eMedicine Specialties > Dermatology > Pediatric Diseases

Granuloma Gluteale Infantum: Treatment & Medication

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

Treatment

Medical Care

  • Treatment is generally not required because lesions spontaneously resolve.11
  • Treatment of any initiating inflammatory process, with its associated maceration and secondary infection, is beneficial.

Medication

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Some of the treatments used include barrier products, intralesional corticosteroids, and flurandrenolide-impregnated tape.12

Protectants

These agents are the treatment of choice. Protective or preventive measures include barrier products to seal the skin from exogenous factors, such as urine, feces, and other external irritants, which may predispose an individual to granuloma gluteale.


Zinc oxide (Zincofax, Ihle's Paste)

Skin protectant generally used to prevent and treat diaper rash. Use 15% ointment or 25% paste.

Adult

Apply to affected area prn until redness disappears

Pediatric

Infants: Apply on diaper area at every diaper changing or prn until redness disappears
Children: Apply as in adults

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

For external use only; do not apply to eyes; mineral oil may facilitate removal

Corticosteroids

Intralesional administration is indicated to treat localized hypertrophic, infiltrated inflammatory lesions. Granuloma gluteale infantum, granuloma gluteale adultorum, and diaper area granuloma of the aged fit into this category of lesions. Flurandrenolide-impregnated tape, which combines a barrier with an anti-inflammatory action, has been reported to be beneficial.


Triamcinolone (Kenalog-10)

For inflammatory dermatosis responsive to steroids; decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Intramuscular injection may be used for widespread skin disorder or intralesional injections may be used for localized skin disorder.
Each mL of sterile, aqueous susp contains triamcinolone acetonide 10 mg. Nonmedicinal ingredients include benzyl alcohol, carboxymethylcellulose sodium, hydrochloric acid, polysorbate, sodium chloride, sodium hydroxide, and water. Suspended in sterile sodium chloride solution at a final concentration of 2.5-5 mg/mL.

Adult

0.1-0.2 mL ID into each lesion; multiple sites separated by 1 cm or more may be injected; may repeat qwk prn

Pediatric

Administer as in adults

Coadministration with estrogens may decrease clearance; when used with digoxin, digitalis toxicity secondary to hypokalemia may increase; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics

Documented hypersensitivity; fungal, viral, and bacterial skin infections

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Multiple complications (eg, severe infections, hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression) may occur; abrupt discontinuation of glucocorticoids may cause adrenal crisis


Flurandrenolide (Cordran tape)

Topical anti-inflammatory agent supplied as a 4 mcg/cm2 topical adhesive tape. Despite possible causative role of topical corticosteroids in some cases of granuloma gluteale infantum, various hypertrophic lesions have been effectively thinned in 3 d with the use of this treatment.

Adult

Apply to affected area after gently cleansing and drying the skin; replace after 12 h prn; allow skin to be open to air for 1 h before applying new tape

Pediatric

Apply as in adults

Coadministration with estrogens may decrease clearance; when used with digoxin, digitalis toxicity secondary to hypokalemia may increase; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics

Documented hypersensitivity; draining lesions or flexures

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Prolonged use may cause cutaneous atrophy; can suppress growth in children and reduce host defense against surface organisms

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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