Palisaded Neutrophilic and Granulomatous Dermatitis Associated with Lupus Profundus: A Case Report and Literature Review

Abstract

Palisaded neutrophilic granulomatous dermatitis (PNGD) is an uncommon histological pattern of reactive granulomatous dermatitis, characterized by distinctive cutaneous manifestations. The primary histological features include localized collagen degeneration and palisading lymphohistiocytic infiltration, with or without vasculitis and mucin deposition. Although its etiology remains elusive, PNGD is frequently associated with systemic underlying conditions, such as autoimmune connective tissue disorders, lymphoproliferative diseases, and infections. It can precede the onset of underlying disorders or develop concurrently. Furthermore, certain medications can precipitate this condition. This report discusses the case of a 63-year-old woman who exhibited numerous painful erythematous papules and plaques on both extensors of the lower extremities, which were histologically consistent with palisaded neutrophilic and granulomatous dermatitis. The patient demonstrated improvement following eight months of dapsone treatment. Upon discontinuation of dapsone for two months, new skin lesions recurred on both knees, accompanied by the onset of non-scarring alopecia in the frontal and right temporal areas. A skin biopsy from the frontal area of the scalp revealed lupus profundus. The patient was subsequently administered dapsone and hydroxychloroquine, resulting in a favorable clinical response.