Granuloma gluteale infantum with atrophic scars: clinical and histological observations in eleven cases

Abstract

Eleven infants, 4 to 5 months old, treated for napkin (diaper), seborrhoeic or atopic dermatitis with topical fluorinated steroids, developed granulomatous lesions in the napkin area. Seven patients were followed up for more than 6 months: in four of them the granulomatous lesions regressed leaving lax atrophic scars. It is suggested that fluorinated steroid creams and plastic pants are the precipitating causes.While the pathogenesis of granuloma infantum (Tappeiner & Pfleger, 1971) still remains to be fully elucidated, most authors {Bazex et al., 1972;Delacretaz et al., 1972;Uyeda et al.^ 1973) believe that the use of topical fluorinated steroids is a major precipitating factor.The occurrence of eight new cases in 1979 and the persistence of atrophic lax scars in the first cases which we were called upon to treat in 1975, prompted us to review the subject. Case reportsCase I. An infant boy, was referred to us in 1975 at the age of 4 months, with an erythematous dermatitis in the napkin area and with reddish blue, cord-like nodular perianal lesions, which had been treated for long periods with fluorinated steroids. Mycological investigations showed the presence of Candida albicans. Following treatment with wet compresses, the lesions disappeared in 2 months. Case 2. An infant boy, was referred to us at the age of 5 months in 1975. From the second month of life he had severe seborrhoeic dermatitis involving the inguinal regions and was 0307-6938,81 0100-0023 S02.00 0 1981 Blackwell Scientific Publications 23 E.Bonifazi et al.

Erosive papulonodular dermatosis associated with topical benzocaine: A report of two cases and evidence that granuloma gluteale, pseudoverrucous papules, and Jacquet's erosive dermatitis are a disease spectrum

“…Granuloma gluteale infantum is a benign condition of granulomatous-appearing nodules in the diaper region classically seen in infants between 2 and 9 months of age. [3][4][5][6][20][21][22] Generally the lesions are preceded by a dermatitis in the diaper area, but there does not appear to be a correlation between the severity of the pre-existing dermatitis and the development of lesions. 4 Similar lesions have also been described in the diaper regions of adults who are incontinent.…”

“…Other potential causative and/or exacerbating factors include Candida, fluorinated topical steroid use, starchcontaining powders, and plastic pants. [3][4][5]7,[22][23][24] In 1992, Goldberg et al 1 described a series of 5 children with an eruption in the perianal and suprapubic areas comprised of more than a dozen 2-to 8-mm shiny, smooth, red, moist, flat-topped, round lesions. All patients had either encopresis or urinary incontinence.…”

“…Occlusion, powder, topical halogenated steroids, Candida infection, urine, and feces are all postulated to contribute to the eruption. [3][4][5][6][7] Classically, the lesions appear as oval, red-purple, granulomatous nodules in areas of occlusion. Similar lesions may also be seen in adults.…”

Skin Nodules Over the Diaper Area

“…Plastic pants have been considered important in the pathogenesis of the disease since the granulomas are restricted to the area under the pants and may develop at sites of maximal contact. 2 Kelly and Campbell' have reported a case of GGI in which the typical Maltese cross ap¬ pearance of the starch granules was present when histopathologic sections were viewed through crossed Nicol prisms. Starch granules are well known to pro¬ duce granulomas in the peritoneum and surgical wounds; however, their histologie appearance is at variance with the findings reported by Kelly and Campbell in GGI.…”

“…However, the rarity of the disease despite the widespread use of these measures suggests that these may act only as precipitating factors in predisposed individuals. 2 The histopathologic picture in GGI is not diagnos¬ tic. The epidermis may show eczematous changes.…”