What are the other Names for this Condition? (Also known as/Synonyms)

• PNGD (Palisading Neutrophilic Granulomatous Dermatitis)

What is Palisading Neutrophilic Granulomatous Dermatitis? (Definition/Background Information)

• Palisading Neutrophilic Granulomatous Dermatitis (PNGD) is a form of granulomatous dermatitis, an uncommon skin condition, which presents red to violet skin rashes mostly in adults with certain systemic conditions such as systemic lupus erythematosus, rheumatoid arthritis, and lymphoproliferative disorders
• The treatment of Palisading Neutrophilic Granulomatous Dermatitis is based on the signs and symptoms, which may wax and wane, and associated conditions. With adequate treatment of the associated condition, PNGD is known to improve or resolve completely

Who gets Palisading Neutrophilic Granulomatous Dermatitis? (Age and Sex Distribution)

• Palisading Neutrophilic Granulomatous Dermatitis (PNGD) is a rare condition that is generally observed in adults; occasionally, PNGD is noted in children
• Both males and females are known to be affected. But, it is reported that a greater number of cases are generally seen in women
• The condition may affect individuals of all racial and ethnic groups

What are the Risk Factors for Palisading Neutrophilic Granulomatous Dermatitis? (Predisposing Factors)

A wide variety of conditions have been associated with Palisading Neutrophilic Granulomatous Dermatitis:

• Autoimmune connective tissue disorders
• Autoimmune hepatitis
• Autoimmune thyroiditis
• Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis)
• Collagen vascular disease (systemic vasculitis) including Takayasu arteritis
• Diabetes
• Granulomatosis with polyangiitis (Wegener granulomatosis)
• Infections caused by pathogens such as, Epstein-Barr virus (EBV), HIV, parvovirus, and Streptococcus
• Inflammatory bowel disease (IBD)
• Lymphoproliferative disorders including myelodysplastic syndrome
• Rheumatoid arthritis
• Sjögren syndrome
• Systemic lupus erythematous (SLE)
• Systemic sclerosis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Palisading Neutrophilic Granulomatous Dermatitis? (Etiology)

The exact cause of formation of Palisading Neutrophilic Granulomatous Dermatitis (PNGD) is unknown. The granulomatous lesions are believed to develop as a reactive process of the body to certain antigens in the body.

• This inflammatory skin condition is noted in individuals with a wide variety of systemic disorders and infections
• Medical experts suggest that PNGD may develop as hypersensitive reaction of the skin, as inflammation of the small blood vessels (small vessel vasculitis), or due to other immune-mediated processes

What are the Signs and Symptoms of Palisading Neutrophilic Granulomatous Dermatitis?

In a majority of individuals, Palisading Neutrophilic Granulomatous Dermatitis presents asymptomatic skin lesions. The signs and symptoms may include:

• Presence of numerous papules, plaques, and nodules that are tender
• These granulomatous skin lesions may range in color from buff-colored, pink, red, or violet
• The lesions are usually located on the skin around a joint (extensor surfaces), usually in the extremities, such as the toes and fingers, and even on the palms
• Other locations include the bony prominences such as elbows
• Sometimes, the lesions may present mild itching to burning sensation
• Lesions may ulcerate and bleed
• The skin lesions may be present for several days to months; a waxing and waning of the lesions is noted

Additional signs and symptoms of the associated condition, if any present, may be noted.

How is Palisading Neutrophilic Granulomatous Dermatitis Diagnosed?

The following tests and exams may be used in diagnosing Palisading Neutrophilic Granulomatous Dermatitis:

• Evaluating the clinical history (physical exam) and a thorough family history (including history of autoimmune or other infectious disease)
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• KOH tests to rule out a fungal infection
• Skin tissue biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Tests and procedures to diagnose the associated condition, if any present, is important.

A differential diagnosis to eliminate other skin conditions may be needed before arriving at a definitive diagnosis. These may include:

• Granuloma annulare
• Leukocytoclastic vasculitis
• Neutrophilic urticaria
• Sweet syndrome

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Palisading Neutrophilic Granulomatous Dermatitis?

The complications of Palisading Neutrophilic Granulomatous Dermatitis may include:

• Emotional stress
• Cosmetic concerns
• Relapse of the condition

Complications of the underlying/associated condition, if any, may be noted.

How is Palisading Neutrophilic Granulomatous Dermatitis Treated?

There is no standard treatment for Palisading Neutrophilic Granulomatous Dermatitis (PNGD) but treating the underlying/associated condition is important.

The treatment measures for PNGD may include:

• Use of topical steroid creams and ointments
• Oral and systemic steroids, if necessary
• Administration of medications such as dapsone, hydroxychloroquine, and methotrexate

How can Palisading Neutrophilic Granulomatous Dermatitis be Prevented?

Currently, there are no specific preventative measures available for Palisading Neutrophilic Granulomatous Dermatitis (PNGD).

• Adequately treating any underlying/associated disorder may lower the risk for PNGD
• Maintaining a healthy lifestyle with good eating habits, adequate physical activities, and avoidance of smoking or drinking is beneficial

What is the Prognosis of Palisading Neutrophilic Granulomatous Dermatitis? (Outcomes/Resolutions)

• Palisading Neutrophilic Granulomatous Dermatitis may improve or resolve with adequate treatment of the associated condition
• The overall prognosis is dependent upon the severity of the associated systemic condition

Additional and Relevant Useful Information for Palisading Neutrophilic Granulomatous Dermatitis:

Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition.