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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Adult gluteal granuloma &#40;AGG&#41; is an inflammatory dermatosis that occurs in adults or the elderly on skin exposed to prolonged contact with feces and urine&#46; It presents as well-demarcated areas of erythema&#44; edema&#44; scaling&#44; papules&#44; nodules&#44; erosions&#44; and ulcerations&#46; On histopathological analysis&#44; there is no granuloma&#44; but there is acanthosis&#44; spongiosis&#44; varying degrees of a mixed superficial and deep inflammatory infiltrate&#44; and proliferation of vessels in the dermis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is a rare condition&#44; with few reports in the literature and it is classically known to occur in children&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">An 86-year-old man presented with erythematous&#44; infiltrated&#44; well-defined plaques&#44; with a slightly scaling border and central clearing&#44; asymptomatic&#44; on the lateral aspects of the hips for six months &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The patient had a history of diabetes mellitus&#44; radical prostatectomy due to adenocarcinoma&#44; urinary incontinence and recurrent urinary infections&#46; Complementary tests showed glycated hemoglobin of 10&#46;3&#37; and urinary pH of 8&#46;5&#46; Direct mycological examination of the lesion was negative and the histopathological analysis showed acanthosis&#44; spongiosis mainly in the acrosyringial ducts&#44; a discrete perivascular dermal inflammatory infiltrate with lymphocytes&#44; histiocytes&#44; eosinophils&#44; plasmocytes&#44; and red blood cell extravasation &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; The Grocott stain was negative for fungi&#46; After behavioral measures to keep the diaper area dry and 0&#46;05&#37; fluticasone propionate cream&#44; the lesions disappeared&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Gluteal granuloma is an inflammatory condition&#44; most commonly observed in infanthood&#44; in the form of papules and nodules in the diaper area&#46; Of uncertain etiology&#44; it is believed that a skin reaction occurs to the repeated contact with irritating substances present in feces&#44; urine and cleaning utensils&#46; Infection by <span class="elsevierStyleItalic">Candida albicans</span>&#44; occlusion and halogenated corticosteroids are possible pathogenic factors&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The pH of normal skin is approximately 5&#46;5&#59; while that of urine is around 6 or higher&#44; when there is bacteriuria or infection by urease-producing bacteria&#44; an environment that increases the activity of lipases and proteases&#44; impairs the skin barrier and predisposes to the action of local irritants&#46; Our patient had a urinary pH of 8&#46;5 and bacteriuria&#44; corroborating the findings reported by Isogai et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The distribution of the lesions is related to the patient&#8217;s position&#44; with nodules located in the scrotum and labia majora of patients who remain seated for a long time&#44; and nodules around the anus in bedridden patients&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Our patient had the diapers frequently changed during the day and&#44; when sleeping&#44; remained in lateral decubitus&#44; associated with polyuria due to decompensated diabetes&#44; factors that caused the lesions on the lateral aspects of the hips&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Recently&#44; dermoscopic findings have been described in a case of AGG&#44; showing papillae with rounded white areas surrounded by erythema and serrated white borders&#46; These papillae were separated by fissures and contained a whitish mesh&#44; comedo-like openings and dotted vessels under the greatest magnification&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Keeping the skin clean and dry is the main treatment and the best form of prevention&#46; There are individual reports or case series and&#44; in most of them&#44; topical treatments&#44; including corticosteroids&#44; have failed&#46; The use of topical corticosteroids was effective in two patients&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">With the aging of the population and the increase in the number of incontinent individuals&#44; we will possibly face this entity more frequently&#44; justifying the importance of learning about it&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Anna Karoline Gouveia de Oliveira&#58; Drafting and editing of the manuscript&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Neusa Yuriko Sakai Valente&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the manuscript&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Thais do Amaral Carneiro Cunha&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Agatha Ramos Oppenheimer&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Case Letter
Infiltrated plaques on the lateral aspects of the hips disclosing a case of adult gluteal granuloma
Anna Karoline Gouveia de Oliveira
Corresponding author
a.karolineoliveira@gmail.com

Corresponding author.
, Neusa Yuriko Sakai Valente, Thais do Amaral Carneiro Cunha, Agatha Ramos Oppenheimer
Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology&#58; Epidermis with acanthosis and spongiosis mainly affecting the acrosyringial ducts and a mild superficial perivascular inflammatory infiltrate in the dermis &#40;Hematoxylin &#38; eosin&#44; &#215;200&#41;&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Adult gluteal granuloma &#40;AGG&#41; is an inflammatory dermatosis that occurs in adults or the elderly on skin exposed to prolonged contact with feces and urine&#46; It presents as well-demarcated areas of erythema&#44; edema&#44; scaling&#44; papules&#44; nodules&#44; erosions&#44; and ulcerations&#46; On histopathological analysis&#44; there is no granuloma&#44; but there is acanthosis&#44; spongiosis&#44; varying degrees of a mixed superficial and deep inflammatory infiltrate&#44; and proliferation of vessels in the dermis&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is a rare condition&#44; with few reports in the literature and it is classically known to occur in children&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">An 86-year-old man presented with erythematous&#44; infiltrated&#44; well-defined plaques&#44; with a slightly scaling border and central clearing&#44; asymptomatic&#44; on the lateral aspects of the hips for six months &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The patient had a history of diabetes mellitus&#44; radical prostatectomy due to adenocarcinoma&#44; urinary incontinence and recurrent urinary infections&#46; Complementary tests showed glycated hemoglobin of 10&#46;3&#37; and urinary pH of 8&#46;5&#46; Direct mycological examination of the lesion was negative and the histopathological analysis showed acanthosis&#44; spongiosis mainly in the acrosyringial ducts&#44; a discrete perivascular dermal inflammatory infiltrate with lymphocytes&#44; histiocytes&#44; eosinophils&#44; plasmocytes&#44; and red blood cell extravasation &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; The Grocott stain was negative for fungi&#46; After behavioral measures to keep the diaper area dry and 0&#46;05&#37; fluticasone propionate cream&#44; the lesions disappeared&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Gluteal granuloma is an inflammatory condition&#44; most commonly observed in infanthood&#44; in the form of papules and nodules in the diaper area&#46; Of uncertain etiology&#44; it is believed that a skin reaction occurs to the repeated contact with irritating substances present in feces&#44; urine and cleaning utensils&#46; Infection by <span class="elsevierStyleItalic">Candida albicans</span>&#44; occlusion and halogenated corticosteroids are possible pathogenic factors&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The pH of normal skin is approximately 5&#46;5&#59; while that of urine is around 6 or higher&#44; when there is bacteriuria or infection by urease-producing bacteria&#44; an environment that increases the activity of lipases and proteases&#44; impairs the skin barrier and predisposes to the action of local irritants&#46; Our patient had a urinary pH of 8&#46;5 and bacteriuria&#44; corroborating the findings reported by Isogai et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The distribution of the lesions is related to the patient&#8217;s position&#44; with nodules located in the scrotum and labia majora of patients who remain seated for a long time&#44; and nodules around the anus in bedridden patients&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Our patient had the diapers frequently changed during the day and&#44; when sleeping&#44; remained in lateral decubitus&#44; associated with polyuria due to decompensated diabetes&#44; factors that caused the lesions on the lateral aspects of the hips&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Recently&#44; dermoscopic findings have been described in a case of AGG&#44; showing papillae with rounded white areas surrounded by erythema and serrated white borders&#46; These papillae were separated by fissures and contained a whitish mesh&#44; comedo-like openings and dotted vessels under the greatest magnification&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Keeping the skin clean and dry is the main treatment and the best form of prevention&#46; There are individual reports or case series and&#44; in most of them&#44; topical treatments&#44; including corticosteroids&#44; have failed&#46; The use of topical corticosteroids was effective in two patients&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">With the aging of the population and the increase in the number of incontinent individuals&#44; we will possibly face this entity more frequently&#44; justifying the importance of learning about it&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Anna Karoline Gouveia de Oliveira&#58; Drafting and editing of the manuscript&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Neusa Yuriko Sakai Valente&#58; Approval of the final version of the manuscript&#59; drafting and editing of the manuscript&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#59; critical review of the manuscript&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Thais do Amaral Carneiro Cunha&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Agatha Ramos Oppenheimer&#58; Intellectual participation in propaedeutic and&#47;or therapeutic conduct of the studied cases&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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Article information
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Idiomas
Anais Brasileiros de Dermatologia
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