Granuloma Gluteale Infantum Clinical Presentation
- Author: Marlene T Dytoc, MD, PhD, FRCPC; Chief Editor: Dirk M Elston, MD more...
Most infants with granuloma gluteale infantum have a history of a preceding inflammatory skin condition in an area of seborrheic or candidal dermatitis or contact with a known irritant.[4, 5] These conditions have been treated with a variety of topical agents, including fluorinated corticosteroids.[6, 7]
Lesions associated with granuloma gluteale infantum are characterized by the following :
One to 30 lesions in affected area
Red-purple to red-brown in color
Nodules that are 5-40 mm in diameter
Oval, firm-to-hard, discrete dermal nodules with smooth or slightly lichenified surfaces
Aligned with the long axis parallel to the skin folds
Located on the gluteal surfaces, in the groin area, and on the upper thighs, lower abdomen, or, rarely, the neck and the face
No involvement of the inguinal folds and the gluteal cleft (presumably because diaper contact is absent)
The etiology of granuloma gluteale infantum is unclear. The disorder is believed to represent a unique cutaneous response to local inflammation, maceration, and secondary infection.
Diapering-related items (eg, diapers, plastic pants, paper napkins, laundry detergents, starch, powder), halogenated corticosteroids, candidal infection, and urine and feces are possible etiologies.[9, 10]
Sparing of deep body folds suggests that contact occlusion is predisposing.
Candida hyphae are detected in skin biopsy specimens obtained from some, but not all, patients. Intradermal testing to Candida albicans antigen does not elicit immediate or delayed hypersensitivity. Serum precipitates to C albicans and Candida parapsilosis are not found.
Most patients, including infants with facial and neck lesions, have previously been treated with a topical fluorinated steroid. This observation suggests a causative role for topical fluorinated steroids in this skin disorder. Absorption of corticosteroid preparations through inflamed skin of the diaper area leads to altered dermal collagen, which, in turn, stimulates an inflammatory response.
Urine can increase the pH of the diaper-covered area, promoting the action of fecal proteases and lipases. Together, urine and feces can irritate diapered skin, increasing its permeability and susceptibility to other irritants. Van et al reported a case related to adult urinary incontinence.[11, 12]
Tappeiner J, Pfleger L. [Granuloma gluteale infantum]. Hautarzt. 1971 Sep. 22(9):383-8. [Medline].
Fujita M, Ohno S, Danno K, Miyachi Y. Two cases of diaper area granuloma of the adult. J Dermatol. 1991 Nov. 18(11):671-5. [Medline].
Maekawa Y, Sakazaki Y, Hayashibara T. Diaper area granuloma of the aged. Arch Dermatol. 1978 Mar. 114(3):382-3. [Medline].
De Zeeuw R, Van Praag MC, Oranje AP. Granuloma gluteale infantum: a case report. Pediatr Dermatol. 2000 Mar-Apr. 17(2):141-3. [Medline].
Al-Faraidy NA, Al-Natour SH. A forgotten complication of diaper dermatitis: Granuloma gluteale infantum. J Family Community Med. 2010 May. 17(2):107-9. [Medline].
Dytoc MT, Fiorillo L, Liao J, Krol AL. Granuloma gluteale adultorum associated with use of topical benzocaine preparations: case report and literature review. J Cutan Med Surg. 2002 May-Jun. 6(3):221-5. [Medline].
Robson KJ, Maughan JA, Purcell SD, Petersen MJ, Haefner HK, Lowe L. 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. J Am Acad Dermatol. 2006 Nov. 55(5 Suppl):S74-80. [Medline].
Sweidan NA, Salman SM, Kibbi AG, Zaynoun ST. Skin nodules over the diaper area. Granuloma gluteale infantum. Arch Dermatol. 1989 Dec. 125(12):1703-4, 1706-7. [Medline].
Konya J, Gow E. Granuloma gluteale infantum. Australas J Dermatol. 1996 Feb. 37(1):57-8. [Medline].
Maruani A, Lorette G, Barbarot S, Potier A, Bessis D, Hasselmann C, et al. Re-emergence of papulonodular napkin dermatitis with use of reusable diapers: report of 5 cases. Eur J Dermatol. 2013 Apr 1. 23 (2):246-9. [Medline].
Van L, Harting M, Rosen T. Jacquet erosive diaper dermatitis: a complication of adult urinary incontinence. Cutis. 2008 Jul. 82(1):72-4. [Medline].
Isogai R, Yamada H. Factors involved in the development of diaper-area granuloma of the aged. J Dermatol. 2013 Dec. 40 (12):1038-41. [Medline].
Bluestein J, Furner BB, Phillips D. Granuloma gluteale infantum: case report and review of the literature. Pediatr Dermatol. 1990 Sep. 7(3):196-8. [Medline].
Maekawa Y, Kiyoi K, Kunitake Y. Hemilateral distribution of papular lesions on the buttock histologically resembling granuloma gluteale infantum. J Dermatol. 2001 Apr. 28(4):231-3. [Medline].
Kikuchi I, Jono M. Letter: Flurandrenolide-impregnated tape for granuloma gluteale infantum. Arch Dermatol. 1976 Apr. 112(4):564. [Medline].