Perianal infectious dermatitis: An underdiagnosed, unremitting and stubborn condition

Table 5 Previous investigations, diagnoses and therapies in children with perianal infectious dermatitis

Name, yr, country	Population size; age; sex	Previous performed investigations and/or suspected diagnosis	Previous therapy
Spear, 1985, United States[28]	14; mean age 3.9 yr (range: 1-10 yr); M/F: 3.7/1	2 proctoscopies under general anesthesia, upper gastrointestinal x-ray series, barium enema; anal fissure, IBD, behavior disturbance, psychogenic stool holding, psoriasis, candidiasis, ammoniacal diaper dermatitis	Laxatives, suppositories, hydrocortisone, polymyxin, bacitracin and neomycin, povidone-iodine, triamcinolone
Farmer, 1987, United Kingdom[65]	1. 4 yr, M	1. Anal pinworms (negative)	1. Piperazine, miconazole, and hydrocortisone cream
	2. 5 yr, F	2. Anal pinworms (negative)	2. Clotrimazole cream
Kokx, 1987, United States[4]	31; 7 mo to 8 yr, mean 4.25 ± 1.8 yr; M 77%	Hemorrhoids, poor hygiene, perianal allergy to toilet paper perfumes, rectal fissures, and/or constipation
Rehder, 1998, United States[61]	1. 3 yr, M		1. Soaks, topical antifungals and corticosteroids
	2. 3 yr, M		2. Topical hydrocortisone, nystatin, triamcinolone and zinc oxide
	3. 4 yr, M	3. Pinworms	3. Oral cefaclor, with clearing of erythema, but recurrence
Marks, 1988, United States[63]	5 yr, M	Pinworms and stool for ova and parasites: negative	Topical A and D ointment, hydrocortisone, ketoconazole
Duhra, 1990, United Kingdom[29]	5 yr, M	Considered as possible case of sexual abuse; threadworms, candidiasis, psoriasis and eczema	Treatment for threadworms, candidiasis, psoriasis and eczema
Goodyear, 1991, United Kingdom[30]	4 yr, M	Examination under anesthesia and proctoscopy	Stool softeners, stimulant laxatives, topical anesthetics, steroid and antifungal creams
Montemarano, 1993, United States[32]	3 yr, M		Topical and oral nystatin
Grant, 1993, United Kingdom[10]	20; 5 mo to 12 yr; 75% M	2 cases: suspected Crohn’s disease 1 case: suspected sexual abuse	3 patients treated for worms, 7 treated for constipation, 5 topical treatment (steroids, lignocaine, eosin, fucidin)
Guppy, 1993, Australia[33]	1. 7 yr, M		1. Topical antifungal, antibacterial and steroid creams, oral pyrantel embonate and metronidazole
	2-3. 5 and 2.5 yr		2-3. Various antifungal, antibacterial and steroid creams, oral pyrantel embonate
	4. 4 yr, M		4. Local nystatin, hydrocortisone; oral pyrantel embonate
Patrizi, 1994, Italy[22]	5; 4-10 yr; 3 M		Topical agents, including steroid cream
Bugatti, 1998, Italy[39]	12 yr, M		Topical antifungal agents
Adams, 1999, Canada[40]	1 yr, M		Topical corticosteroids and clotrimazole
Roos, 1999, Sweden[41]	5 yr, M		Topical steroids
Herbst, 2000, Germany[9]	4 yr, M		Various ointments for the last several months
Brilliant, 2000, United States[43]	1. 4 yr, M		1. Topical ointment and baby powder, topical antifungal
	4. 4 yr, F		4. Topical antifungal
Heidelberger, 2000, Germany[45]	1. 6 yr, M		1. Tannolact seat baths and topical tetracycline
	2. 9 yr, M		2. Tannolact seat baths and topical clotrimazole
Soulliet, 2000, France[13]	7 yr, F	Candidiasis	Nystatin unsuccessful for suspected candidiasis
Lunghi, 2001, Italy[47]	Brother (4 yr) and sister (6 yr)		Both: Local and oral antifungal drugs for 4 mo
Mateo, 2002, Spain[19]	10; 9 mo to 7 yr; 6 M		4 cases: 2 steroids cream, 1 clotrimazole cream and 1 betamethasone and clotrimazole cream
Reimer,2004, Sweden[50]	1. 4 yr, M	1. Pinworms (negative)
	3. 4 yr, F		3. Local ointment (kenacutan)
Jongen, 2008, Germany[8]	21; < 14 yr (mean age 6.3 yr), 76% M	Anoscopy and rectoscopy: negative	Topical agents (zinc paste, corticosteroids, antimycotic ointments)
Rasi, 2009, Iran[56]	4 yr, M		Topical antibiotics, steroids and antifungal creams, 3 mo
Zhang, 2016, Canada[3]	1: 4 yr, M		1. Topical terbinafine and hydrocortisone acetate
	3: 3 yr, F		3. Gentle skin care, zinc barrier cream, topical antifungals, corticosteroids, and mupirocin
Garritsen, 2017, Netherlands[60]	19 mo, M		Topical corticosteroids and antimycotic agents
Serban, present paper, Romania	1. 9 yr 4 mo, M	1. Psoriasis, pinworms, candidiasis, eczema; Hospitalization in 6 public clinics and 2 private hospitals; upper and lower endoscopy under general anesthesia; magnetic resonance enterography – all negative; considered as Crohn’s disease and sent to our clinic	1. Topical antibiotics, steroids, antifungal and anesthetics creams; oral antiallergics
	2. 9 yr 6 mo, M	2. Pinworms, intestinal dysbiosis	2. Oral probiotics and therapy against worms; topical baneocin and neomycin, cortisone and anti-hemorrhoids
	3. 11 yr 9 mo, M	3. Eczema, anal fissure, constipation	3. Oral probiotics, osmotic laxatives and stool softeners; topical hydrocortisone, cicatrizants

F: Female; IBD: Inflammatory bowel disease; M: Male.