Gluteal granuloma

Formerly known as infantile gluteal granuloma toxic dermatitis Crop bromidismul vegetant or potassium bromide is a rare skin disorder of controversial etiology characterized by granulomatous nodules, oval, red-purple on the surface of the gluteal and groin area. The lesions may be found in intertriginous areas: neck, axilla. longitudinal axis is parallel to the grooves of most skin lesions of maximum skin tension.

Granuloame similare au fost observate si la adultii imobilizati la pat. Aceste conditii se refera la granulomul gluteal al adultului sau granulomul celor in virsta. Fata de granulomul gluteal infantum versiunea adultului este observata doar in regiunile genitocrurale si nu in zonele intertriginoase ( intertrigo =pliu) . Similar granulomas were observed in adults and bedridden. These conditions relate to granuloma gluteal granuloma of the adult or the elderly. Granuloma gluteal infantum compared to the adult version, is seen not only in regions genitocrurale and intertriginous areas ( intertrigo = fold) . Nodulii in varianta adultului sunt frecvent erodati si nu arata un aranjament paralel cu liniile cutanate. Nodules are often eroded in the adult version and does not show a parallel arrangement with the skin lines.

In general nu este necesar un tratament deoarece leziunile se rezolva spontan. Se trateaza procesele inflamatorii asociate cu macerarea si infectiile secundare. Generally no treatment is necessary because the lesions resolve spontaneously. It treats the inflammatory processes associated with the maceration and secondary infections. Se foloseste oxidul de zinc si corticosteroizii usori. It uses zinc oxide and corticosteroids lighter.

Cauze si factori de risc Causes and Risk Factors

Etiologia granulomului este neclara. The etiology of granuloma is unclear. Afectiunea este considerata a reprezenta un raspuns cutanat unic la inflamarea locala, macerare si infectie secundara. Etiologiile posibile sunt fecalele, urina, infectia candidozica, corticosteroizii halogenati, scutecele, servetele de hirtie, detergentii de rufe, pudra . The condition is considered to represent a unique cutaneous response to local inflammation, maceration and secondary infection. Etiologies are possible feces, urine, candida infection, halogenated corticosteroids, diapers, paper towels, laundry detergents, powder. Absenta leziunilor in santul interfesier profund arata ca acestea sunt conditionate de contactul cu scutecul. Absence of deep lesions in the ditch buttocks look like they are conditioned by contact with the diaper.
Hifele de candida sunt detectate la biopsia pielii. Hyphae of candidates are detected in skin biopsies. Testarea intradermica nu arata o sensibilitate la antigenele candidei. Intradermal testing showed no susceptibility to Candida antigens. Cei mai multi pacienti incluzind cei cu leziuni ale gitului si fetei au fost tratati in antecedente cu un steroid fluorinat topic. Aceasta observatie sugereaza un rol cauzativ al steroizilor fluorinati in aceasta afectiune a pielii. Most patients including those with neck and facial injuries were treated in history with a topical fluorinated steroid. This observation suggests a causative role of fluorinated steroids in the skin condition.
Urina poate creste pH-ul zonei acoperite de scutec promovind actiunea proteazelor fecale si lipazelor. Urine pH can increase the area covered by the diaper fecal proteases and lipases promote action. Impreuna urina si fecalele pot irita pielea acoperita de scutec crescind permeabilitatea si succeptibilitatea la alte iritatii. Together urine and feces can irritate the skin covered by nappy succeptibilitatea advancing the permeability and other irritations.

Semne si simptome. Signs and symptoms.

Conditia patologica se dezvolta la copii intre 4-9 luni care folosesc scutece si la adultii imobilizati la pat. Cei mai multi copii cu granulom gluteal au un istoric de conditii inflamatorii ale pielii in antecedente intro zona de dermatita seboreica sau candidozica sau de contact cu un agent iritant. Aceste conditii sunt tratate cu agenti topici, incluzind corticosteroizii fluorinati. Pathological condition develops in children between 4-9 months and adults who use diapers bedridden. Most children have a history of gluteal granuloma, inflammatory skin conditions in the introductory history of seborrheic dermatitis or candidiasis or contact with a irritants. These conditions are treated with topical agents, including fluorinated corticosteroids.

Examen fizic. Physical examination.
Leziunile asociate cu granulomul gluteal sunt caracterizate de urmatoarele: Gluteal lesions associated with granuloma characterized by the following:
-una pina la 30 de leziuni in zona afectata One to 30 lesions in the affected area
-de culoare rosu-purpuriu sau rosu-maro Black-red-purple or red-brown
-noduli de 5-40 mm diametru 5-40 mm-diameter nodules
-ovali, fermi-duri, noduli dermici discreti cu suprafata neteda sau usor lichefiata -Oval, firm, tough, discreet dermal nodules with smooth or slightly liquefied
-aliniati cu axa longitudinala paralela cu faldurile pielii -Aligned with the longitudinal axis parallel to skin folds
-localizati in zona gluteala, inghinala, abdomenul inferior, rar pe fata sau git la copii -Located in the gluteal region, groin, lower abdomen, often on the face and neck in children
-fara implicarea faldurilor inghinale sau a snatului interfesier, deoarece contactul cu scutecul nu exista. Inguinal folds, without involving NAT or buttocks, as contact with the diaper does not exist.

Diagnostic. Diagnosis.
Studii de laborator: Laboratory studies:
-prelevarea de biopsii pentru a exclude fungii -Biopsy sampling to exclude fungi
-cultura fungica, testare pentru bacili Fungal-culture, testing for bacteria
-coloratia Warthin-Starry pentru spirochete Warthin-Starry-staining for spirochetes
-microscopie polarizata pentru corpuri straine si cristale -Polarized microscopy for foreign bodies and crystals
-testul plasmatic pentru sifilis. -Serum test for syphilis.
Diagnosticul diferential se face cu urmatoarele afectiuni: candidoza cutanata, dermatita de contact iritanta, tuberculoza cutanata, sarcomul Kaposi , mastocitoza, granulomul piogenic, sifilis, scabia , granulomul de corp strain. The differential diagnosis is made with the following conditions: candida skin, contact dermatitis irritant, tuberculosis cutaneous Kaposi's sarcoma , mastocytosis, granuloma piogenic, syphilis, scabies , foreign body granuloma.

Tratament. Treatment.

Tratamentul nu este in general necesar deoarece conditia se rezolva spontan . Treatment is generally not necessary because the condition resolves spontaneously. Se trateaza infectiile secundare si procesele inflamatorii asociate cu maceratia pielii. Treat secondary infections and inflammatory processes associated with skin macerate. Farmacoterapia deoreste reducerea morbiditatii si prevenirea complicatiilor. Pharmacotherapy deoreste reduce morbidity and prevent complications. Unele tratamente includ produse de bariera, corticosteroizi intralezionali si servetele impregnate cu flurandrenolide. Some products include barrier treatments, intralesional corticosteroids and wipes impregnated with flurandrenolide.

Agentii protectori sunt tratamentul preferat. Protective agents are the preferred treatment. Acestia includ produse bariera pentru a evita contactul pielii cu factorii exogeni, urina, fecalele si alti iritanti exogeni care pot predispune la granulom gluteal. These products include skin barrier to prevent contact with exogenous factors, urine, feces and other exogenous irritants that may predispose to gluteal granuloma. Exemple: oxid de zinc pasta sau ulei . Examples: zinc oxide paste or oil.
Corticosteroizii administrati intralezional sunt indicati pentru a trata leziunile localizate hipertrofice, infiltrate . Intralesional corticosteroids are administered to treat localized lesions indicate hypertrophic, infiltrated. Servetele impregnate cu flurandrenolide care combina actiunea de bariera cu cea antiinflamatorie sunt raportate ca eficiente. Wipes impregnated with flurandrenolide that combines anti-inflammatory action of the barrier are reported as effective. Se mai foloseste si tramcinolonul. It is also used tramcinolonul.

Prognostic. Prognosis.
Leziunile persista 3-6 saptamini urmate de regresie spontana in 2-4 saptamini. The lesions persist for 3-6 weeks followed by spontaneous regression within 2-4 weeks. Maculele hiperpigmentate maro si cicatricile atrofice, laxe reziduale sunt observate la unele persoane. Hyperpigmented brown macules and atrophic scars, lax treatment are seen in some people.