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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