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Granuloma gluteale adultorum
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Granuloma gluteale adultorum

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Contributors: Matilda Nicholas MD, PhD, Susan Burgin MD
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Synopsis

Although granuloma gluteale infantum is a more widely recognized entity, a less common but equally severe form can present in adults. Most commonly known as granuloma gluteale adultorum, this is a misnomer as granulomas are not typically seen on histopathologic examination, and the eruption is not only seen in the gluteal region but can also be present in the vulva or other regions of the body. A more accurate term is the descriptive one: erosive papulonodular dermatosis.

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.

Codes

ICD10CM:
T49.95XA – Adverse effect of unspecified topical agent, initial encounter

SNOMEDCT:
403675008 – Drug-induced dermatosis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Reviewed: 04/23/2019
Last Updated: 05/07/2019
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Granuloma gluteale adultorum
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Granuloma gluteale adultorum : benzocaine, Painful skin lesions, Pruritus, Skin erosions
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