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The importance of skin biopsy in the diverse clinical manifestations of cholesterol embolism

These functional changes could lead to a release of cytokines and an upregulation of expression of some adhesion molecules such as a4-integrin, all changes that might promote adhesion of neutrophils to vessel walls, damage to the endothelium, diapedesis and accumulation in some areas such as the dermis. The earliest phase of this recovery is probably ongoing while the peripheral count still shows a sometimes deep granulocytopenia, the functional properties of these first neutrophils being more important than their absolute number. This theory could also possibly apply to usual cases of Sweet’s syndrome, where a rapid increase in neutrophil count by bone marrow stimulation for various reasons could explain both the usual high neutrophil count and the unusual behaviour of these highly stimulated cells. A similar mechanism has been suggested by some authors to account for cases of Sweet’s syndrome occurring during myelodysplastic syndromes. Finally, a similar pathogenesis could also be hypothesized for ATRA-induced ND, as ATRA is a potent stimulator of some neutrophil functions.