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Author: Dr Olivia Charlton, Resident Medical Officer, St George Hospital, Kogarah, Sydney, NSW, Australia. DermNet NZ Editor in Chief: Adjunct A/Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Maria McGivern/Gus Mitchell. July 2018.
Granuloma gluteale infantum is a rare form of napkin dermatitis in which there are reddish-purple nodules in the napkin (diaper) area of infants. It was first described in 1891 as 'vegetating bromidism' owing to its occurrence following the use of topical bromide-containing ointments [1,2].
The term 'granuloma' is a misnomer, as the histological examination of granuloma gluteale infantum does not reveal any granulomas .
Granuloma gluteale infantum
Granuloma gluteale infantum usually occurs in infants aged 1–9 months. It is more common in infant boys than in girls .
A similar disorder, named granuloma gluteale adultorum, is rarely observed in bed-ridden adults with incontinence (incontinence-associated dermatitis).
Granuloma gluteale infantum is a complication of irritant contact dermatitis (napkin dermatitis). The exact cause is unknown . No correlation has been found between the severity of napkin dermatitis and the incidence of granuloma gluteale infantum .
Possible causative factors include:
Granuloma gluteale infantum is characterised by asymptomatic firm erythematous or violaceous nodules. The nodules are located in inguinal folds, on the convexities of the buttocks, and less commonly, in the scrotal area and medial thighs.
The nodules are often ovoid in shape and are typically 0.5–4 cm in size, with the long axis lying parallel to skin-fold lines.
Granuloma gluteale infantum may result in post-inflammatory hyperpigmentation and atrophic scarring.
Granuloma gluteale infantum is suspected from the infant patient’s clinical history and the findings on examination of the infant's napkin region.
The diagnosis can be confirmed by biopsy and histological evaluation. A dense dermal inflammatory perivascular infiltrate of lymphocytes, neutrophils, eosinophils and plasma cells is seen, with overlying parakeratosis and hyperplasia of the epidermis .
Other forms of napkin dermatitis can be differentiated from granuloma gluteale infantum by the clinical features.
Less common conditions that may require consideration include:
The napkin region of the affected infant should be cleaned, kept dry, and moisturised. Candida albicans should be treated with a topical antifungal agent. The nodules spontaneously regress within 1–2 months without any active treatment, often leaving an atrophic scar.
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