Palisaded neutrophilic and granulomatous dermatitis | |
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Specialty | Dermatology |
Palisaded neutrophilic and granulomatous dermaititis (PNGS) is usually associated with a well-defined connective tissue disease, lupus erythematosus or rheumatoid arthritis most commonly, and often presents with eroded or ulcerated symmetrically distributed umbilicated papules or nodules on the elbows.[1][2]
Typical clinical manifestations include erythematous to violaceous plaques that are symmetrically distributed, skin-colored linear cords involving the lateral trunks, and skin-colored or erythematous papules with crusting, perforation, or umbilication.[3]
Palisaded neutrophilic and granulomatous dermaititis is associated with subacute bacterial endocarditis,[4] ledipasvir/sofosbuvir,[5] allopurinol,[6] Hodgkin’s and non-Hodgkin’s lymphoma,[4] chronic myelomonocytic leukemia,[7] ulcerative colitis,[8] Takayasu arteritis,[4] systemic vasculitis,[8] systemic lupus erythematosus (SLE),[9] sarcoidosis,[10] rheumatoid arthritis,[11] eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome),[8] chronic uveitis,[10] and adult-onset still’s disease.[4]
The underlying illness is the main focus of PNGD treatment. Up to 20% of patients may experience spontaneous resolution of the lesions. Topical corticosteroids, NSAIDs (non-steroidal anti-inflammatory drugs), dapsone, prednisone, colchicine, oral tacrolimus, and TNF inhibitors are among the available treatment options.[3]