Childhood granulomatous periorificial dermatitis

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Childhood granulomatous periorificial dermatitis
Other namesGianotti-type perioral dermatitis or Facial Afro-Caribbean childhood eruption
Specialty Dermatology

Childhood granulomatous periorificial dermatitis (CGPD), is a rare benign granulomatous skin disease of unknown cause. [1] The disorder was first described in 1970 by Gianotti in a case series of five children. [2] CGPD is more common in boys than girls. [3]

Contents

Signs and symptoms

CGPD is characterized by the presence of small, raised, dome-shaped, flesh-colored or yellow-brown papules primarily distributed around the mouth, eyes, and nose. [1] Affected children may also have papules on the ears, eyelids, cheeks, forehead, and nose. [1] CGPD skin lesions rarely affect areas of the skin other than the face. [1]

Cause

The cause of CGPD is unknown. [3]

Diagnosis

The approach to diagnosing CGPD is controversial. [2] Certain dermatologists suggest that ruling out infectious and allergic causes of similar skin eruptions and a skin biopsy demonstrating features consistent with CGPD is adequate for diagnosis. In contrast, other dermatologists advocate for performing a complete history and physical examination and obtaining laboratories and appropriate imaging to rule out cutaneous sarcoidosis. [2] On microscopy, non-tuberculous granulomas with surrounding lymphocytes clustered around hair follicles may be seen; additionally, infiltrates of epithelioid macrophages, lymphocytes, and giant cells may also be seen. [2] [3]

Several conditions exhibit skin findings similar to those of CGPD. These conditions include perioral dermatitis, acne vulgaris, granulomatous rosacea, contact dermatitis, folliculitis, atopic dermatitis, cheilitis, medication-induced acneiform eruptions, lupus miliaris disseminatus faciei, benign cephalic histiocytosis, granulosis rubra nasi, xanthomas, zinc deficiency, glucagonoma, cutaneous sarcoidosis, and scabies. [2] [3]

Treatment

Treatment recommendations for CGPD vary and may include observation without treatment, stopping the use of topical corticosteroids, and the use of topical or oral antibiotics as well as isotretinoin. [2] Topical antibiotics such as metronidazole and erythromycin have been used for CGPD. [2] Oral antibiotics of the tetracycline class such as minocycline, doxycycline, and tetracycline have been recommended for CGPD. [1] Trimethoprim/sulfamethoxazole has also been used. [2] The use of oral systemic antibiotics is limited by side effects such as nausea, vomiting, and sensitivity of the skin to sunlight. [1] Tetracycline antibiotics are not recommended for children under the age of 8 since tetracyclines are known to deposit in teeth (thereby staining them) and impair bone growth in children. [1]

The use of calcineurin inhibitor creams such as tacrolimus or pimecrolimus on the skin is controversial and results have been mixed. [1] Certain studies found the use of topical calcineurin inhibitors led to resolution of CGPD whereas others saw incomplete resolution or prolonged symptoms. [1] Topical azelaic acid has been used successfully to treat CGPD. [1] Immediate discontinuation of topical corticosteroids is recommended since corticosteroids are thought to worsen CGPD. [2]

Prognosis

CGPD is known to be a temporary skin disease with a benign course. [1] The skin papules typically resolve after a few months to a few years. After CGPD resolves, the skin may return to normal without scarring or may have small atrophic depressions with collagen loss, milia, or small pit-like scars. [1]

Epidemiology

CGPD occurs most often in children of Afro-Caribbean descent before puberty though reports of this disease occurring in Asian and Caucasian children have also been described. [1] [3] Due to the limited number of reported cases, it remains controversial whether CGPD occurs more often in African children than in children of other races. [2] CGPD is more common in boys than girls. [3]

History

Gianotti et al. first described CGPD in five Italian children in 1970. [3] In 1990, Williams et al. described a similar skin eruption in five children of Afro-Caribbean descent and coined the proposed term "facial Afro-Caribbean childhood eruption (FACE)". [3] Subsequently, another article by Katz and Lesher first introduced the term CGPD since some reported cases were not found in children of Afro-Caribbean descent and to avoid confusion with perioral dermatitis. [3]

See also

Related Research Articles

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References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 Dessinioti, C; Antoniou, C; Katsambas, A (January–February 2014). "Acneiform eruptions". Clinics in Dermatology (Review). 32 (1): 24–34. doi:10.1016/j.clindermatol.2013.05.023. PMID   24314375.
  2. 1 2 3 4 5 6 7 8 9 10 Zalaudek, I; Di Stefani, A; Ferrara, G; Argenziano, G (April 2005). "Childhood granulomatous periorificial dermatitis: a controversial disease". Journal of the German Society of Dermatology (Review). 3 (4): 252–5. doi:10.1111/j.1610-0387.2005.05009.x. PMID   16370472. S2CID   9802651.
  3. 1 2 3 4 5 6 7 8 9 Kim, YJ; Shin, JW; Lee, JS; Park, YL; Whang, KU; Lee, SY (August 2011). "Childhood granulomatous periorificial dermatitis". Annals of Dermatology (Review). 23 (3): 386–8. doi:10.5021/ad.2011.23.3.386. PMC   3162274 . PMID   21909215.
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