Another in the series of not quite what it looks. These
lesions arose on the backs of both hands as possible blisters that then crusted
although the one on the little finger remained as a purplish nodule. The
patient had multiple myeloma. Infection was considered the likeliest cause by
his treating doctors but swabs were negative and high dose antibiotics made no
difference. The alleged blisters did not break and leak any fluid so were not
true blisters. Patients who have myeloma and other myeloproliferative leukaemic
disorders are certainly susceptible to infections but they also get a rare skin
rash called Sweet’s syndrome after the UK dermatologist who first described the
disorder. It is a neutrophilic condition where masses of neutrophils invade the
dermis and cause subepidermal oedema simulating a blister. Pustules can
sometimes be seen in the overlying epidermis but are inflammatory not
infective. Sweets responds to high dose oral steroids reducing over three weeks.
The condition also commonly occurs in people with inflammatory bowel disorders
such as Crohns and Ulcerative colitis.
