NERDS: A Syndrome with Two Faces

Valentina Broshtilova; Nencho Smilov; Irina Yungareva; Yoanna Velevska-Vatova; Alexander Trenovski; Sonya Marina

doi:doi:10.11648/j.ijcd.20250802.11

Review Article |

| Peer-Reviewed

NERDS: A Syndrome with Two Faces

Valentina Broshtilova

, Nencho Smilov

, Irina Yungareva

, Yoanna Velevska-Vatova

, Alexander Trenovski

, Sonya Marina^*

Published in International Journal of Clinical Dermatology (Volume 8, Issue 2)

Received: 7 July 2025 Accepted: 22 July 2025 Published: 8 August 2025

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Abstract

NERDS syndrome (Nodules, Eosinophilia, Rheumatism, Dermatitis, Swelling) is a rare eosinophilic inflammatory disorder, characterized by the presence of periarticular or subcutaneous nodules, persistent peripheral eosinophilia, arthralgias resembling rheumatoid arthritis, chronic dermatitis, and limb swelling. To provide a comprehensive overview of the clinical, laboratory, and histopathological features of NERDS syndrome, and to propose a structured diagnostic approach to differentiate it from other eosinophilic or rheumatologic conditions. We conducted a systematic review of published cases of NERDS syndrome, analyzing clinical manifestations, laboratory findings, histopathological features, and response to treatment. We propose a structured diagnostic approach to differentiate it from other eosinophilic or rheumatologic conditions. NERDS syndrome typically presents with firm nodules near joints, rheumatoid-like joint pain, dermatitis, and localized or generalized swelling. Laboratory tests show marked eosinophilia (>1500/μL), elevated inflammatory markers (CRP, ESR), and eosinophilic infiltration in affected tissues. The main differential diagnoses include DRESS syndrome, eosinophilic granulomatosis with polyangiitis, idiopathic hypereosinophilic syndrome, eosinophilic rheumatoid arthritis, and parasitic infections. NERDS syndrome is a distinct eosinophilic disease requiring careful clinical and laboratory evaluation to ensure accurate diagnosis. Systemic corticosteroids remain the first-line therapy and usually result in rapid improvement. In refractory or relapsing cases, immunosuppressive or biologic agents may be considered. The proposed diagnostic approach may facilitate early recognition and optimal management of this underdiagnosed condition.

Published in	International Journal of Clinical Dermatology (Volume 8, Issue 2)
DOI	10.11648/j.ijcd.20250802.11
Page(s)	44-50
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

NERDS Syndrome, Nodules, Eosinophilia, Rheumatism, Dermatitis, Swelling, Eosinophilic Inflammation, Autoimmune Syndrome

1. Introduction

The accronym NERDS is used in medical literature to denote two distinct clinical syndromes originating from completely different fields - dermatology on one hand, and hematology/rheumatology, on the other. This overlap creates a risk of confusion, especially in interdisciplinary communication or interpretation of clinical findings.

In dermatology and wound care, NERDS stands for: Nodule, Erythema, Recurrence, Discharge, and chronicity - criteria used to identify superficial infection in chronic wounds, proposed by R. G. Sibbald et al. (2006-2009)

[1]

. This abbreviation is widely accepted in clinical practice and facilitates early recognition of local infection that requires appropriate antimicrobial treatment.

In hematology and immunology, however, NERDS refers to a rare, non-infectious, eosinophilic inflammatory syndrome introduced by J. H. Butterfield et al. (1993)

[2]

, where the acronym stands for: Nodules, Eosinophilia, Rheumatism, Dermatitis, Swelling.

Although less well known, NERDS (eosinophilic syndrome) represents a valuable model for understanding non-infectious inflammatory processes mediated by eosinophils

[3]

. Unlike superficial infection of chronic ulcers, this inflammation is systemic, autoimmune or idiopathic, with the potential to become chronic, but typically has a favorable prognosis and responds well to corticosteroid treatment.

The aim of this review is to present the less commonly used NERDS syndrome as an example of non-infectious, eosinophilic inflammation; to summarize its clinical and laboratory features; and to differentiate it from other similar eosinophilic conditions.

2. Etiology and Pathogenesis

The NERDS syndrome (Nodules, Eosinophilia, Rheumatism, Dermatitis, Swelling) was first described in 1993. Its exact etiology remains unclear, but available data suggest an immunologically mediated mechanism involving eosinophilic hyperreactivity, a Th2-dominant immune response, and mast cell participation.

Almost all reported cases are characterized by persistent peripheral eosinophilia (>1500/μL) and tissue eosinophilic infiltration. Activated eosinophils release cytotoxic granules containing Major Basic Protein (MBP), Eosinophil Cationic Protein (ECP), Eosinophil-Derived Neurotoxin (EDN), and Eosinophil Peroxidase (EPO). These mediators cause tissue damage, endothelial dysfunction, and further activate the immune cascade

[4-6]

. Histological studies demonstrate MBP deposition and the presence of degranulated eosinophils in affected tissues

[4, 7]

. Elevated serum EDN levels correlate with disease activity and serve as an indicator of systemic eosinophilic activation

[5, 8]

Flow cytometric analyses in NERDS patients reveal a predominance of activated CD4+/HLA-DR+ T-helper cells, typical of a Th2-type immune response

[9]

. These cells secrete IL-4, IL-5, and IL-13, which promote eosinophil differentiation and survival, enhance IgE production, and support eosinophil migration and infiltration into tissues. This cytokine profile resembles the pathogenesis of hypereosinophilic syndrome, eosinophilic granulomatosis with polyangiitis, and other Th2-mediated diseases

[10]

Patients also exhibit mast cell infiltration in affected tissues, including the dermal and synovial compartments

[7]

. Mast cells release histamine, IL-5, TNF-α, and prostaglandins, which increase vascular permeability and cause edema, reinforcing the Th2-mediated immune response.

The frequent clinical findings of edema and angioedema in NERDS may result from the release of vasodilators (histamine, prostaglandins, bradykinin) by mast cells, as well as the direct endothelial toxicity caused by eosinophilic granules

[6, 11]

Some patients experience rheumatoid-like symptoms such as arthralgia and polyarthritis, raising the possibility of an autoimmune pathogenesis. However, in most cases, antinuclear antibodies (ANA) and rheumatoid factor (RF) are negative, making an autoantibody-mediated mechanism unlikely

[4, 10]

Table 1. Key Etiopathogenetic Features of NERDS Syndrome.

Parameter	Description
Primary Etiology	Eosinophil-mediated hyperreactivity; likely allergic, autoimmune, or idiopathic origin
Immune Response	Th2-dominant (IL-4, IL-5, IL-13); activated CD4+/HLA-DR+ T-helper cells
Cytotoxic Mediators	MBP, ECP, EDN, EPO - cause tissue injury and endothelial dysfunction
Mast Cell Involvement	Present - with secretion of histamine, TNF-α, IL-5, and prostaglandins
Serum Markers	Elevated EDN levels - correlate with disease activity
Autoimmune Markers	ANA and RF usually negative

3. Clinical Presentation

The NERDS syndrome (Nodules, Eosinophilia, Rheumatism, Dermatitis, Swelling) is characterized by a subacute to chronic, relapsing course with predominantly eosinophil-mediated inflammatory processes

[12, 13]

. The main clinical manifestations include cutaneous, articular, and systemic symptoms, most commonly affecting peripheral body parts and periarticular tissues.

Subcutaneous and periarticular nodules are typically non-painful, measuring 0.5 to 3 cm, with an elastic or fibrotic consistency, most often located over the extensor surfaces of joints. Dermatological manifestations include transient urticarial exanthema, angioedema, and diffuse xerosis, usually accompanied by intense pruritus. Edema is particularly prominent, most commonly involving the lower limbs

[12, 15]

, often severely painful and more intense with each recurrence. It is not associated with cardiac or renal insufficiency and resolves rapidly with systemic corticosteroid therapy. In some cases, lower motor neuron-type paralysis may occur

[14, 16, 17]

. Patients often present with cervical and axillary lymphadenopathy, peripheral eosinophilia (usually >1500/μL, and in some cases >5000/μL), which correlates with disease activity

[12, 14, 16]

Rheumatologic symptoms include symmetrical arthralgias, myalgias, and morning stiffness. There is no joint destruction or erosions, but the pain can significantly limit movement, particularly during relapses

[12, 13]

4. Laboratory Investigations

Laboratory and imaging studies play a crucial role in the evaluation of NERDS syndrome. The most characteristic finding is sustained absolute eosinophilia, often exceeding 1500/μL, along with leukocytosis and moderate to marked elevation of inflammatory markers such as ESR and CRP

[1, 2]

. Eosinophils often exhibit a hypodense phenotype, characteristic of functionally activated cells

[3]

Bone marrow aspirate (myelogram) reveals marked hyperplasia of eosinophil precursors, without evidence of clonality or malignant transformation

[4]

. Flow cytometry shows an imbalance in the T-cell population, with predominance of CD4⁺ T-lymphocytes and reduced CD8⁺ cells, as well as increased expression of activation markers such as HLA-DR and CD25 on eosinophils

[5, 6]

, indicating their functional activation.

Serologic tests are usually negative for ANA and ANCA. Rheumatoid factor (RF) is typically negative, although persistently elevated values have been described, even in the absence of joint erosions

[7]

Elevated serum levels of IgE, IgM, and circulating immune complexes (CIC) are commonly observed

[8]

. The immunocytokine profile in some patients shows increased levels of sIL-2R, IL-2, and TNF-α, reflecting a Th2-dominant activated state and eosinophilic inflammation

[5, 9]

Histological Features

Histological examination of skin lesions typically reveals perivascular and diffuse infiltrates of polymorphonuclear cells, predominantly eosinophils, located in the papillary and reticular dermis. Common findings include eosinophil degranulation, leukocytoclasia, and foci of partial collagen degeneration, without necrosis or vasculitis

[10, 11]

, forming the characteristic “flame figures”.

Lymph node histology may show hypoplasia of lymphoid follicles and expansion of the pulp, with pleomorphic proliferation of lymphoid cells, including immunoblasts and eosinophils

[6, 12]

Periarticular nodules exhibit a histologic pattern resembling eosinophilic cellulitis (Wells syndrome), with a mixed-cell infiltrate of eosinophils and lymphocytes, but without necrosis or vasculitis

[10, 13]

Imaging studies usually do not reveal destructive joint changes, and organ function remains preserved in most patients

[14]

Table 2. Summary of Clinical, Paraclinical, and Histological Features of NERDS Syndrome.

Category	Parameter	Findings
Clinical	Disease course	Subacute to chronic, relapsing
	Skin manifestations	Transient urticarial exanthema, angioedema, diffuse xerosis, intense pruritus
	Nodules	Subcutaneous/periarticular, 0.5-3 cm, soft or fibrotic, extensor surfaces
	Edema	Prominent, especially in lower limbs, painful, steroid-responsive
	Neurologic involvement	Lower motor neuron-type paralysis (in some cases)
	Lymphadenopathy	Cervical and axillary
	Rheumatologic symptoms	Symmetrical arthralgia, myalgia, morning stiffness; no joint destruction or erosions
	Eosinophilia	>1500/μL; may exceed 5000/μL
Laboratory	CBC	Absolute eosinophilia, leukocytosis
	Inflammatory markers	Elevated ESR and CRP
	Bone marrow	Eosinophilic hyperplasia, no clonality or malignancy
	Flow cytometry	CD4⁺ T-cell predominance, ↓ CD8⁺, ↑ HLA-DR and CD25 on eosinophils
	Autoantibodies	ANA, ANCA, and RF typically negative (RF may be elevated without erosive disease)
	Immunoglobulins	Elevated IgE, IgM, and circulating immune complexes (CIC)
	Cytokines	↑ sIL-2R, IL-2, TNF-α - indicating Th2-type inflammation
Histology	Skin biopsy	Perivascular/diffuse eosinophilic infiltrates, degranulation, leukocytoclasia, flame figures
	Lymph node	Follicular hypoplasia, pulp hyperplasia with eosinophils and immunoblasts
	Nodules	Resemb

5. Diagnosis

The diagnosis of NERDS syndrome is based on the characteristic clinical picture involving recurrent episodes of joint pain, periarticular nodules, urticaria with angioedema, and chronic absolute peripheral eosinophilia

[18, 19]

Confirmation of the diagnosis

[16, 20, 21]

relies on the constellation of clinical features matching the core criteria of the syndrome (nodules, dermatitis, edema, joint complaints), with the following key distinguishing features: absence of significant organ damage, predominantly cutaneous-articular involvement, slow progression and relapsing course

[1-3]

. Laboratory findings include stable peripheral eosinophilia (>1500/μL, sometimes >5000/μL), elevated serum IgE levels, activated T-cell subpopulations (increased CD4⁺ lymphocytes with HLA-DR and CD25 expression). Histological examination of affected tissues (skin, lymph nodes, periarticular nodules) shows perivascular eosinophilic infiltration, leukocytoclasia, eosinophil degranulation, and absence of fibrinoid endothelial necrosis

[21-23]

6. Differential Diagnosis

A critical aspect of the diagnostic process is the differentiation between the two syndromes that share the same abbreviation (NERDS). In this context, the focus lies on the immuno-inflammatory nature of the eosinophilic NERDS syndrome versus the chronic infectious character of the dermatological NERDS acronym used in wound care.

A detailed comparison of etiology, clinical features, and laboratory characteristics is presented in Table 3

[24-27]

Table 3. Comparative Overview of the Two Syndromes Referred to as NERDS.

Parameter	NERDS (Eosinophilic Syndrome)	NERDS (Chronic Inflammatory Wound Syndrome)
Full Name	Nodules, Eosinophilia, Rheumatism, Dermatitis, Swelling	Nodule, Erythema, Recurrence, Discharge, Chronicity
Etiology / Pathogenesis	Immune-mediated response, Th2-dominant, with activated eosinophils and elevated IL-2, TNF-α, sIL-2R	Chronic bacterial infection - often Staphylococcus aureus, Streptococcus spp.
Clinical Presentation	Skin nodules, eosinophilic dermatitis, edema, arthralgia or arthritis, general malaise	Painful nodules with erythema and purulent discharge, recurrences, fistulas, abscesses
Laboratory Findings	↑ Eosinophils, ↑ IgE, ↑ CRP/ESR, ANA/ANCA negative, skin biopsy showing eosinophils	↑ CRP/ESR, cultures with pathogenic bacteria, ultrasound for deep tissue involvement
Histology / Microbiology	Eosinophilic perivascular infiltration, no necrosis or vasculitis	Suppurative inflammation, often with colonization, microbiologically confirmed
Treatment	Systemic corticosteroids (e.g., prednisone); if needed: immunosuppressants (methotrexate, azathioprine), antihistamines	Antibiotics based on susceptibility, surgical drainage or excision, local antiseptic treatment
Follow-up / Complications	Monitor eosinophil count, screen for steroid dependence and immunosuppression-related risks	Risk of recurrence, fistulas, chronic infection, potential scarring

The NERDS syndrome should be differentiated from other eosinophilic inflammatory conditions, some of which present with a more aggressive course, systemic organ dysfunction, or are associated with specific etiological factors such as drug-induced toxicity or parasitic infestation (see Table 4).

Table 4. Differential Diagnosis of NERDS Syndrome Compared to Other Eosinophilic Disorders.

Condition

Distinguishing Features

Hypereosinophilic Syndrome (HES)

[28, 29]

Organ dysfunction (heart, CNS, lungs); aggressive course. Persistent eosinophilia is also present in HES, but NERDS lacks organ damage, especially cardiac involvement.

EGPA / Churg-Strauss Syndrome

[30]

Asthma, peripheral neuropathy, vasculitis, ANCA-positive. Key criteria: asthma, neuropathy, pulmonary infiltrates, sinusitis.

DRESS Syndrome

[31]

History of drug exposure, fever, hepatitis, lymphadenopathy.

Eosinophilic Fasciitis

[32]

Sclerotic induration of fascia, restricted mobility, no vasculitis.

Eosinophilic cellulitis

[32]

clinically mimicks bacterial cellulitis, evolving in annular patches, often with vesicules and blisters

Gelich syndrome

[32]

Recurrent episods of angioedema, fever, weight gain

Parasitic Infections

[14, 20]

Travel history, positive serology, elevated IgE, parasites detected in stool samples.

Episodic Angioedema with Eosinophilia

[33]

Recurrent facial angioedema, fever, weight gain, but no joint or nodular lesions.

Eosinophilia-Myalgia Syndrome

[34]

Linked to L-tryptophan intake, scleroderma-like changes, absence of nodules.

Kimura Disease

[35]

Skin nodules and lymphadenopathy, but histology shows granulomatous and vascular proliferation.

Rheumatoid Arthritis Exclusion

Rheumatoid arthritis should be excluded using the clinical, laboratory, and radiological criteria established by ACR/ARA. In NERDS, erosive arthritis and autoantibodies (typically negative ANA and ANCA) are absent

[18, 21]

7. Prognosis

The NERDS syndrome (eosinophilic variant) generally has a favorable prognosis, especially when recognized early and managed appropriately

[2, 3]

. No organ dysfunction is observed

[2, 4]

. Symptoms typically respond well to low-to-moderate doses of corticosteroids, resulting in rapid resolution of urticaria, nodules, angioedema, and arthralgias

[10, 36]

. In many cases, prolonged therapy is not required

[19, 24]

. However, long-term follow-up is necessary to monitor for recurrences and any changes in the clinical presentation

[36]

8. Treatment

The mainstay of therapy for NERDS syndrome is systemic corticosteroids. Prednisone at a dose of 0.5-1 mg/kg/day typically results in rapid clinical improvement. In some cases, even low maintenance doses administered on alternate days are sufficient to maintain remission while minimizing side effects

[10, 36-38]

For patients with steroid dependence or incomplete therapeutic response, immunosuppressive agents can be introduced such as azathioprine (1-2 mg/kg/day) or methotrexate (7.5-15 mg weekly). These agents offer steroid-sparing effects and may help achieve stable remission

[39, 40]

. Antihistamines may be used as adjunct therapy, particularly to relieve urticarial rash and pruritus

[36]

. There are isolated reports supporting the use of interferon-alpha in resistant cases

[41]

. Its mechanism involves inhibition of eosinophilic infiltration and suppression of mediator release.

Regardless of the treatment regimen, weekly monitoring of peripheral eosinophil counts is recommended as an indirect marker of disease activity and treatment response

[36]

9. Conclusion

The NERDS syndrome (eosinophilic type) is a distinct eosinophilic inflammatory condition with characteristic skin and joint manifestations. Early diagnosis is essential to avoid unnecessary invasive investigations and to initiate effective pathogenetic therapy. Increasing awareness among healthcare professionals would enable better recognition of clinical cases, enhance understanding of the underlying pathophysiology, and support a more targeted therapeutic approach

[25, 42]

Abbreviations

CRP	C-Reactive Protein
ESR	Erythrocyte Sedimentation Rate
IL	Interleukin
TNF	Tumor Necrosis Factor
HLA-DR	Human Leukocyte Antigen - DR Isotype
ANCA	Antineutrophil Cytoplasmic Antibodies
ACR/ARA	American College of Rheumatology / American Rheumatism Association

Author Contributions

Valentina Broshtilova: Writing – review & editing

Nencho Smilov: Formal Analysis, Funding acquisition

Irina Yungareva: Formal Analysis, Funding acquisition

Yoanna Velevska: Formal Analysis, Funding acquisition

Aleksandar Trenovski: Formal Analysis, Funding acquisition

Sonya Marina: Writing – original draft

Conflicts of Interest

The authors declare no conflicts of interest.

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Broshtilova, V., Smilov, N., Yungareva, I., Velevska-Vatova, Y., Trenovski, A., et al. (2025). NERDS: A Syndrome with Two Faces. International Journal of Clinical Dermatology, 8(2), 44-50. https://doi.org/10.11648/j.ijcd.20250802.11

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Broshtilova, V.; Smilov, N.; Yungareva, I.; Velevska-Vatova, Y.; Trenovski, A., et al. NERDS: A Syndrome with Two Faces. Int. J. Clin. Dermatol. 2025, 8(2), 44-50. doi: 10.11648/j.ijcd.20250802.11

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Broshtilova V, Smilov N, Yungareva I, Velevska-Vatova Y, Trenovski A, et al. NERDS: A Syndrome with Two Faces. Int J Clin Dermatol. 2025;8(2):44-50. doi: 10.11648/j.ijcd.20250802.11

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@article{10.11648/j.ijcd.20250802.11,
  author = {Valentina Broshtilova and Nencho Smilov and Irina Yungareva and Yoanna Velevska-Vatova and Alexander Trenovski and Sonya Marina},
  title = {NERDS: A Syndrome with Two Faces
},
  journal = {International Journal of Clinical Dermatology},
  volume = {8},
  number = {2},
  pages = {44-50},
  doi = {10.11648/j.ijcd.20250802.11},
  url = {https://doi.org/10.11648/j.ijcd.20250802.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcd.20250802.11},
  abstract = {NERDS syndrome (Nodules, Eosinophilia, Rheumatism, Dermatitis, Swelling) is a rare eosinophilic inflammatory disorder, characterized by the presence of periarticular or subcutaneous nodules, persistent peripheral eosinophilia, arthralgias resembling rheumatoid arthritis, chronic dermatitis, and limb swelling. To provide a comprehensive overview of the clinical, laboratory, and histopathological features of NERDS syndrome, and to propose a structured diagnostic approach to differentiate it from other eosinophilic or rheumatologic conditions. We conducted a systematic review of published cases of NERDS syndrome, analyzing clinical manifestations, laboratory findings, histopathological features, and response to treatment. We propose a structured diagnostic approach to differentiate it from other eosinophilic or rheumatologic conditions. NERDS syndrome typically presents with firm nodules near joints, rheumatoid-like joint pain, dermatitis, and localized or generalized swelling. Laboratory tests show marked eosinophilia (>1500/μL), elevated inflammatory markers (CRP, ESR), and eosinophilic infiltration in affected tissues. The main differential diagnoses include DRESS syndrome, eosinophilic granulomatosis with polyangiitis, idiopathic hypereosinophilic syndrome, eosinophilic rheumatoid arthritis, and parasitic infections. NERDS syndrome is a distinct eosinophilic disease requiring careful clinical and laboratory evaluation to ensure accurate diagnosis. Systemic corticosteroids remain the first-line therapy and usually result in rapid improvement. In refractory or relapsing cases, immunosuppressive or biologic agents may be considered. The proposed diagnostic approach may facilitate early recognition and optimal management of this underdiagnosed condition.},
 year = {2025}
}

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TY  - JOUR
T1  - NERDS: A Syndrome with Two Faces

AU  - Valentina Broshtilova
AU  - Nencho Smilov
AU  - Irina Yungareva
AU  - Yoanna Velevska-Vatova
AU  - Alexander Trenovski
AU  - Sonya Marina
Y1  - 2025/08/08
PY  - 2025
N1  - https://doi.org/10.11648/j.ijcd.20250802.11
DO  - 10.11648/j.ijcd.20250802.11
T2  - International Journal of Clinical Dermatology
JF  - International Journal of Clinical Dermatology
JO  - International Journal of Clinical Dermatology
SP  - 44
EP  - 50
PB  - Science Publishing Group
SN  - 2995-1305
UR  - https://doi.org/10.11648/j.ijcd.20250802.11
AB  - NERDS syndrome (Nodules, Eosinophilia, Rheumatism, Dermatitis, Swelling) is a rare eosinophilic inflammatory disorder, characterized by the presence of periarticular or subcutaneous nodules, persistent peripheral eosinophilia, arthralgias resembling rheumatoid arthritis, chronic dermatitis, and limb swelling. To provide a comprehensive overview of the clinical, laboratory, and histopathological features of NERDS syndrome, and to propose a structured diagnostic approach to differentiate it from other eosinophilic or rheumatologic conditions. We conducted a systematic review of published cases of NERDS syndrome, analyzing clinical manifestations, laboratory findings, histopathological features, and response to treatment. We propose a structured diagnostic approach to differentiate it from other eosinophilic or rheumatologic conditions. NERDS syndrome typically presents with firm nodules near joints, rheumatoid-like joint pain, dermatitis, and localized or generalized swelling. Laboratory tests show marked eosinophilia (>1500/μL), elevated inflammatory markers (CRP, ESR), and eosinophilic infiltration in affected tissues. The main differential diagnoses include DRESS syndrome, eosinophilic granulomatosis with polyangiitis, idiopathic hypereosinophilic syndrome, eosinophilic rheumatoid arthritis, and parasitic infections. NERDS syndrome is a distinct eosinophilic disease requiring careful clinical and laboratory evaluation to ensure accurate diagnosis. Systemic corticosteroids remain the first-line therapy and usually result in rapid improvement. In refractory or relapsing cases, immunosuppressive or biologic agents may be considered. The proposed diagnostic approach may facilitate early recognition and optimal management of this underdiagnosed condition.
VL  - 8
IS  - 2
ER  -

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Author Information

Valentina Broshtilova

Department of Internal Medicine, Pharmacology and Clinical Pharmacology, Pediatrics, Epidemiology, Infectious and Skin Diseases, Faculty of Medicine, Sofia University, Sofia, Bulgaria

Contact Email

http://orcid.org/0000-0003-2317-0398
Nencho Smilov

Clinic of Urology, Medical Institute of the Ministry of Interior, Sofia, Bulgaria

Contact Email

http://orcid.org/0000-0002-0218-2069
Irina Yungareva

Department of Skin and Venereal Diseases, Medical Institute of the Ministry of Interior, Sofia, Bulgaria

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http://orcid.org/0009-0009-3613-7184
Yoanna Velevska-Vatova

Department of Infectious Diseases, Parasitology and Dermatovenereology, Medical University, Varna, Bulgaria

Contact Email

http://orcid.org/0000-0002-6172-0808
Alexander Trenovski

Department of Anesthesiology and Intensive Care, Medical Institute of the Ministry of Interior, Sofia, Bulgaria

Contact Email

http://orcid.org/0009-0005-0402-301X
Sonya Marina

Diagnostic and Consultative Sector, Medical Institute of the Ministry of Interior, Sofia, Bulgaria

Contact Email

http://orcid.org/0000-0002-8830-517X

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APA Style

Broshtilova, V., Smilov, N., Yungareva, I., Velevska-Vatova, Y., Trenovski, A., et al. (2025). NERDS: A Syndrome with Two Faces. International Journal of Clinical Dermatology, 8(2), 44-50. https://doi.org/10.11648/j.ijcd.20250802.11

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ACS Style

Broshtilova, V.; Smilov, N.; Yungareva, I.; Velevska-Vatova, Y.; Trenovski, A., et al. NERDS: A Syndrome with Two Faces. Int. J. Clin. Dermatol. 2025, 8(2), 44-50. doi: 10.11648/j.ijcd.20250802.11

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AMA Style

Broshtilova V, Smilov N, Yungareva I, Velevska-Vatova Y, Trenovski A, et al. NERDS: A Syndrome with Two Faces. Int J Clin Dermatol. 2025;8(2):44-50. doi: 10.11648/j.ijcd.20250802.11

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@article{10.11648/j.ijcd.20250802.11,
  author = {Valentina Broshtilova and Nencho Smilov and Irina Yungareva and Yoanna Velevska-Vatova and Alexander Trenovski and Sonya Marina},
  title = {NERDS: A Syndrome with Two Faces
},
  journal = {International Journal of Clinical Dermatology},
  volume = {8},
  number = {2},
  pages = {44-50},
  doi = {10.11648/j.ijcd.20250802.11},
  url = {https://doi.org/10.11648/j.ijcd.20250802.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcd.20250802.11},
  abstract = {NERDS syndrome (Nodules, Eosinophilia, Rheumatism, Dermatitis, Swelling) is a rare eosinophilic inflammatory disorder, characterized by the presence of periarticular or subcutaneous nodules, persistent peripheral eosinophilia, arthralgias resembling rheumatoid arthritis, chronic dermatitis, and limb swelling. To provide a comprehensive overview of the clinical, laboratory, and histopathological features of NERDS syndrome, and to propose a structured diagnostic approach to differentiate it from other eosinophilic or rheumatologic conditions. We conducted a systematic review of published cases of NERDS syndrome, analyzing clinical manifestations, laboratory findings, histopathological features, and response to treatment. We propose a structured diagnostic approach to differentiate it from other eosinophilic or rheumatologic conditions. NERDS syndrome typically presents with firm nodules near joints, rheumatoid-like joint pain, dermatitis, and localized or generalized swelling. Laboratory tests show marked eosinophilia (>1500/μL), elevated inflammatory markers (CRP, ESR), and eosinophilic infiltration in affected tissues. The main differential diagnoses include DRESS syndrome, eosinophilic granulomatosis with polyangiitis, idiopathic hypereosinophilic syndrome, eosinophilic rheumatoid arthritis, and parasitic infections. NERDS syndrome is a distinct eosinophilic disease requiring careful clinical and laboratory evaluation to ensure accurate diagnosis. Systemic corticosteroids remain the first-line therapy and usually result in rapid improvement. In refractory or relapsing cases, immunosuppressive or biologic agents may be considered. The proposed diagnostic approach may facilitate early recognition and optimal management of this underdiagnosed condition.},
 year = {2025}
}

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TY  - JOUR
T1  - NERDS: A Syndrome with Two Faces

AU  - Valentina Broshtilova
AU  - Nencho Smilov
AU  - Irina Yungareva
AU  - Yoanna Velevska-Vatova
AU  - Alexander Trenovski
AU  - Sonya Marina
Y1  - 2025/08/08
PY  - 2025
N1  - https://doi.org/10.11648/j.ijcd.20250802.11
DO  - 10.11648/j.ijcd.20250802.11
T2  - International Journal of Clinical Dermatology
JF  - International Journal of Clinical Dermatology
JO  - International Journal of Clinical Dermatology
SP  - 44
EP  - 50
PB  - Science Publishing Group
SN  - 2995-1305
UR  - https://doi.org/10.11648/j.ijcd.20250802.11
AB  - NERDS syndrome (Nodules, Eosinophilia, Rheumatism, Dermatitis, Swelling) is a rare eosinophilic inflammatory disorder, characterized by the presence of periarticular or subcutaneous nodules, persistent peripheral eosinophilia, arthralgias resembling rheumatoid arthritis, chronic dermatitis, and limb swelling. To provide a comprehensive overview of the clinical, laboratory, and histopathological features of NERDS syndrome, and to propose a structured diagnostic approach to differentiate it from other eosinophilic or rheumatologic conditions. We conducted a systematic review of published cases of NERDS syndrome, analyzing clinical manifestations, laboratory findings, histopathological features, and response to treatment. We propose a structured diagnostic approach to differentiate it from other eosinophilic or rheumatologic conditions. NERDS syndrome typically presents with firm nodules near joints, rheumatoid-like joint pain, dermatitis, and localized or generalized swelling. Laboratory tests show marked eosinophilia (>1500/μL), elevated inflammatory markers (CRP, ESR), and eosinophilic infiltration in affected tissues. The main differential diagnoses include DRESS syndrome, eosinophilic granulomatosis with polyangiitis, idiopathic hypereosinophilic syndrome, eosinophilic rheumatoid arthritis, and parasitic infections. NERDS syndrome is a distinct eosinophilic disease requiring careful clinical and laboratory evaluation to ensure accurate diagnosis. Systemic corticosteroids remain the first-line therapy and usually result in rapid improvement. In refractory or relapsing cases, immunosuppressive or biologic agents may be considered. The proposed diagnostic approach may facilitate early recognition and optimal management of this underdiagnosed condition.
VL  - 8
IS  - 2
ER  -

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