INTERSTITIAL GRANULOMATOUS DERMATITIS
By Gary M. White, MD
Interstitial granulomatous dermatitis (IGD) is somewhat a poorly defined condition that has gone by various names including palisaded neutrophilic granulomatous dermatitis, linear subcutaneous bands, interstitial granulomatous dermatitis with cutaneous cords and arthritis, rheumatoid papules, and Churg-Strauss granuloma. Linear, cordlike bands seen in the axillae are associated with arthritis.
- The main consideration in the differential diagnosis is granuloma annulare.
- Autoantibodies may be seen, e.g. RF, ANA, ANCA, thyroglobulin, and anti-DNA histone.
- Typically affected joints include the fingers, wrists, elbows, and shoulders symmetrically.
- Morning stiffness is common.
- It is associated with a variety of conditions but most commonly autoimmune diseases such as rheumatoid arthritis or lupus.
- It may be associated with various hematology malignancies, e.g. leukemia and lymphoma.
- It has been reported as the initial manifestation of myeloma [JAMADerm 2015;151;1141] or sarcoidosis.
Multiple asymptomatic papules and plaques develop. In a small subset of patients, linear, prominent, red, cutaneous cords occur--often in the axilla. This is the so-called "rope sign". Patients are typically in their 50-60's with a female predominance.
Dermatology Online Journal 19(2)
Dermatology Online Journal 18(12)
An asymptomatic plaque of IGD as the initial manifestation of myeloma. JAMADerm 2015;151;1141]
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