Palisaded neutrophilic and granulomatous dermatitis

Palisaded Neutrophilic and Granulomatous Dermatitis (PNGD) is a rare skin condition characterized by the presence of neutrophils and granulomas in the dermis. It is considered a reactive process rather than a distinct disease, often associated with systemic conditions such as rheumatoid arthritis, systemic lupus erythematosus, and other autoimmune diseases. The etiology of PNGD remains largely unknown, but it is thought to involve a complex interplay of genetic, immunologic, and environmental factors.

Symptoms and Diagnosis

The clinical presentation of PNGD can vary but typically includes tender or asymptomatic papules, nodules, and plaques that are red to violaceous in color. These lesions predominantly occur on the extremities, especially the elbows and fingers. Histologically, PNGD is characterized by a triad of features: a palisaded granuloma surrounding areas of degenerated collagen, a dense inflammatory infiltrate rich in neutrophils, and leukocytoclasia without evidence of vasculitis.

Diagnosis of PNGD is primarily based on the histopathological examination of a skin biopsy. Clinical correlation with systemic symptoms and serological tests may aid in identifying associated systemic diseases.

Treatment and Prognosis

Treatment of PNGD focuses on managing the underlying systemic condition, if identified. Corticosteroids, both topical and systemic, are commonly used to reduce inflammation and control symptoms. Other treatments may include antimalarial drugs, dapsone, and immunosuppressive agents, depending on the patient's overall health and associated conditions.

The prognosis of PNGD is generally good, with appropriate treatment leading to resolution of skin lesions. However, the underlying systemic disease may influence the overall outcome.

Epidemiology

PNGD is a rare condition, with limited epidemiological data available. It can occur at any age but is most commonly diagnosed in adults. There is no clear gender predilection.

Pathophysiology

The pathogenesis of PNGD is not fully understood. It is believed to involve an immune-mediated response, possibly triggered by an underlying systemic disease or environmental factors. The formation of granulomas is thought to be a reaction to an unknown antigen, with neutrophils playing a key role in the inflammatory process.

See Also

• Dermatitis
• Granuloma
• Rheumatoid Arthritis
• Systemic Lupus Erythematosus
• Autoimmune Diseases