What causes granuloma gluteale infantum (GGI)?

Updated: May 27, 2021
  • Author: Marlene T Dytoc, MD, PhD, FRCPC; Chief Editor: Dirk M Elston, MD  more...
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Answer

Granuloma gluteale infantum is the result of chronic maceration. Diapering-related items (eg, diapers, plastic pants, paper napkins, laundry detergents, starch, powder), halogenated corticosteroids, candidal infection, and urine and feces are possible contributing factors. [6, 7, 8]

Sparing of deep body folds suggests that contact occlusion is predisposing.

Candida hyphae are detected in skin biopsy specimens obtained from some, but not all, patients. Intradermal testing to Candida albicans antigen does not elicit immediate or delayed hypersensitivity. Serum precipitates to C albicans and Candida parapsilosis are not found.

Most patients, including infants with facial and neck lesions, have previously been treated with a topical fluorinated steroid. This observation suggests a causative role for topical fluorinated steroids in this skin disorder. Absorption of corticosteroid preparations through inflamed skin of the diaper area leads to altered dermal collagen, which, in turn, stimulates an inflammatory response.

Urine can increase the pH of the diaper-covered area, promoting the action of fecal proteases and lipases. Together, urine and feces can irritate diapered skin, increasing its permeability and susceptibility to other irritants. Van et al reported a case related to adult urinary incontinence. [4, 5, 9]


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