Elsevier

Dermatologic Clinics

Volume 33, Issue 3, July 2015, Pages 373-387
Dermatologic Clinics

Reactive Granulomatous Dermatitis: A Review of Palisaded Neutrophilic and Granulomatous Dermatitis, Interstitial Granulomatous Dermatitis, Interstitial Granulomatous Drug Reaction, and a Proposed Reclassification

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Key points

  • Palisaded neutrophilic and granulomatous dermatitis, interstitial granulomatous dermatitis, and interstitial granulomatous drug reaction represent cutaneous reaction patterns that occur in the setting of a systemic trigger.

  • Systemic triggers include connective tissue diseases (lupus, vasculitis, other), arthritides (rheumatoid arthritis, other inflammatory and reactive arthritides), malignancy (hematologic more often than solid organ), and medications.

  • We suggest the unifying term “reactive

Palisaded neutrophilic and granulomatous dermatitis

Palisaded neutrophilic and granulomatous dermatitis is a term originally coined by Chu and colleagues in 19942 to encompass a cutaneous reaction pattern seen in association with a number of systemic diseases. These authors described characteristic symmetric skin colored to erythematous smooth, umbilicated, or crusted papules primarily on the elbows and extremities with a spectrum of histologic findings ranging from frank leukocytoclastic vasculitis to dense neutrophilic infiltrates and

Interstitial granulomatous dermatitis

The first use of the term IGD is attributed to Ackerman in 1993.30 Over the years, IGD has alternately been referred to as IGD with arthritis, IGD with cords and arthritis,31 linear subcutaneous bands of rheumatoid arthritis,32 linear rheumatoid nodules,33 linear granuloma annulare,34 railway track dermatitis,35 and Ackerman syndrome.36, 37 The initial descriptions were of patients with inflammatory arthritis and a pathognomonic linear band on the upper trunk, which was firm, palpable, and

Reactive granulomatous dermatitis

As detailed, there exists substantial overlap between PNGD, IGD, and IGDR. The terms are at times used interchangeably in the literature,1, 23 and some authors view drug-induced IGD and IGDR as the same entity with authors viewing IGD as a subset of PNGD, whereas other authors draw strict distinctions. The confusing nomenclature dates back to the earliest report, by Dykman and colleagues32 in 1965, who are credited with the first report of PNGD while describing patients with rheumatoid

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    Conflict of interest: No relevant conflicts.

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