Nine month old infant girl with Genital Nodule

presented by

David Elpern MD

Williamstown, MA, USA

on January 5, 2005

Dermatologist, The Skin Clinic, Williamstown, MA, USA

Abstract The patient is a female infant with a solitary labial lesion which has waxed and waned over the past few months. The clinical presentation is unusual. It is hoped that VGRD participants can help shed some light on this.
Nine month old infant girl
5 months
Right labia majorum

At birth the patient had a culture proven staph aureus infection at or around both labia. This was treated with oral antibiotics and Bactroban cream.
Subsequently, she has developed localized episodic swelling on the right labia on a number of occasions. Both times, she was treated with Bactroban ointment and the areas appeared to have resolved after a few days.

Physical Examination

The examination shows a calm, well-cared for infant. On the right labia, she has a 1 cm in diameter soft erythematous nodule with well-defined borders. There are no pustules or crusts at the time of the exam. The lesion when palpated between two fingers does not appear to be a solid tumour


Laboratory Data




Diagnosis ? Granuloma Gluteale Infantum
Reasons Presented

What are your thoughts regarding the diagnosis?


Would you recommend any diagnostic studies?
How would you treat this baby?


De Zeeuw R, Van Praag MC, Oranje AP. Granuloma gluteale infantum: a case report Pediatr Dermatol. 2000 Mar-Apr;17(2):141-3.

Department of Dermatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.

Granuloma gluteale infantum is a benign disorder with the clinical appearance of "granulomatous" nodules involving the diaper area. It is an uncommon disorder considered a complication of primary irritant diaper dermatitis. A 6-month-old boy with reddish-purple oval nodules located on the right inguinal fold and right buttock diagnosed as granuloma gluteale infantum is presented. A contributing factor in our patient could be a primary irritant dermatitis or a preexisting candidial infection. The name granuloma gluteale infantum is a misnomer since no granulomas are found in these lesions.

Comments from Faculty and Members

Khalifa Shaquie MD, PhD, Professor of Dermatology, College of Medicine, University of Baghdad, Baghdad, Iraq on Jan 5, 2005

Diagnosis is very suggestive of granuloma gluteale infantum.The whole skin of vulva is unhealthy as we can see erythema of the skin with scattered small papules. In Iraq it is very common problem as a result of excessive use of napkin for proloned time.So management by no more use napkin and condition will disappear over time as it is self limiting disease. Using topical emollient with or without toical steroid is enough.

Bernard A Cohen MD, Associate Professor of Pediatrics and Dermatology, Director of Pediatric Dermatology, Johns Hopkins Children's Center, Baltimore, Maryland, USA on Jan 6, 2005

This is not my concept of granuloma gluteale infantum. That is usually a widespread symmetric eruption in the genital area probably as a result of chronic irritant dermatitis from urine/stool etc. I have seen this in the setting of severe chronic diarrhea, around ileostomy or other osteomy sites, but not as a solitary nodule. I would consider a cyst or perhaps recurrent boils. Are these lesions tender and have you cultured organisms at subsequent flares. Could there be a congenital structural abnormality that allows for recurrent cysts (eg. fistula in ano)? Thanks.

Omid Zargari MD, Assistant Professor of Dermatology, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran on Jan 7, 2005

Good case! It might be a case of granuloma gluteale infantum, although this condition usually arises within preexisting severe diaper dermatitis and in my experience almost always after using topical steroids. According to history, there is an "episodic swelling" with response(?)to antibacterial ointment. This history may be more compatible with a cyst. I just recommend wait and see!

Khalifa Shaquie MD, PhD, Professor of Dermatology, College of Medicine, University of Baghdad, Baghdad, Iraq on Jan 9, 2005

It is not uncommon to see severe napkin dermatitis with single nodule of granuloma gluteale infantum which might continue for few months inspite the dermatitis might disappear within two weeks.To stop this dilemma about diagnosis ,biopsy is recommended, even if the result of histopathology is not specific, still in favour of granuloma infantum

Larry Solomon MD, Chicago, USA on Jan 11, 2005

I have been accosted by this kind of problem on numerous occasions, having considered granuloma infantum. I eventually found these unilateral lesions become deep seated lymphangiomas or hemangiolymphomas with superficial infection(strep). This may not become apparent till the post puberty period. Give this a second thought.

Nurul Amin MD, Dhaka, Bangladesh on Jan 11, 2005

Good presentation. It is a place for many glands. So irritation with topical application & infection may help to form cyst. Wait for next changes.

Hayani Raafa MD, Baghdad, Iraq on Jan 12, 2005

Although the distribution of the lesion is odd but the shape of lesion is suggeestive of the this diagnosis. It is a common disease in Iraq but usually it is more than three nodules and stopping napkin use resolve the condition but it needs time it is some time helpful to add miconazol creams to mild steroid as hydrocortison 2.5

Azad Kassim MD, Al-Haza, Saudi Arabia on Jan 29 12, 2005

Both infantile napkin dermatitis and peri-stomal (eg. ileostomy) dermatitis have same etiopathology due to irritation caused by urinary & fecal materials. Both conditions in their course (when chronic) may have either papules and/or nodules on a background of erythema. I agree with Prof. Sharquie this kind of dermatosis is frequently seen in some Iraqi infants specially those who use diaper & those with parents self-medication by high potent steroids.So, avoid any potent steroid application , decrease frequency of diaper use and avoid topical irritants (like high ph soaps) and give enough time for spontaneous resolutions.

Thomas Jayakar MD, PhD , Professor of Dermatology, Chennai, India on March 11, 2005

GGI is violaceous or purplish in color presenting as multiple and almost symmetric nodules, with a prior history of nappy dermatitis quite often.
This looks more suggestive of recurrent furuncle and that too with the background of staph aureus positive culture.
Should we treat with topical mupirocin and oral antibiotics . Maintain topical prophylactic mupirocin in aroun affected area as well as in around the nares.

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