Case for Diagnosis
Periorificial Lesions in a Young Girl
Lesiones periorificiales en una niña
A. Mayor-Ibarguren
, R. Maseda-Pedrero, M. Feito-Rodríguez
Corresponding author
Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain
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Mayor-Ibarguren, R. Maseda-Pedrero, M. Feito-Rodríguez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Mayor-Ibarguren" "email" => array:1 [ 0 => "andermayor@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Maseda-Pedrero" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Feito-Rodríguez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital Universitario La Paz, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Lesiones periorificiales en una niña" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 401 "Ancho" => 975 "Tamanyo" => 78944 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Medical History</span><p id="par0005" class="elsevierStylePara elsevierViewall">An 8-year-old girl with no relevant personal or family medical history presented with asymptomatic facial lesions that had appeared several months earlier and had not responded to topical corticosteroids. The patient had no history of atopic dermatitis. She was in good general health, with no joint pain, fever, abdominal pain, or weight loss.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Physical Examination</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient presented numerous firm, skin-colored, monomorphous papules distributed in periorificial areas (perioral, perinasal, periocular), accompanied by erythema and desquamation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Similar lesions were present in the vulvar area (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The physical examination was otherwise completely normal.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Histopathology</span><p id="par0015" class="elsevierStylePara elsevierViewall">A biopsy of a vulvar lesion revealed a dense lymphohistiocytic perivascular infiltrate in the upper dermis as well as the formation of noncaseating epithelioid granulomas (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The epidermis was spared. Ziehl-Neelsen and periodic acid-Schiff stains were negative. The presence of <span class="elsevierStyleItalic">Demodex folliculorum</span> was not detected in the follicles.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Additional Tests</span><p id="par0020" class="elsevierStylePara elsevierViewall">A complete blood count and biochemistry profile revealed no abnormalities. Levels of angiotensin-converting enzyme (ACE) and immunoglobulins were normal. A Mantoux test was negative and a chest radiograph showed no anomalies.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">What Is Your Diagnosis?</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Diagnosis</span><p id="par0030" class="elsevierStylePara elsevierViewall">Childhood granulomatous periorificial dermatitis (CGPD).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Course and Treatment</span><p id="par0035" class="elsevierStylePara elsevierViewall">Topical corticosteroids were suspended. Treatment with oral erythromycin was started, but little improvement was noted. The patient was switched to oral metronidazole (250<span class="elsevierStyleHsp" style=""></span>mg/d). A striking improvement was noted after 2 weeks and the lesions had resolved completely at 4 weeks.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Childhood granulomatous periorificial dermatitis (CGPD) is a benign, self-limited skin disease that has many characteristics in common with the perioral dermatitis typically seen in middle-aged women. The disease was first described in 1970 by Gianotti,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> who reported a case series of 5 children with monomorphous papules that resembled perioral dermatitis. Other names have been used to describe this entity, including facial Afro-Caribbean cutaneous eruption (FACE), sarcoid-like granulomatous dermatitis, and Gianotti-type perioral dermatitis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> The term <span class="elsevierStyleItalic">childhood granulomatous periorificial dermatitis</span>, first used by Urbatsch et al.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> in 1989, is currently the most widely accepted term because it most accurately encompasses the characteristics of the entity. CGPD usually affects prepubertal children, and the incidence of the disease may be higher in black patients, although publication bias may account for the difference.</p><p id="par0045" class="elsevierStylePara elsevierViewall">CGPD is characterized by the appearance of lesions in the form of monomorphous skin-colored papules distributed across the periorificial regions of the face, which may be accompanied by erythema and desquamation. Unlike perioral dermatitis, CGPD generally does not manifest with pustules.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Extrafacial involvement can include the perivulvar region, the neck, the upper trunk, and the limbs. The lesions are usually asymptomatic and tend to resolve without scarring. The etiology of CGPD is unknown, but it appears that topical corticosteroids, especially fluorinated corticosteroids, can trigger or exacerbate the process.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Histologic findings show a perivascular and perifollicular lymphohistiocytic infiltrate and the formation of epithelioid granulomas that can be either caseating or noncaseating.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,3</span></a> The presence of granulomas is not a necessary criterion for diagnosis. The differential diagnosis should include rosacea, acne vulgaris, sarcoidosis, Blau syndrome, lupus miliaris disseminatus faciei, candidiasis, angular cheilitis, atopic dermatitis, demodicidosis, and benign cephalic histiocytosis.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> It is important to ask about constitutional symptoms, joint pain, and respiratory involvement. A laboratory workup including angiotensin-converting enzyme levels and a chest radiograph should be ordered in order to rule out sarcoidosis. In the case of our patient, it was possible to rule out these possible diagnoses on the basis of the medical history and the additional test results.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Treatment options include the suspension of topical corticosteroids and the application of various topical antibiotics, including erythromycin and 0.75% metronidazole, with variable results. In patients with extensive or refractory lesions, systemic treatment with erythromycin or doxycycline is recommended (the latter in children older than 8 years of age).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> A recent case report described the successful treatment of CGPD with oral metronidazole, as in our patient.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Medical History" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Physical Examination" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Histopathology" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Additional Tests" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Diagnosis" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Clinical Course and Treatment" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Comment" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Mayor-Ibarguren A. Lesiones periorificiales en una niña. Actas Dermosifiliogr. 2016;107:773–774.</p>" ] ] "multimedia" => array:3 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 401 "Ancho" => 975 "Tamanyo" => 78944 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 336 "Ancho" => 400 "Tamanyo" => 40278 ] ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 302 "Ancho" => 400 "Tamanyo" => 86864 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hematoxylin-eosin, original magnification ×100.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Particuliére dermatite periorale infantile. Observations sur cinq cas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Gianotti" 1 => "E. Ermacora" 2 => "M.G. Bennelli" 3 => "R. Caputo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Bull Soc Fr Dermatol Syphiligr" "fecha" => "1970" "volumen" => "77" "paginaInicial" => "341" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood granulomatous periorificial dermatitis: A controversial disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "I. Zalaudek" 1 => "A. di Stefani" 2 => "G. Ferrara" 3 => "G. 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Lesher" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "1996" "volumen" => "13" "paginaInicial" => "131" "paginaFinal" => "134" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9122070" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood granulomatous periorificial dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.C. Williams" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "1996" "volumen" => "6" "paginaInicial" => "515" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Childhood granulomatous periorificial dermatitis with a good response to oral metronidazole" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Rodríguez-Caruncho" 1 => "I. Bielsa" 2 => "M.T. Fernández-Figueras" 3 => "C. Ferrándiz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/pde.12110" "Revista" => array:6 [ "tituloSerie" => "Pediatr Dermatol" "fecha" => "2013" "volumen" => "30" "paginaInicial" => "e98" "paginaFinal" => "e99" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23437890" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010700000009/v1_201611010039/S1578219016301883/v1_201611010039/en/main.assets" "Apartado" => array:4 [ "identificador" => "6154" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case for Diagnosis" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010700000009/v1_201611010039/S1578219016301883/v1_201611010039/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219016301883?idApp=UINPBA000044" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 16 | 14 | 30 |
| 2024 October | 69 | 49 | 118 |
| 2024 September | 89 | 32 | 121 |
| 2024 August | 110 | 51 | 161 |
| 2024 July | 87 | 42 | 129 |
| 2024 June | 73 | 52 | 125 |
| 2024 May | 88 | 44 | 132 |
| 2024 April | 67 | 26 | 93 |
| 2024 March | 73 | 32 | 105 |
| 2024 February | 77 | 40 | 117 |
| 2024 January | 48 | 25 | 73 |
| 2023 December | 55 | 29 | 84 |
| 2023 November | 63 | 24 | 87 |
| 2023 October | 55 | 27 | 82 |
| 2023 September | 64 | 32 | 96 |
| 2023 August | 57 | 15 | 72 |
| 2023 July | 46 | 24 | 70 |
| 2023 June | 34 | 19 | 53 |
| 2023 May | 37 | 23 | 60 |
| 2023 April | 45 | 25 | 70 |
| 2023 March | 33 | 32 | 65 |
| 2023 February | 43 | 30 | 73 |
| 2023 January | 43 | 20 | 63 |
| 2022 December | 67 | 34 | 101 |
| 2022 November | 42 | 32 | 74 |
| 2022 October | 72 | 23 | 95 |
| 2022 September | 23 | 23 | 46 |
| 2022 August | 75 | 27 | 102 |
| 2022 July | 65 | 34 | 99 |
| 2022 June | 28 | 26 | 54 |
| 2022 May | 35 | 28 | 63 |
| 2022 April | 32 | 26 | 58 |
| 2022 March | 52 | 36 | 88 |
| 2022 February | 31 | 22 | 53 |
| 2022 January | 43 | 36 | 79 |
| 2021 December | 34 | 33 | 67 |
| 2021 November | 31 | 35 | 66 |
| 2021 October | 43 | 46 | 89 |
| 2021 September | 21 | 43 | 64 |
| 2021 August | 22 | 25 | 47 |
| 2021 July | 31 | 26 | 57 |
| 2021 June | 26 | 21 | 47 |
| 2021 May | 33 | 32 | 65 |
| 2021 April | 69 | 46 | 115 |
| 2021 March | 68 | 26 | 94 |
| 2021 February | 44 | 25 | 69 |
| 2021 January | 24 | 21 | 45 |
| 2020 December | 24 | 12 | 36 |
| 2020 November | 21 | 15 | 36 |
| 2020 October | 17 | 13 | 30 |
| 2020 September | 37 | 12 | 49 |
| 2020 August | 23 | 18 | 41 |
| 2020 July | 18 | 13 | 31 |
| 2020 June | 38 | 24 | 62 |
| 2020 May | 21 | 10 | 31 |
| 2020 April | 27 | 12 | 39 |
| 2020 March | 33 | 16 | 49 |
| 2020 February | 6 | 2 | 8 |
| 2019 December | 4 | 0 | 4 |
| 2019 September | 4 | 0 | 4 |
| 2019 June | 2 | 0 | 2 |
| 2019 May | 1 | 0 | 1 |
| 2019 April | 0 | 4 | 4 |
| 2019 March | 2 | 0 | 2 |
| 2019 February | 3 | 0 | 3 |
| 2019 January | 3 | 0 | 3 |
| 2018 December | 17 | 0 | 17 |
| 2018 November | 13 | 0 | 13 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 3 | 0 | 3 |
| 2018 February | 29 | 6 | 35 |
| 2018 January | 107 | 14 | 121 |
| 2017 December | 102 | 7 | 109 |
| 2017 November | 49 | 7 | 56 |
| 2017 October | 39 | 13 | 52 |
| 2017 September | 37 | 12 | 49 |
| 2017 August | 31 | 6 | 37 |
| 2017 July | 42 | 9 | 51 |
| 2017 June | 35 | 8 | 43 |
| 2017 May | 32 | 8 | 40 |
| 2017 April | 32 | 13 | 45 |
| 2017 March | 23 | 8 | 31 |
| 2017 February | 20 | 9 | 29 |
| 2017 January | 20 | 8 | 28 |
| 2016 December | 37 | 23 | 60 |
| 2016 November | 53 | 38 | 91 |
| 2016 October | 12 | 10 | 22 |
Show all
