Palisaded neutrophilic and granulomatous dermatitis

Palisaded neutrophilic and granulomatous dermatitis (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]

Palisaded neutrophilic and granulomatous dermatitis
Specialty	Dermatology

Signs and symptoms

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]

Causes

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,^[8] chronic uveitis,^[10] and adult-onset Still’s disease.^[4]

Treatment

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]

See also

• Skin lesion
• List of cutaneous conditions