title: Palisaded neutrophilic and granulomatous dermatitis: an unusual cutaneous manifestation of immune-mediated disorders.
abstract: OBJECTIVE
  Palisaded neutrophilic and granulomatous dermatitis (PNGD) is an uncommon skin eruption most often associated with rheumatoid arthritis and other immune-mediated diseases. We present 4 cases to familiarize rheumatologists with the clinical presentation and histopathology of PNGD.
  
  
  METHODS
  We report 4 cases to illustrate the clinical and histologic spectrum of this rare skin disease found in rheumatologic patients. The disease pathogenesis and treatment options are discussed.
  
  
  RESULTS
  All 4 patients presented with symmetric erythematous-to-violaceous papules and plaques that, upon biopsy, revealed a dermatitis composed of variable numbers of histiocytes and neutrophils. Some cases responded to topical corticosteroid treatment or to dapsone, whereas others resolved spontaneously.
  
  
  CONCLUSIONS
  PNGD is a rare cutaneous finding in patients with a variety of immune-mediated systemic diseases, most often rheumatoid arthritis. It is a benign condition that may spontaneously remit or may respond favorably to topical corticosteroids or dapsone.
authors.affiliation: Department of Dermatology, Oregon Health and Science University, Portland, OR 97239, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bremner
authors.forename: Eric
authors.initials: E
authors.lastname: Simpson
authors.forename: Clifton R
authors.initials: CR
authors.lastname: White
authors.forename: Lynne
authors.initials: L
authors.lastname: Morrison
authors.forename: Atul
authors.initials: A
authors.lastname: Deodhar
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000473:pathology*; D003622:Dapsone / Q000627:therapeutic use; D003872:Dermatitis / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D004359:Drug Therapy, Combination; D005260:Female; D006099:Granuloma / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D006801:Humans; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology*; D011241:Prednisone / Q000627:therapeutic use; D012075:Remission, Spontaneous; D017444:Skin Diseases, Papulosquamous / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D016896:Treatment Outcome
chemical_list: D003622:Dapsone; D011241:Prednisone