Pseudoverrucous papules and nodules in the setting of a chronically draining abscess

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Conference Proceeding

Publication Date


Publication Title

J Am Acad Dermatol


We report a case of a 48-year-old African American male with a history of poorly controlled diabetes and hypertension was admitted to the hospital for a chronically draining left mid back paraspinal abscess for over one year. He had a history of recurrent abscesses on different areas of his skin, however the one on his left back had been persistent. On physical exam, on the mid back to the left of midline there was a collection of verrucous, keloidal papules and nodules coalescent into a large irregularly shaped plaque with surrounding erythema, tenderness and fluctuance. Punch biopsies of the exophytic nodules showed acanthosis, hyperkeratosis, papillomatosis, fibrotic dermis with increased vessels, and sparse lymphoid inflammation. These histologic findings were consistent with the diagnosis of pseudoverrucous papules and nodules (PPN). After failing multiple oral antibiotics, per the Infectious Disease team the patient was treated with IV daptomycin and the goal was to keep the skin clean and dry. PPN has been commonly described in the perianal or peristomal region in children or adults with chronic urinary and/or fecal incontinence for multiple reasons. It was first noted around urostomy sites. In all cases of PPN, prolonged wetness seems to be the key factor. It has been proposed that Jacquet erosive diaper dermatitis and granuloma gluteal infantum/adultorum are a spectrum of disease with PPN. The most important factor in treating PPN is removing the irritant. Zinc oxide creams can restore the barrier function of the skin and topical steroids decrease inflammation.




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