Case Report: Pediatric Palisaded Neutrophilic and Granulomatous Dermatitis without Systemic Diseases Treated with Sulfasalazine

Qiuyang Guo^1,2,3Yumeng Wang^1,2,3Qiuyi Han^1,2,3Jinxiang Yang^1,2,3Jiayan Zhang^1,2,3Guofang Li^1,2,3Yijun Yang^1,2,3Ruhong Cheng^1,2,3*Zhirong Yao^1,2,3*

• ¹Dermatology Center, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
• ²Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
• ³Institute of Dermatology, Shanghai Jiaotong University School of Medicine, Shanghai, China, Shanghai, China

Abstract: Palisaded neutrophilic and granulomatous dermatitis (PNGD) is a rare neutrophilic dermatosis strongly associated with systemic conditions. Pediatric cases with exclusive cutaneous involvement are exceptionally rare. Current treatment options for PNGD include oral dapsone, hydroxychloroquine, and intralesional or systemic corticosteroids. Here we report a 6-year-old girl with skin-limited PNGD, presenting symmetric annular plaques on limb extensor surfaces and atypical lesions on the face, palms, and buttocks. Significant lesion resolution was achieved after two months of oral sulfasalazine therapy (25 mg/kg/day in divided doses), with only mild abdominal discomfort. To our knowledge, this represents the first successful use of sulfasalazine for PNGD, providing a dapsone-sparing alternative for pediatric PNGD.