Granuloma gluteale infantum: an unusual complication of napkin dermatitis.

A 7-month-old male infant was brought to this department by his parents without referral from his family doctor. For 6 months he had suffered from a rash in the napkin area which was resistant to various treatments. These had included a variety of 'barrier' creams, topical antifungal agents and Hydrocortisone ointment. Recently the parents had become concerned by the development of two lesions within the napkin area. Examination revealed a dry erythematous papular rash over the lower abdomen, the centre of which contained two raised, bluish-purple, nodular lesions of differing size and shape. The proximal lesion was rounded and 05 cm in diameter, whilst the distal lesion was oval-shaped with dimensions of 5 x 2 cm. (Fig. 1) The patient was referred to a dermatologist who diagnosed Granuloma Gluteale Infantum. The infant was admitted to hospital for observation and treatment. Hydrocortisone cream was applied to the granulomatous areas and a fluorinated steroid cream to the remainder of the rash. Both the napkin dermatitis and granulomas improved on this regimen. The patient remained on this regimen for 3 weeks, requiring only barrier cream thereafter. Subsequent review over 6 months demonstrated slow resolution but not complete healing of the granulomas, without evidence of scarring.