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

Erosive Papulonodular Dermatosis of the Lower Extremities: A Reactive Change in the Setting of Chronic Lymphedema

“…Erosive papulodnodular dermatosis (EPD) is classified as an inflammatory cutaneous eruption secondary to a chronic, external irritant [1,2]. Treatment for EPD focuses on eliminating the presumed irritant [2] and preventing secondary bacterial infection [1,3].…”

“…Elephantiasis nostra verrucosa is a more frequent complication of longstanding lymphedema and also demonstrates pseudoepitheliomatous hyperplasia on biopsy [5,6]. Our case is differentiated from ENV clinically by the presence of moist, red papules and nodules with erosions, and histopathologically by the absence of dermal and subcutaneous woody fibrosis, as well as by the maintenance of the dermal papillae, eccrine glands and elastic fibers [5,6].Treatment for EPD centers on eliminating the irritant (commonly urine, feces, or chronic moisture) [2], preventing secondary bacterial infection, and removing precipitating factors in an attempt to [1,3]. We present a case of EPD, secondary to inflammation from lymphatic stasis, refractory to medical and antimicrobial treatment.…”

“…Evaluation of a punch biopsy revealed parakeratotic, spongiotic epidermal, verruci form hyperplasia with prominent dermal edema, fibroplasia, and a superficial, mixed, perivascular infiltrate ( Figure 2) maintenance of the dermal papillae, eccrine glands and elastic fibers. The histopathologic picture supported the clinical diagnosis of erosive papulonodular dermatosis (EPD); however, arising in the setting of chronic lymphedema, elephantiasis nostra verrucosa (ENV) was also considered.EPD is considered an inflammatory cutaneous eruption secondary to a chronic, external irritant and includes the previously distinct entities of perianal pseudoverrucous papules and nodules, granuloma gluteale infantum, and Jacquet erosive dermatitis [1,2]. Papulonodules are classically found in the diaper area and at urostomy and colostomy sites following repeated leakage, encopresis or urinary incontinence [1].…”

“…EPD is considered an inflammatory cutaneous eruption secondary to a chronic, external irritant and includes the previously distinct entities of perianal pseudoverrucous papules and nodules, granuloma gluteale infantum, and Jacquet erosive dermatitis [1,2]. Papulonodules are classically found in the diaper area and at urostomy and colostomy sites following repeated leakage, encopresis or urinary incontinence [1].…”

“…Papulonodules are classically found in the diaper area and at urostomy and colostomy sites following repeated leakage, encopresis or urinary incontinence [1]. However, striking cases have been reported in less common locations secondary to post-operative inflammation combined with an occlusive wound dressing [2], and following continuous wear of medical examination gloves due to an underlying delusion [4].…”