Interstitial granulomatous dermatitis

Interstitial Granulomatous Dermatitis (IGD), also known as Interstitial Granulomatous Drug Reaction, is a rare skin condition characterized by the presence of granulomatous inflammation within the dermis. It is often associated with systemic diseases, such as rheumatoid arthritis, autoimmune diseases, and less commonly, with certain medications. The condition presents with a variety of skin manifestations, including erythematous plaques, nodules, and linear bands, typically located on the trunk and extremities.

Etiology

The exact cause of Interstitial Granulomatous Dermatitis is not well understood. It is believed to be a reaction pattern that can be triggered by various underlying conditions or drugs. Common associations include:

• Rheumatoid arthritis
• Autoimmune diseases such as systemic lupus erythematosus (SLE) and dermatomyositis
• Medications, including ACE inhibitors, calcium channel blockers, and statins
• Malignancies (rare)

Clinical Presentation

Patients with IGD typically present with asymptomatic or mildly pruritic, erythematous to violaceous plaques, nodules, or linear bands. These lesions are most commonly found on the trunk, inner thighs, and arms. The skin changes may be accompanied by systemic symptoms if associated with an underlying systemic disease.

Diagnosis

Diagnosis of Interstitial Granulomatous Dermatitis is primarily based on clinical examination and histopathological findings. A skin biopsy is essential for confirming the diagnosis, revealing interstitial granulomatous inflammation with histiocytes and multinucleated giant cells. Direct immunofluorescence studies are typically negative. It is also important to investigate for associated systemic diseases or medication use that could trigger IGD.

Treatment

Treatment of IGD focuses on managing the underlying condition and discontinuing any offending medications. Topical and systemic corticosteroids are commonly used to control skin lesions. Other treatment options may include immunosuppressive agents such as methotrexate, azathioprine, or mycophenolate mofetil for patients with severe or refractory disease. The prognosis of IGD is generally good, with skin lesions often resolving with appropriate treatment, although recurrences can occur.

Conclusion

Interstitial Granulomatous Dermatitis is a rare dermatological condition that requires a high index of suspicion for diagnosis. It is associated with various systemic diseases and medications, highlighting the importance of a comprehensive evaluation for affected individuals. Management involves treating the underlying cause and controlling skin symptoms, with most patients achieving good outcomes.

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