Case Report
Erosive papulonodular dermatosis associated with topical benzocaine: A report of two cases and evidence that granuloma gluteale, pseudoverrucous papules, and Jacquet's erosive dermatitis are a disease spectrum

https://doi.org/10.1016/j.jaad.2005.12.025Get rights and content

Granuloma gluteale infantum/adultorum, pseudoverrucous papules, and Jacquet's erosive diaper dermatitis are fairly uncommon manifestations of irritant contact dermatitis historically thought to be distinct clinical entities. Here we report two informative cases of an erosive papulonodular dermatosis in the genital and suprapubic area associated with topical benzocaine. We review granuloma gluteale infantum, pseudoverrucous papules and nodules, and Jacquet's erosive diaper dermatitis, and propose that these disorders may all be variants of genitocrural irritant dermatitis.

Section snippets

Case 1

A 28-year-old white woman presented to our center for vulvar diseases with a 2-year history of a painful, pruritic vulvar eruption. She was initially treated by an outside physician with tacrolimus 0.1% ointment with little relief of her symptoms. The patient reported her only relief came from the use of a topical benzocaine preparation (Vagisil Anti-Itch Creme, Combe Inc, White Plains, NY) that she applied to the area several times a day. On examination of the vulva and groin area, there was

Discussion

Irritant contact dermatitis is a common cause of genital eruptions and has been estimated to represent a fifth of presenting anogenital symptoms.15, 16 Contact dermatitis of the vulva can also be a confounding factor in patients with symptoms of vulvar pruritis, irritation, or burning.16 Vulvar skin is more readily irritated than skin on the trunk and extremities, presumably a result of decreased barrier function as compared with other anatomic sites.17, 18, 19 We believe the erosive

References (40)

  • Y. Maekawa et al.

    Hemilateral distribution of papular lesions on the buttock histologically resembling granuloma gluteale infantum

    J Dermatol

    (2001)
  • M. Fujita et al.

    Two cases of diaper area granuloma of the adult

    J Dermatol

    (1991)
  • Y. Maekawa et al.

    Diaper area granuloma of the aged

    Arch Dermatol

    (1978)
  • B. Bergman et al.

    Chronic papillomatous dermatitis as a peristomal complication in conduit urinary diversion

    Scand J Urol Nephrol

    (1979)
  • M.T. Dytoc et al.

    Granuloma gluteale adultorum associated with use of topical benzocaine preparations: case report and literature review

    J Cutan Med Surg

    (2002)
  • M. Hara et al.

    Jacquet erosive diaper dermatitis in a young girl with urinary incontinence

    Pediatr Dermatol

    (1991)
  • A. Virgili et al.

    Diaper dermatitis in an adult: a case of erythema papuloerosive of Sevestre and Jacquet

    J Reprod Med

    (1998)
  • A. Bauer et al.

    Allergic contact dermatitis in patients with anogenital complaints

    J Reprod Med

    (2000)
  • L.J. Margesson

    Contact dermatitis of the vulva

    Dermatol Ther

    (2004)
  • M.B. Britz et al.

    Human cutaneous vulvar reactivity to irritants

    Contact Dermatitis

    (1979)
  • Cited by (49)

    • Case Report: An Uncommon Etiology of Vulvar Irritation and Swelling in an Adolescent Patient

      2022, Journal of Pediatric and Adolescent Gynecology
      Citation Excerpt :

      Adverse outcomes after chronic topical benzocaine use have been described in the adult population. Robson et al described 2 patients who presented with significant skin changes.6 They reported the case of a 28-year-old woman with painful, pruritic vulvar irritation prompting her to apply topical benzocaine several times per day.

    • Perivulvar Pseudoverrucous Papules and Nodules in a 4-Year-Old Girl with Urinary and Fecal Incontinence: Case Report

      2022, Journal of Pediatric and Adolescent Gynecology
      Citation Excerpt :

      Similar to chronic (diaper) dermatitis, PPNs tend to occur where skin barriers and dermal thickness are decreased (such as in the genital area) compared with other parts of the body.9,12 Case reports from the literature suggest that the gross appearance of PPNs can be quite variable and mistaken for other irritant dermatoses associated with fecal and urinary incontinence (Jacquet's erosive dermatitis and granuloma gluteale infantum) or as manifestations of STIs.2,9 It is paramount to rule out HPV infection and secondary syphilis (condylomata lata) given the implications of sexual abuse in a pediatric patient.

    • Noninfectious Peritoneal Dialysis Exit Site Rash—An Unusual Case Report and Review of the Literature

      2018, Kidney International Reports
      Citation Excerpt :

      Granuloma gluteale aldutorum is part of the erosive papulonodular dermatosis disease spectrum and is believed to be from irritant contact dermatitis. It has been described in children as diaper rash8 and in adults with irritation of the skin from urine or topical benzocaine use.9 Granuloma gluteale infantum/adultorum is an uncommon proliferative reactive condition in response to severe chronic irritant contact dermatitis, which is usually seen in the anogenital region of patients with chronic diarrhea and or urinary incontinence.

    • Napkin dermatitis

      2015, Annales de Dermatologie et de Venereologie
    View all citing articles on Scopus

    Production and distribution supported by an educational grant to the American Academy of Dermatology by Stiefel Laboratories, Inc.

    Funding sources: None.

    Conflicts of interest: None identified.

    View full text