Palisaded neutrophilic and granulomatous dermatitis (PNGS) is usually associated with a well-defined connective tissue disease, lupus erythematosus or rheumatoid arthritis most commonly, and often presents with eroded or ulcerated symmetrically distributed umbilicated papules or nodules on the elbows.James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. Page 181. .
Signs and symptoms Typical clinical manifestations include erythematous to violaceous plaques that are symmetrically distributed, skin-colored linear cords involving the lateral trunks, and skin-colored or erythematous papules with crusting, perforation, or umbilication.
Causes Palisaded neutrophilic and granulomatous dermaititis is associated with subacute bacterial endocarditis, ledipasvir/sofosbuvir, allopurinol, Hodgkin’s and non-Hodgkin’s lymphoma, chronic myelomonocytic leukemia, ulcerative colitis, Takayasu arteritis, systemic vasculitis, systemic lupus erythematosus (SLE), sarcoidosis, rheumatoid arthritis, eosinophilic granulomatosis with polyangiitis, chronic uveitis, and adult-onset Still’s disease.
Treatment The underlying illness is the main focus of PNGD treatment. Up to 20% of patients may experience spontaneous resolution of the lesions. Topical corticosteroids, NSAIDs (non-steroidal anti-inflammatory drugs), dapsone, prednisone, colchicine, oral tacrolimus, and TNF inhibitors are among the available treatment options.
See also Skin lesion List of cutaneous conditions
References
Further reading
External links UpToDate VisualDx