a slow-tapering regimen for 8 weeks&#44; along with topical betamethasone&#47;gentamicin cream&#46; Steroid therapy induced a dramatic response of both cutaneous lesions and thoracic pain&#46; Moreover&#44; the patient achieved to stop using cocaine since hospitalization to this day&#46; During 1-year follow-up&#44; no recurrence of the cutaneous lesions was observed&#44; and the patient remained completely asymptomatic&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">NDDH is currently considered an uncommon&#44; localized variant of SS&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Clinically&#44; NDDH is characterized by erythematous-violaceous plaques and nodules&#44; frequently ulcerated&#44; predominantly involving the dorsal hands&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> This disorder has a predilection for the radial aspect of the hands and is generally bilateral&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The localized distribution&#44; clinical features and neutrophilic infiltration often lead to the initial diagnosis of cutaneous infection&#46; However&#44; the lesions do not respond to antibiotics and cultures are negative&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Blood analysis usually reveals leukocytosis&#44; neutrophilia and elevated ESR&#46; Nevertheless&#44; these findings are less common than in classical SS&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Most cases of classic SS are idiopathic&#46; Nevertheless&#44; as in classical SS&#44; there is a significant association between NDDH and systemic disease&#46; In this sense&#44; hematological disorders &#40;mainly myelodysplastic syndrome and plasma cell dyscrasias&#41;&#44; solid organ tumors&#44; inflammatory bowel disease&#44; and recent infections have been reported as triggers&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> For this reason&#44; it is of paramount importance to perform a thorough physical examination and request complementary tests to rule out underlying systemic disease&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Pulmonary involvement in classic SS is rare&#46; Skin lesions and pulmonary involvement are generally concomitant&#44; being the most common symptoms of dyspnea and cough&#46; Radiologic findings range from unilateral or bilateral interstitial infiltrates to lung opacities&#44; with or without pleural effusion&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> When performed&#44; cytological examination or biopsy can reveal a high proportion of neutrophils with negative cultures&#46; In the present study&#8217;s case&#44; these investigations were not performed because of the mild symptoms and its rapid improvement with steroids&#46; To the authors&#8217; best knowledge&#44; there are no previous reports of suspected pulmonary involvement in NDDH&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Histologically&#44; NDDH is characterized by a dense dermal neutrophilic infiltrate with associated dermal edema&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; findings of leukocytoclastic vasculitis are more frequent than in classic SS&#46; These findings are probably secondary to endothelial damage and are not necessary to make the diagnosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;5&#44;7</span></a> Direct immunofluorescence is typically negative&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Although the spontaneous resolution has been rarely described&#44; patients with NDDH usually receive active treatment&#46; Although systemic corticosteroids are the mainstay of treatment&#44; many patients benefit from the use of a steroid-sparing systemic agent in order to prevent recurrences&#44; mainly dapsone&#46; Other alternative drugs are colchicine&#44; tetracycline or potassium iodide&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Mucocutaneous manifestations of cocaine abuse have been recently reviewed&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Cocaine-induced vasculopathy is a well-described phenomenon that manifests as purpuric plaques predominantly involving the ears&#44; nose and other facial regions&#46; This purpuric eruption is related to microvascular thrombosis with or without leukocytoclastic vasculitis&#46; Levamisole&#44; a cocaine adulterant&#44; has been identified as a trigger for the autoimmune response linked to this phenomenon&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Regarding neutrophilic dermatoses&#44; Pyoderma Gangrenosum &#40;PG&#41; secondary to chronic cocaine use is well documented and tends to present with multiple lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Indeed&#44; the strongest evidence for drug-induced PG concerns cocaine&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The histologic examination may show vasculitic changes as a distinctive but no constant finding&#46; It is not well known whether levamisole can be the pathogenic culprit behind cocaine-related PG&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Jeong et al&#46; propose that levamisole is possibly implicated in the pathogenesis of cocaine-induced PG because of the similarity in the serologic profile of both entities&#46; In this sense&#44; p-ANCA &#40;perinuclear antineutrophil cytoplasmic antibody&#41; and antiphospholipid antibodies are frequently elevated in both vasculopathic levamisole toxicity and PG&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Considering that neutrophilic dermatoses are frequently considered a continuum and there is a significant overlap between these disorders&#44; it is reasonable to hypothesize that levamisole-adultered cocaine could be involved in the genesis of other neutrophilic cutaneous diseases&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In conclusion&#44; the authors report a patient with NDDH&#44; in which cocaine abuse was identified as a possible trigger&#46; Cocaine use withdrawal along with appropriate acute phase treatment led to a prolonged time without recurrences and need for maintenance therapy&#46; As far as the authors know&#44; the relationship between cocaine and NDDH has not been previously reported&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#8217; contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Marcial &#193;lvarez-Salafranca&#58; Approval of the final version of the manuscript&#59; composition of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; participation in the design of the study&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Mar Garc&#237;a-Garc&#237;a&#58; Approval of the final version of the manuscript&#59; composition of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; participation in the design of the study&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Bego&#241;a de Escalante Yang&#252;ela&#58; Approval of the final version of the manuscript&#59; composition of the manuscript&#59; collection&#44; analysis&#44; and interpretation of data&#59; participation in the design of the study&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0090" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Neutrophilic dermatoses encompass a wide spectrum of diseases characterized by a dense infiltration mainly composed of neutrophils&#46; Neutrophilic dermatosis of the dorsal hands is currently considered a localized variant of Sweet syndrome&#46; Cocaine abuse has been related to a wide range of mucocutaneous manifestations&#44; including neutrophilic dermatoses such as pyoderma gangrenosum&#46; The authors of this study present a patient with neutrophilic dermatosis of the dorsal hands&#44; in which cocaine abuse was identified as a probable trigger&#46;</p></span>"
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Article information
ISSN: 03650596
Original language: English
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