Granuloma gluteale adultorum
While in children this entity is thought to be an exuberant irritant dermatitis or reaction to Candida overgrowth, in adults a significant subset, or possibly a majority, of cases present as a reaction to local benzocaine use, with most cases reported in women. Benzocaine is readily available over the counter at concentrations of up to 20% in products such as Lanacane. Discontinuation of this topical medication can result in complete and permanent remission of this extremely painful condition. However, discontinuation can be physically and emotionally challenging for affected patients since painful and severe flares may occur, and cases requiring admission to an inpatient ward have been documented. Prednisone, tapered slowly as with a contact dermatitis, and pain control can hasten the process and make it significantly more tolerable.
If no benzocaine exposure can be identified, the cause is typically chronic moist occlusion, with or without significant irritant dermatitis or Candida overgrowth. While granuloma gluteale adultorum is most commonly seen on the buttocks in the setting of chronic incontinence, a case presenting on the back after occlusive dressing has been reported.
Symptoms include severe pain at rest and with pressure, sometimes to debilitating levels. Pruritus can be present as well. Erosions and sores are often reported, and many patients are extensively worked up for sexually transmitted diseases (STDs). Biopsy is nonspecific and often leads to significantly delayed diagnosis. However, with its distinct and classic clinical appearance, this entity can be recognized and very effectively treated.
T49.95XA – Adverse effect of unspecified topical agent, initial encounter
403675008 – Drug-induced dermatosis
Differential Diagnosis & Pitfalls
Drug Reaction Data