Palisaded neutrophilic and granulomatous dermatitis: an unusual cutaneous manifestation of immune-mediated disorders.
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.
Bremner
Rebecca
R
Department of Dermatology, Oregon Health and Science University, Portland, OR 97239, USA.
Simpson
Eric
E
White
Clifton R
CR
Morrison
Lynne
L
Deodhar
Atul
A
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
D003622:Dapsone; D011241:Prednisone