granulomatous dermatitis

Granulomatous Dermatitis: A Description

Granulomatous dermatitis refers to a group of reactive dermatologic disorders characterized by distinct histopathological patterns, clinical manifestations, and underlying causes [2][3]. This condition is marked by the presence of non-neoplastic histiocytes and multinucleated giant cells in the skin, which are indicative of an inflammatory response [3].

The lesions associated with granulomatous dermatitis can vary in shape, size, and color, and may appear as red or skin-colored patches, papules, and plaques [1]. They often exhibit a characteristic waxy texture and may be accompanied by other symptoms such as itching, pain, or swelling.

Granulomatous dermatitis can be caused by various factors, including foreign bodies that enter the skin, autoimmune processes, infections, or malignancies [4][8]. The condition is often associated with distinct histopathological patterns, which can aid in its diagnosis.

Types of Granulomatous Dermatitis

Some specific types of granulomatous dermatitis include:

• Palisaded Neutrophilic and Granulomatous Dermatitis (PNGD): A rare inflammatory cutaneous disorder characterized by the presence of palisading neutrophils and multinucleated giant cells [7].
• Granuloma Annulare: A skin condition that causes a raised rash or bumps in a ring pattern, usually on the hands and feet [6].

References

[1] Context result 1 [2] Context result 5 [3] Context result 3 [4] Context result 4 [7] Context result 7 [8] Context result 8

Symptoms of Granulomatous Dermatitis

Granulomatous dermatitis, a type of skin disorder, presents with various symptoms that can vary in severity and presentation. Here are some common signs and symptoms associated with this condition:

• Skin lesions: The most common symptom is the presence of skin lesions, which can appear as nodules, indurated plaques, or umbilicated papules on the face, trunk, and extremities [3].
• Linear cords: In some cases, granulomatous dermatitis may present with linear cords on the flank, often described as a "burning rope sign" [3].
• Erythematous papules and plaques: Interstitial granulomatous dermatitis can manifest as erythematous papules, plaques, or ropelike cords on the skin [7, 10].
• Rash or lumps under the skin: Some people may experience a raised, discolored rash or lumps under their skin, which can be tender to touch [9].

Associated Conditions

Granulomatous dermatitis is often associated with other systemic conditions, including:

• Chronic granulomatous disease (CGD): A rare inherited disorder that affects the immune system and increases susceptibility to bacterial and fungal infections [2].
• Systemic lupus erythematosus (SLE): An autoimmune disorder that can cause a range of symptoms, including skin lesions [13].

Treatment

The treatment of granulomatous dermatitis is based on the signs and symptoms, which may wax and wane, and associated condition. With adequate treatment of the associated condition, granulomatous dermatitis may improve or resolve completely [15].

Diagnostic Tests for Granulomatous Dermatitis

Granulomatous dermatitis, a group of reactive dermatologic disorders characterized by distinct histopathological patterns and clinical manifestations, can be diagnosed through various tests.

• Skin Biopsy: A skin biopsy is the most definitive test to diagnose granulomatous dermatitis. The diagnosis of Palisaded Neutrophilic Granulomatous Dermatitis (PNGD) is confirmed by skin biopsy [10]. Histologic examination may vary based on lesion age, underlying etiologies, and associated diseases [3].
• Histologic Examination: Histologic differential diagnosis for granulomatous dermatitis is broad, and particular attention to architectural arrangement of the histiocytes is necessary to narrow the differential [4].
• Imaging Studies: Imaging studies are not generally necessary in diagnosing granuloma annulare, but may be helpful in evaluating other conditions [9].

Other Diagnostic Tests

In addition to skin biopsy and histologic examination, other tests may be used to diagnose specific types of granulomatous dermatitis:

• Genetic Testing: Genetic testing can diagnose Chronic Granulomatous Disease (CGD) by identifying specific genetic alterations [1].
• Blood Tests: Blood tests, such as the DHR test, can also diagnose CGD [7].

References

[1] Providers usually use this test to diagnose CGD. Genetic testing. Your provider may request a genetic test to confirm the presence of a specific genetic alteration that results in chronic granulomatous disease.

[3] Granulomatous dermatitis includes a group of reactive dermatologic disorders characterized by distinct histopathological patterns, clinical manifestations, and associated diseases.

[4] The histologic differential diagnosis for a granulomatous dermatitis is broad and therefore particular attention to architectural arrangement of the histiocytes is necessary to narrow the differential.

[7] Blood tests: A blood test called a DHR test (dihydrorhodamine test) can diagnose CGD.

Treatment Options for Granulomatous Dermatitis

Granulomatous dermatitis, a rare skin disorder, can be challenging to treat. However, various medications have been found to be effective in managing the condition. Here are some treatment options:

• Hydroxychloroquine: This antimalarial drug has been used successfully in treating granulomatous dermatitis. Regular use of hydroxychloroquine can lead to remission of lesions [14].
• Steroids: Both topical and systemic corticosteroids have been found useful in treating granulomatous dermatitis. They help reduce inflammation and alleviate symptoms [14].
• Corticosteroid creams or ointments: Prescription-strength products containing corticosteroids can help clear the skin faster [4].
• Corticosteroid injections: In some cases, corticosteroid injections may be recommended to treat granulomatous dermatitis [4].

It's essential to note that treatment response can vary from person to person, and a healthcare provider may recommend a combination of these treatments or other medications based on individual needs.

References:

[14] - Successful treatments include hydroxychloroquine- It is an antimalarial drug used in this condition. Patients after regular use experience successful remission of the lesions. Steroids- Steroids (topical or systemic form) are useful in the treatment of granulomatous dermatitis. [4] - Corticosteroid creams or ointments. Prescription-strength products may help clear the skin faster. · Corticosteroid injections. If the ...

Differential Diagnosis of Granulomatous Dermatitis

Granulomatous dermatitis, a group of reactive dermatologic disorders characterized by distinct histopathological patterns, clinical manifestations, and associated diseases, has several differential diagnoses. Here are some of the key entities to consider:

• Leucocytoclastic vasculitis: This condition is distinguished from granulomatous dermatitis by the presence of neutrophils and dust in the dermis, which are more widely distributed throughout the dermis in addition to around vessels.
• Granuloma annulare: The changes in granuloma annulare may be similar, particularly to the interstitial variant of granuloma annulare.
• Palisaded neutrophilic and granulomatous dermatitis (PNGD): This condition is a subtype of reactive granulomatous dermatitis and presents with symmetric nodules and indurated plaques on the face and trunk, as well as umbilicated papules on the extensor surfaces of the extremities.
• Rheumatoid nodule: Rheumatoid nodules are a type of non-necrotizing granuloma that can occur in patients with rheumatoid arthritis.
• Necrobiosis lipoidica (NL), necrobiosis xanthogranuloma (NXG), and rheumatoid nodule (RN): These conditions are all part of the differential diagnosis for red granulomas.
• Lupus erythematosus, dermatomyositis, and chronic actinic dermatitis: These conditions should be considered in the differential diagnosis of granulomatous dermatitis, particularly when there is a history of autoimmune disease or other systemic symptoms.
• Sarcoidosis: Sarcoidosis is a type of non-caseating granuloma that can occur in various parts of the body, including the skin.

References

• Table 1: Complete list of differential diagnoses for non-necrotizing, non-caseating granulomatous dermatitis (Source: [14])
• Palisaded neutrophilic granulomatous dermatitis (PNGD) is a condition associated with underlying disease states, including autoimmune connective tissue disease, lymphoproliferative disorders, and infections. (Source: [12])

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