Perianal infectious dermatitis: An underdiagnosed, unremitting and stubborn condition

Table 2 Studies/case series with perianal infectious dermatitis: Therapy and follow-up of patients

Name, yr, country	Therapy of PID and results	Follow-up of PID
Amren, 1966, United States[2]	IM Pen, 10 d plus oral Pen, 10 d: disappearance of symptoms in 2-3 d	After therapy: 2 cases GAS positive; 10 d of Pen (same type): Effective in eradicating GAS in both cases
Spear, 1985, United States[28]	Oral Pen: rapid resolution of PID	Recurrence of infection: Not uncommon, requiring a repeated course of oral AB
Kokx, 1987, United States[4]	Oral Pen or amoxicillin, 10 d: clinical and bacteriological clearance in 61%	39% relapses, treated with IM or oral Pen; 4 children failed; 3 successfully treated with oral clindamycin, 10 d; 4th case successfully treated with oral Pen (10 d) and rifampin (last 4 d)
Krol, 1990, Canada[20]	Oral Pen, 10 d plus topical mupirocin in 4 cases (these 4 without recurrence)	2 cases: 2nd course of therapy within 1 mo
Grant, 1993, United Kingdom[10]	Oral Pen, 3 wk: 14 responded (6 plus topical fucidin)	6 cases: No complete response; successful 2nd course of oral Pen and topical fucidin
Patrizi, 1994, Italy[22]	1. Oral erythromycin, 14 d	1. 4 wk later, GP and PID disappeared and all swabs negative
	2. Oral Pen, 2 wk	2. Lesions improved, but swab positive: erythromycin, 2 wk: complete healing (including negative GAS)
	3. Oral erythromycin, 2 wk	3. Lesions disappeared in maximum 5 wk
	4. Oral erythromycin and topical mupirocin, 2 wk	4. 4 wk later, lesions and culture negative
	5. Amoxicillin, 2 wk: good results	5. 4 wk later, perianal GAS, no lesions; 2nd course of amoxicillin: good results
Wright, Australia, 1994[11]	Oral amoxicillin - clavulanate plus topical bacitracin, 2 wk	50%: Response to treatment in 2 wk; no recurrence
Barzilai, 1998, Israel[14]	Oral amoxicillin, 10 d and topical mupirocin: 16 patients clinically cured; perianal cultures GAS negative: days 3-5 of therapy and weeks 2 to 3 post-therapy	Recurrence: 2 cases (clinical and culture); successfully retreated 1 wk after finishing first therapy
Mateo, 2002, Spain[19]	IM Pen (1), oral amoxicillin (5), topical mupirocin (4)	All with favorable response and no recurrence
Petersen, 2003, Denmark[27]	Oral Pen, 10 d: ineffective in 3 cases	3 cases: Clarithromycin, 7 d; no recurrence
Landolt, 2005, Switzerland[17]	10 with > 1 symptom: oral Pen, 10 d; 3: oral or IV amoxicillin-clavulanate	4 with persistent symptoms: 2nd course of AB - oral Pen (3 cases), 14 d and oral clarithromycin (1 case), 10 d; 1 mo later: all 4 healed
Echeverría Fernández, 2006, Spain[6]	Oral Pen, 10 d	Favorable in 85%, perianal GAS negative in 95%
Meury, 2008, Switzerland[12]	15 cases: oral Pen, 10 d and 14 cases: oral cefuroxime, 7 d	Clinical improvement: More rapid in the cefuroxime group (P = 0.028) and perianal GAS negative the last day of therapy in 93% on cefuroxime vs 47% on Pen (P < 0.01)
Jongen, 2008, Germany[8]	Oral Pen ± local polihexanid, 10-14 d	1 case: New GAS associated PID 5 mo later; successfully treated with oral AB
Shouval, 2008, Israel[18]	Oral amoxicillin, 10 d and topical mupirocin (8/11); complete healing in 73%	Recurrence: 3/11; 2nd course of AB administered
Heath, 2009, United States[26]	Oral cephalexin for S. aureus: Successful in all but one; 4 cases with S. aureus cleared on topical mupirocin and 1 on bleach baths and topical steroids	1 case with MRSA: 2nd course of oral AB required
Olson, 2011, United States[25]	Oral AB alone: 81.4%; topical agent alone: 2.5%; both: 16%; duration: oral beta-lactams 10 d, azithromycin 5 d, cephalexin 5 d, oral Pen 14 d	Recurrence 32.1%; recurrence within 6 wk 69.2%; recurrence rate: After Pen or amoxicillin 38.1% vs 27.8% after a beta-lactamase resistant AB (adjusted odds ratio: 2.02)
Clegg, 2015, United States[23]	Amoxicillin 82.2%; cephalexin 11%; other AB 7%; topical therapy: 6%	Recurrence rate (symptomatic PID) 6 mo after the initial episode: 13.4% after any AB, 12.4% after amoxicillin, 29.4% after cephalexin, and 0% after all other AB (oral Pen, amoxicillin-clavulanate, azithromycin, clarithromycin, cefprozil and cefdinir)
Garcia, 2015, Spain[21]	Oral AB (Pen 5, amoxicillin 1), plus 4 topical mupirocin and 3 clotrimazole	Satisfactory; 1 recurrence
Sterbenc, 2016, Slovenia[24]		All BHS: susceptible to Pen; all GAS susceptible to clindamycin, 1.4% resistant to erythromycin; GBS resistant to erythromycin in 14.8% and clindamycin in 7.4% of cases

AB: Antibiotic; BHS: Beta-hemolytic streptococci; GAS: Group A beta-hemolytic streptococci; GBS: Group B beta-hemolytic streptococci; GP: Guttate psoriasis; IM: Intramuscular; IV: Intravenous; Pen: Penicillin; MRSA: Methicillin-resistant S. aureus; PID: Perianal infectious dermatitis.