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

Abstract

Granuloma gluteale infantum is a rare nodular complication of irritant diaper dermatitis. The association of this condition with the widespread use of nondisposable cloth diapers has been increasingly recognized. We present the case of an 18-month-old girl with granuloma gluteale infantum. Our aims are to emphasize the importance of clinical recognition of this re-emerging complication of diaper dermatitis and to point out the potential role of topical calcineurin inhibitors as a treatment option.

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

“…Infection with Candida albicans has also been implicated [1,13]. However, there is no difference in the isolation rate of Candida albicans from patients with granuloma gluteale infantum and from patients with other forms of dermatitis in the diaper area alone [7,12,14]. e average onset is between 9 and 12 months of age [3].…”

“…Clinically, granuloma gluteale infantum presents with asymptomatic, well-demarcated, firm, round-to-oval, red to purple, papules or nodules [1,11,14,15]. e size of lesions can range from 0.5 to 3 cm in diameter [11,[14][15][16]. e surface of the lesion can be smooth, lichenified, eroded, or ulcerated depending on the stage of lesions [1].…”

“…In addition, there is a dense perivascular dermal infiltrate with lymphocytes, neutrophils, histiocytes, plasma cells, and eosinophils [11,14]. e histologic findings are neither specific nor diagnostic but sufficiently characteristic to exclude a number of other conditions in the differential diagnoses [14,17]. e differential diagnosis is broad and includes Jacquet erosive diaper dermatitis, pseudoverrucous papules and nodules, Candidal diaper dermatitis, seborrheic dermatitis, atopic dermatitis, perianal streptococcal dermatitis, plaque psoriasis, bullous impetigo, juvenile xanthogranuloma, molluscum contagiosum, acrodermatitis enteropathica, nodular scabies, Langerhans cell histiocytosis, and maculopapular cutaneous mastocytosis [3,[18][19][20][21][22].…”

“…There is no gender predilection [ 3 ]. Clinically, granuloma gluteale infantum presents with asymptomatic, well-demarcated, firm, round-to-oval, red to purple, papules or nodules [ 1 , 11 , 14 , 15 ]. The size of lesions can range from 0.5 to 3 cm in diameter [ 11 , 14 – 16 ].…”

Art of prevention: The importance of proper diapering practices

“…Medical evaluation is sought for more persistent or robust cases (Shin, 2014, Stamatas and Tierney, 2014). More severe presentations include vesiculobullous (Harfmann et al, 2014), granuloma gluteal infantum (a rare but re-emerging condition with the use of nondisposable diapers; Ramos Pinheiro et al, 2018), Jacquet’s erosive DD (Klunk et al, 2014), and DD complicated by secondary infection (most often Candida albicans or Staphylococcus aureus ; Stamatas and Tierney, 2014).…”