Interstitial granulomatous dermatitis (IGD) is a rare dermatosis first described by Ackerman in 1993 [1]. IGD is characterized by erythematous to violaceous patches or plaques, symmetrically located on the upper trunk and proximal limbs. Although linear subcutaneous cords or bands, known as the “rope sign”, were initially considered pathognomic, this finding has only been reported in less than 10% of cases [2]. Arthritis is also an inconsistent feature, which may occur prior to, simultaneously with, or after the onset of the cutaneous lesions. Diagnosis is confirmed by histological findings showing palisading or interstitial CD68+ histiocytes, a variable number of neutrophils and eosinophils, and scattered areas of degenerating collagen bundles [2, 3]. The pathogeny of IGD is unclear and it may belong to the same spectrum of palisaded and neutrophilic granulomatous dermatitis [4]. IGD is frequently associated with autoimmune diseases such as rheumatoid arthritis, or neoplasia and hemopathy. Iatrogenic origin is common, especially with beta-blockers, ACE inhibitors, anti-TNF drugs, and more recently, immune checkpoint inhibitors [5, 6]. Spontaneous regression is slow and uncertain, and the treatment is still poorly codified even though satisfactory results have been obtained with topical or systemic corticosteroids, methotrexate, cyclosporin or immunoglobulins [3].

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