You are in: eMedicine Specialties > Dermatology > PEDIATRIC DISEASES Granuloma Gluteale InfantumArticle Last Updated: Jan 12, 2007AUTHOR AND EDITOR INFORMATIONSection 1 of 11
  Author: Marlene T Dytoc, MD, PhD, FRCPC, Staff Physician, Division of Dermatology and Cutaneous Sciences, University of Alberta, Canada Marlene T Dytoc is a member of the following medical societies: Alberta Medical Association, American Academy of Dermatology, American Society of Clinical Pathologists, College of Physicians and Surgeons of Alberta, and Pacific Dermatologic Association 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 Editors: 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; Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center; Van Perry, MD, Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas Health Science Center; Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University; 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 Author and Editor Disclosure Synonyms and related keywords: GGI, Kaposi sarcoma-like granuloma, Kaposi sarcoma–like granuloma, granuloma intertriginosum infantum, infantile vegetating halogenosis, vegetating potassium bromide toxic dermatitis, vegetating bromidism INTRODUCTIONSection 2 of 11
  BackgroundGranuloma 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. 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 GGI. 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. In contrast to GGI, 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. Advances in absorbent diaper technology using synthetic materials have significantly reduced diaper-associated inflammatory skin conditions in recent decades. PathophysiologyNo systemic association is known. FrequencyInternationalGGI is rare; only approximately 30 cases have been reported worldwide. Mortality/MorbidityDiscomfort, secondary infections, and scars may occur in the area of the lesions. SexMales have a higher incidence of GGI than females. AgeThe condition develops in the diaper area of infants aged 4-9 months. CLINICALSection 3 of 11
HistoryMost infants with GGI have a history of a preceding inflammatory skin condition in an area of seborrheic or candidal dermatitis or contact with a known irritant. These conditions have been treated with a variety of topical agents, including fluorinated corticosteroids. PhysicalLesions associated with GGI are characterized by the following:
CausesThe etiology of GGI is unclear.
DIFFERENTIALSSection 4 of 11
Candidiasis, Cutaneous Contact Dermatitis, Irritant Cutaneous T-Cell Lymphoma Cutaneous Tuberculosis Juvenile Xanthogranuloma (Nevoxanthoendothelioma) Kaposi Sarcoma Langerhans Cell Histiocytosis Mastocytosis Pyogenic Granuloma (Lobular Capillary Hemangioma) Scabies Syphilis
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| Drug Name | Zinc oxide (Zincofax, Ihle's Paste) |
|---|---|
| Description | Skin protectant generally used to prevent and treat diaper rash. Use 15% ointment or 25% paste. |
| Adult Dose | Apply to affected area prn until redness disappears |
| Pediatric Dose | Infants: Apply on diaper area at every diaper changing or prn until redness disappears Children: Apply as in adults |
| Contraindications | Documented hypersensitivity |
| Interactions | None reported |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | For external use only; do not apply to eyes; mineral oil may facilitate removal |
Intralesional administration is indicated to treat localized hypertrophic, infiltrated inflammatory lesions. GGI, 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.
| Drug Name | Triamcinolone (Kenalog-10) |
|---|---|
| Description | 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 Dose | 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 Dose | Administer as in adults |
| Contraindications | Documented hypersensitivity; fungal, viral, and bacterial skin infections |
| Interactions | 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 |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| 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 |
| Drug Name | Flurandrenolide (Cordran tape) |
|---|---|
| Description | Topical anti-inflammatory agent supplied as a 4 mcg/cm2 topical adhesive tape. Despite possible causative role of topical corticosteroids in some cases of GGI, various hypertrophic lesions have been effectively thinned in 3 d with the use of this treatment. |
| Adult Dose | 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 Dose | Apply as in adults |
| Contraindications | Documented hypersensitivity; draining lesions or flexures |
| Interactions | 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 |
| Pregnancy | C - Safety for use during pregnancy has not been established. |
| Precautions | Prolonged use may cause cutaneous atrophy; can suppress growth in children and reduce host defense against surface organisms |
| Media file 1: Photograph of a case of granuloma gluteale infantum. | |
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| Media file 2: Photograph of a case of granuloma gluteale adultorum. | |
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| Media file 3: Photomicrograph showing the histologic features of a case of granuloma gluteale adultorum. Granuloma gluteale infantum shares identical histologic features (original magnification X100). | |
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| Media file 4: Photomicrograph showing the histologic features of a case of granuloma gluteale adultorum. Granuloma gluteale infantum shares identical histologic features (original magnification X450). | |
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Granuloma Gluteale Infantum excerpt
Article Last Updated: Jan 12, 2007
