Dermatology - Sweet Syndrome

Dermatology - Sweet Syndrome 

A rare, sudden, and recurring cutaneous reaction caused by cytokines and related with several causes. The age at which symptoms first appear is typically between 30 and 60 years, with a higher prevalence in women compared to men.

Prodromes are characterized by fever and infections in the upper respiratory tract, which may also involve gastrointestinal symptoms, tonsillitis, headache, arthralgia, and malaise. These symptoms often occur 1-3 weeks before the appearance of lesions.
Abnormalities
The lesions are characterized by their bright red color, smooth texture, and tenderness. They appear as little papules, about 2-4 mm in diameter, which merge together to form irregular, well-defined, inflamed plaques. Pseudovesiculation refers to a severe swelling that mimics the appearance of vesiculation. Lesions develop quickly and, as they progress, a central clearance may cause them to form round or curved patterns. Small, shallow pustules may develop. In cases where leukemia is present, the development of bullous lesions is possible and can resemble pyoderma gangrenosum.

​Lesions can occur as a single or several, and they may be distributed asymmetrically or symmetrically. They are most frequently found on the face, neck, and upper extremities, but can also appear on the lower limbs. In certain cases, the lesions may be deep within the fat, resembling panniculitis or erythema nodosum. Truncal lesions are few yet prevalent, and they can manifest in a widespread manner, including generalized forms. Conjunctivitis and episcleritis may coexist.

The diagnosis is made through the assessment of clinical features, examination of tissue samples under a microscope, and confirmation with a skin biopsy. The differential diagnosis comprises erythema multiforme, erythema nodosum, prevesicular herpes simplex infection, and preulcerative pyoderma gangrenosum.


If left untreated, the lesions would gradually increase in size over a span of days or weeks and then disappear without leaving any scars. Lesions are resolved within a few days with the use of oral prednisone, administered at a dosage of 30-50 mg per day and gradually reduced over a period of 2-3 weeks. Alternatively, patients exhibit a positive response to dapsone at a dosage of 100 mg per day, or to potassium iodide. Recurrences manifest in 50% of patients, frequently affecting previously affected areas. Exclude the possibility of sepsis.