eMedicine Specialties > Dermatology > Pediatric Diseases

Granuloma Gluteale Infantum

Author: Marlene T Dytoc, MD, PhD, FRCPC, Associate Clinical Professor, Division of Dermatology and Cutaneous Sciences, University of Alberta, Canada
Coauthor(s): Melody Cheung-Lee, MD, Staff Physician, Department of Dermatology, University of Alberta; Alfons Krol, MD, FRCPC, Associate Professor, Department of Medicine, Division of Dermatology and Cutaneous Sciences, University of Alberta at Edmonton
Contributor Information and Disclosures

Updated: Mar 27, 2009

Introduction

Background

Granuloma gluteale infantum (GGI), previously known as vegetating potassium bromide toxic dermatitis or vegetating bromidism, is a rare skin disorder of controversial etiology characterized by oval, reddish purple granulomatous nodules on the gluteal surfaces and the groin areas of infants. Lesions can also be found in intertriginous areas (eg, neck, axilla). The long axis of most lesions runs parallel to the skin lines of cleavage or maximum skin tension.

Photograph of a case of granuloma gluteale infant...

Photograph of a case of granuloma gluteale infantum.

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Photograph of a case of granuloma gluteale infant...

Photograph of a case of granuloma gluteale infantum.


A similar eruption may have been described in 1891, and, in 1962, as vegetating bromidism due to the application of bromide ointment. In 1971, Tappeiner and Pfleger, from Germany, first reported 6 cases of granuloma gluteale infantum.1 In subsequent years, similar episodes were reported in other parts of Europe, Japan, and the United States.

Similar granulomas have been noted in adults confined to bed. These conditions are referred to as granuloma gluteale adultorum and diaper area granuloma of the aged.2,3 In contrast to granuloma gluteale infantum, the adult versions are observed only in genitocrural regions and not in intertriginous areas; nodules in the adult versions are often eroded, and they do not show an arrangement parallel to the skin lines.

Photograph of a case of granuloma gluteale adulto...

Photograph of a case of granuloma gluteale adultorum.

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Photograph of a case of granuloma gluteale adulto...

Photograph of a case of granuloma gluteale adultorum.


Advances in absorbent diaper technology using synthetic materials have significantly reduced diaper-associated inflammatory skin conditions in recent decades. Also see Pediatrics, Diaper Rash and Diaper Dermatitis.

Pathophysiology

No systemic association is known.

Frequency

International

Granuloma gluteale infantum is rare; only approximately 30 cases have been reported worldwide.

Mortality/Morbidity

Discomfort, secondary infections, and scars may occur in the area of the lesions.

Sex

Males have a higher incidence of granuloma gluteale infantum than females.

Age

The condition develops in the diaper area of infants aged 4-9 months.

Clinical

History

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 These conditions have been treated with a variety of topical agents, including fluorinated corticosteroids.5,6

Physical

Lesions associated with granuloma gluteale infantum are characterized by the following7 :

  • 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)

Causes

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.8
  • 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.9

More on Granuloma Gluteale Infantum

Overview: Granuloma Gluteale Infantum
Differential Diagnoses & Workup: Granuloma Gluteale Infantum
Treatment & Medication: Granuloma Gluteale Infantum
Follow-up: Granuloma Gluteale Infantum
Multimedia: Granuloma Gluteale Infantum
References
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References

  1. Tappeiner J, Pfleger L. [Granuloma gluteale infantum]. Hautarzt. Sep 1971;22(9):383-8. [Medline].

  2. Fujita M, Ohno S, Danno K, Miyachi Y. Two cases of diaper area granuloma of the adult. J Dermatol. Nov 1991;18(11):671-5. [Medline].

  3. Maekawa Y, Sakazaki Y, Hayashibara T. Diaper area granuloma of the aged. Arch Dermatol. Mar 1978;114(3):382-3. [Medline].

  4. De Zeeuw R, Van Praag MC, Oranje AP. Granuloma gluteale infantum: a case report. Pediatr Dermatol. Mar-Apr 2000;17(2):141-3. [Medline].

  5. 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. May-Jun 2002;6(3):221-5. [Medline].

  6. 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. Nov 2006;55(5 Suppl):S74-80. [Medline].

  7. Sweidan NA, Salman SM, Kibbi AG, Zaynoun ST. Skin nodules over the diaper area. Granuloma gluteale infantum. Arch Dermatol. Dec 1989;125(12):1703-4, 1706-7. [Medline].

  8. Konya J, Gow E. Granuloma gluteale infantum. Australas J Dermatol. Feb 1996;37(1):57-8. [Medline].

  9. Van L, Harting M, Rosen T. Jacquet erosive diaper dermatitis: a complication of adult urinary incontinence. Cutis. Jul 2008;82(1):72-4. [Medline].

  10. Bluestein J, Furner BB, Phillips D. Granuloma gluteale infantum: case report and review of the literature. Pediatr Dermatol. Sep 1990;7(3):196-8. [Medline].

  11. Maekawa Y, Kiyoi K, Kunitake Y. Hemilateral distribution of papular lesions on the buttock histologically resembling granuloma gluteale infantum. J Dermatol. Apr 2001;28(4):231-3. [Medline].

  12. Kikuchi I, Jono M. Letter: Flurandrenolide-impregnated tape for granuloma gluteale infantum. Arch Dermatol. Apr 1976;112(4):564. [Medline].

  13. Bonifazi E, Garofalo L, Lospalluti M, Scardigno A, Coviello C, Meneghini CL. Granuloma gluteale infantum with atrophic scars: clinical and histological observations in eleven cases. Clin Exp Dermatol. Jan 1981;6(1):23-9. [Medline].

  14. Pierini AM. Granuloma gluteale infantum. Cutis. May 1983;31(5):489, 493. [Medline].

  15. Simmons IJ. Granuloma gluteale infantum. Australas J Dermatol. Apr 1977;18(1):20-4. [Medline].

  16. Thomsen K. Seborrhoeic dermatitis and napkin dermatitis. Acta Derm Venereol Suppl (Stockh). 1981;95:40-2. [Medline].

  17. Walsh SS, Robson WJ. Granuloma gluteale infantum: an unusual complication of napkin dermatitis. Arch Emerg Med. Jun 1988;5(2):113-5. [Medline].

  18. Wilkinson S, Goldman L. Granuloma gluteale infantum. Cutis. Dec 1981;28(6):644, 648. [Medline].

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Further Reading

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Keywords

granuloma gluteale infantum, GGI, Kaposi sarcoma-like granuloma, Kaposi sarcoma–like granuloma, granuloma intertriginosum infantum, infantile vegetating halogenosis, vegetating potassium bromide toxic dermatitis, vegetating bromidism

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Contributor Information and Disclosures

Author

Marlene T Dytoc, MD, PhD, FRCPC, Associate Clinical Professor, Division of Dermatology and Cutaneous Sciences, University of Alberta, Canada
Marlene T Dytoc, MD, PhD, FRCPC is a member of the following medical societies: Alberta Medical Association, American Academy of Dermatology, and College of Physicians and Surgeons of Alberta
Disclosure: Nothing to disclose.

Coauthor(s)

Melody Cheung-Lee, MD, Staff Physician, Department of Dermatology, University of Alberta
Melody Cheung-Lee, MD is a member of the following medical societies: Alberta Medical Association, American Academy of Dermatology, Canadian Dermatology Association, and Canadian Medical Association
Disclosure: Nothing to disclose.

Alfons Krol, MD, FRCPC, Associate Professor, Department of Medicine, Division of Dermatology and Cutaneous Sciences, University of Alberta at Edmonton
Disclosure: Nothing to disclose.

Medical Editor

Evan R Farmer, MD, Professor of Dermatology, Johns Hopkins University School of Medicine, Clinical Professor of Pathology, Virginia Commonwealth University School of Medicine; Consulting Staff, Department of Dermatology, Johns Hopkins Hospital, VCU Health Services
Evan R Farmer, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society of Dermatopathology, and International Society of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Van Perry, MD, Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas Health Science Center
Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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