Purpose of review <p>This review aims to describe the clinical and histopathologic features that distinguish necrotizing neutrophilic dermatoses from necrotizing fasciitis and guide appropriate management for the inpatient dermatologist.</p> Recent findings <p>Necrotizing neutrophilic dermatoses can be differentiated from necrotizing fasciitis based on certain clinical criteria including: 1) lack of improvement despite antibiotic therapy and surgical debridement, 2) worsening cutaneous involvement after surgical debridement, and 3) improvement with systemic corticosteroids.</p> Summary <p>Necrotizing neutrophilic dermatoses are a recently reclassified subset of neutrophilic dermatoses that involve rapidly progressive violaceous edematous papules or plaques, purpura, and skin necrosis in the setting of systemic inflammation. These include necrotizing pyoderma gangrenosum and necrotizing Sweet syndrome. The distinction between these and infectious entities can be difficult, often causing diagnostic delay and morbidity. Prompt recognition is critical to avoid unnecessary surgical intervention and to ensure timely initiation of immunosuppressive therapy in the inpatient setting.</p>