Case Letter
Infiltrated plaques on the lateral aspects of the hips disclosing a case of adult gluteal granuloma
Anna Karoline Gouveia de Oliveira
, Neusa Yuriko Sakai Valente, Thais do Amaral Carneiro Cunha, Agatha Ramos Oppenheimer
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Hospital do Servidor Público Estadual, São Paulo, SP, Brazil
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It presents as well-demarcated areas of erythema, edema, scaling, papules, nodules, erosions, and ulcerations. On histopathological analysis, there is no granuloma, but there is acanthosis, spongiosis, varying degrees of a mixed superficial and deep inflammatory infiltrate, and proliferation of vessels in the dermis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It is a rare condition, with few reports in the literature and it is classically known to occur in children.</p><p id="par0010" class="elsevierStylePara elsevierViewall">An 86-year-old man presented with erythematous, infiltrated, well-defined plaques, with a slightly scaling border and central clearing, asymptomatic, on the lateral aspects of the hips for six months (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). The patient had a history of diabetes mellitus, radical prostatectomy due to adenocarcinoma, urinary incontinence and recurrent urinary infections. Complementary tests showed glycated hemoglobin of 10.3% and urinary pH of 8.5. Direct mycological examination of the lesion was negative and the histopathological analysis showed acanthosis, spongiosis mainly in the acrosyringial ducts, a discrete perivascular dermal inflammatory infiltrate with lymphocytes, histiocytes, eosinophils, plasmocytes, and red blood cell extravasation (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). The Grocott stain was negative for fungi. After behavioral measures to keep the diaper area dry and 0.05% fluticasone propionate cream, the lesions disappeared.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Gluteal granuloma is an inflammatory condition, most commonly observed in infanthood, in the form of papules and nodules in the diaper area. Of uncertain etiology, it is believed that a skin reaction occurs to the repeated contact with irritating substances present in feces, urine and cleaning utensils. Infection by <span class="elsevierStyleItalic">Candida albicans</span>, occlusion and halogenated corticosteroids are possible pathogenic factors.<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 5.5; while that of urine is around 6 or higher, when there is bacteriuria or infection by urease-producing bacteria, an environment that increases the activity of lipases and proteases, impairs the skin barrier and predisposes to the action of local irritants. Our patient had a urinary pH of 8.5 and bacteriuria, corroborating the findings reported by Isogai et al.<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’s position, with nodules located in the scrotum and labia majora of patients who remain seated for a long time, and nodules around the anus in bedridden patients.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Our patient had the diapers frequently changed during the day and, when sleeping, remained in lateral decubitus, associated with polyuria due to decompensated diabetes, factors that caused the lesions on the lateral aspects of the hips.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Recently, dermoscopic findings have been described in a case of AGG, showing papillae with rounded white areas surrounded by erythema and serrated white borders. These papillae were separated by fissures and contained a whitish mesh, comedo-like openings and dotted vessels under the greatest magnification.<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. There are individual reports or case series and, in most of them, topical treatments, including corticosteroids, have failed. The use of topical corticosteroids was effective in two patients.<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, we will possibly face this entity more frequently, justifying the importance of learning about it.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0045" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ contributions</span><p id="par0050" class="elsevierStylePara elsevierViewall">Anna Karoline Gouveia de Oliveira: Drafting and editing of the manuscript.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Neusa Yuriko Sakai Valente: Approval of the final version of the manuscript; drafting and editing of the manuscript; intellectual participation in propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Thais do Amaral Carneiro Cunha: Intellectual participation in propaedeutic and/or therapeutic conduct of the studied cases.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Agatha Ramos Oppenheimer: Intellectual participation in propaedeutic and/or therapeutic conduct of the studied cases.</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.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-02-21" "fechaAceptado" => "2020-06-23" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Oliveira AKG, Valente NYS, Cunha TAC, Oppenheimer AR. Infiltrated plaques on the lateral aspects of the hips disclosing a case of adult gluteal granuloma. An Bras Dermatol. 2021;96:640–1.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Hospital do Servidor Público Estadual, São Paulo, SP, Brazil.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 680 "Ancho" => 905 "Tamanyo" => 146602 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Erythematous infiltrated, well-delimited plaque, with a slightly scaling edge on the right side of the hip.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 680 "Ancho" => 905 "Tamanyo" => 206023 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Histopathology: Epidermis with acanthosis and spongiosis mainly affecting the acrosyringial ducts and a mild superficial perivascular inflammatory infiltrate in the dermis (Hematoxylin & eosin, ×200).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erosive papulonodular dermatoses associated with topical benzocaine: A report of two cases and evidence that granuloma gluteale, pseudoverrucous papules, and Jacquet’s erosive dermatitis are a Disease spectrum" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "K.J. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 16 | 7 | 23 |
| 2024 Outubro | 110 | 63 | 173 |
| 2024 Setembro | 122 | 79 | 201 |
| 2024 Agosto | 138 | 124 | 262 |
| 2024 Julho | 126 | 102 | 228 |
| 2024 Junho | 92 | 77 | 169 |
| 2024 Maio | 90 | 53 | 143 |
| 2024 Abril | 89 | 81 | 170 |
| 2024 Março | 83 | 67 | 150 |
| 2024 Fevereiro | 79 | 79 | 158 |
| 2024 Janeiro | 71 | 49 | 120 |
| 2023 Dezembro | 43 | 62 | 105 |
| 2023 Novembro | 70 | 84 | 154 |
| 2023 Outubro | 50 | 82 | 132 |
| 2023 Setembro | 71 | 64 | 135 |
| 2023 Agosto | 56 | 34 | 90 |
| 2023 Julho | 83 | 33 | 116 |
| 2023 Junho | 52 | 30 | 82 |
| 2023 Maio | 55 | 19 | 74 |
| 2023 Abril | 53 | 12 | 65 |
| 2023 Março | 57 | 50 | 107 |
| 2023 Fevereiro | 42 | 37 | 79 |
| 2023 Janeiro | 48 | 45 | 93 |
| 2022 Dezembro | 48 | 27 | 75 |
| 2022 Novembro | 62 | 70 | 132 |
| 2022 Outubro | 80 | 68 | 148 |
| 2022 Setembro | 48 | 76 | 124 |
| 2022 Agosto | 46 | 57 | 103 |
| 2022 Julho | 49 | 55 | 104 |
| 2022 Junho | 52 | 54 | 106 |
| 2022 Maio | 43 | 52 | 95 |
| 2022 Abril | 65 | 62 | 127 |
| 2022 Março | 64 | 71 | 135 |
| 2022 Fevereiro | 39 | 32 | 71 |
| 2022 Janeiro | 54 | 87 | 141 |
| 2021 Dezembro | 63 | 60 | 123 |
| 2021 Novembro | 59 | 66 | 125 |
| 2021 Outubro | 91 | 93 | 184 |
| 2021 Setembro | 102 | 87 | 189 |
| 2021 Agosto | 29 | 31 | 60 |
| 2021 Julho | 4 | 9 | 13 |
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