Factors involved in the development of diaper‐area granuloma of the aged

Abstract

An infant skin disease with clusters of nodules in the diaper contact area was reported as granuloma gluteale infantum. Recently, the number of elderly patients with this condition has increased, and it has been reported as diaper-area granuloma of the aged. These lesions are presumably caused by irritation from feces and urine. We observed similar cutaneous symptoms in six elderly patients, five of whom revealed clusters of nodules arranged in a circular pattern in the gluteal region presenting a peculiar clinical picture. They were all bedridden and wore cloth diapers. We speculate that wearing a cloth diaper seems to be a major factor behind this condition. Another factor was sitting during the day. A subject had lesions with nodules on the scrotum. The distribution of nodules appeared to be related to the body position and vigorous movement of the patient. In all cases, topical steroid therapies were not effective. They were all positive for bacteriuria. Chronic urinary tract infection further irritates the skin. It is necessary to reduce urine contact and keep the lesion clean.

Infiltrated plaques on the lateral aspects of the hips disclosing a case of adult gluteal granuloma

“…The pH of normal skin is approximately 5.5; while that of urine is around 6 or higher, when there is bacteriuria or infection by urease-producing bacteria, an environment that increases the activity of lipases and proteases, impairs the skin barrier and predisposes to the action of local irritants. Our patient had a urinary pH of 8.5 and bacteriuria, corroborating the findings reported by Isogai et al 3 …”

Successful Treatment of Recalcitrant Granuloma Gluteale Infantum with Topical Tacrolimus 0.03% Ointment

“…Granuloma gluteale infantum is a rare complication of irritant contact dermatitis [1,2]. Predisposing factors include chronic irritation with urine and feces, high-pH environment (due to breakdown of urea in the urine by fecal urease), and use of nondisposable cloth diapers, plastic pants, baby wipes, laundry detergents, starch or talc powder application, topical fluorinated corticosteroids, topical benzocaine, and bromide-containing ointments [1,2,5,[7][8][9][10][11][12]. Infection with Candida albicans has also been implicated [1,13].…”

Granuloma Glutaeale Infantum: A Re-emerging Complication of Diaper Dermatitis

“…GGI typically occurs in infancy (especially between 4 and 9 months of age). 3 Irrespectively of age group, GGI is particularly common in the setting of chronic diarrhea or fecal or urinary incontinence 4 associated with conditions such as short gut syndrome, inflammatory bowel disease, Hirschsprung disease, or spina bifida. Additionally, GGI occurring in peristomal locations in both children and adults with urostomies or colostomies should be recognized as having a particularly refractory presentation.…”

“…Additionally, GGI occurring in peristomal locations in both children and adults with urostomies or colostomies should be recognized as having a particularly refractory presentation. 4 The etiology of GGI is not fully understood, but a few contributing factors have been proposed. GGI occurs in the setting of severe irritant contact DD 5,6 related to prolonged occlusion from diapers, resulting in increased exposure to feces and urine.…”