Palisaded neutrophilic and granulomatous dermatitis following a long-standing monoclonal gammopathy: A case report

Surgical Excision of Palisaded Neutrophilic and Granulomatous Dermatitis of the Vulva: A Case Report

Palisaded neutrophilic and granulomatous dermatitis (PNGD) is an inflammatory cutaneous disorder of unknown etiology that typically occurs in association with systemic disease. Rheumatoid arthritis and systemic lupus erythematosus are the most common associated diseases. PNGD manifests as skin-colored to erythematous papules and plaques, mainly on the extremities. However, to the best of our knowledge, no cases of PNGD in the vulva have been reported in foreign literature to date. Herein, we report the first case of a 31-year-old female with systemic lupus erythematosus disease who presented multiple plaques and a pigmented, rough, mamillated skin surface affecting the vulva, leading to disfigurement of the vulva and interfering with sexual intercourse due to severe pain, irritation, and frequent infection. Surgical excision of the whole lesion with reconstruction of the vulva was done in two sessions and histologically diagnosed as PNGD.

Palisaded Neutrophilic Granulomatous Dermatitis, Bowel-Associated Dermatosis-Arthritis Syndrome, and Rheumatoid Neutrophilic Dermatitis

Neutrophilic dermatosis is a heterogeneous group of inflammatory skin diseases characterized by the presence of a sterile neutrophilic infiltrate on histopathology. Three specific types of neutrophilic dermatoses are reviewed in this article: palisaded neutrophilic granulomatous dermatitis, bowel-associated dermatosis-arthritis syndrome, and rheumatoid neutrophilic dermatitis. The authors review the literature and highlight the clinical and histopathological features, disease pathogenesis, and the association of these conditions with various systemic diseases such as rheumatoid arthritis, inflammatory bowel disease, and others. A multidisciplinary approach is necessary for the diagnosis and management of these inflammatory skin conditions.