Perianal infectious dermatitis: An underdiagnosed, unremitting and stubborn condition

Abstract

Perianal infectious dermatitis (PID) represents a superficial inflammation of the perianal skin, which is of bacterial origin (classically, group A beta-hemolytic streptococci). This narrative review aims to critically review and summarize the available scientific literature regarding pediatric PID, being the first of its kind, to the best of the author’s knowledge. It also reports the first cases of Romanian children with PID. Multiple databases were subjected to systematic literature search (from 1966 to April 30, 2018) to identify studies and case reports of children with PID. As such, this review provides updated information about essential aspects of PID (epidemiology, etiology, pathogenesis, as well as clinical features, required investigations and therapeutic options) and of diagnostic pitfalls. Although a well-defined entity, PID remains largely underdiagnosed. PID may mimic other common conditions with skin manifestations (like candidiasis, pinworms, eczema, irritant dermatitis, anal fissure, hemorrhoids, Crohn’s disease, psoriasis, seborrheic dermatitis, zinc deficiency dermatosis and even sexual abuse), with consequent unnecessary, sometimes expensive and invasive investigations and futile therapies, which cause patients and families discomfort and distress. Since PID has an unremitting course, early recognition is imperative, as it allows for prompt and efficacious antibiotic therapy. However, PID represents a stubborn condition and, even if properly treated, its recurrence rate remains high. Further well-designed prospective randomized controlled trials, with adequate follow-up, are required in order to formulate the optimum personalized antibiotic therapy (oral alone or in association with topical medication), able to prevent recurrences. Awareness of this condition by healthcare professionals should improve patient outcomes.

Keywords: Perianal dermatitis; Perianal streptococcal dermatitis; Beta-hemolytic streptococci; Staphylococcus aureus; Perineal streptococcal dermatitis; Perianal swab culture; Differential diagnosis; Antibiotic therapy; Perianal streptococcal disease

Core tip: Perianal infectious dermatitis (PID) represents a superficial inflammation of the perianal skin, which is of bacterial origin. This narrative review aims to summarize the available literature regarding pediatric PID, being the first of its kind, to the best of the author’s knowledge. An updated insight into the main features of PID is provided, including diagnostic pitfalls. PID may mimic other common conditions with skin manifestations, with consequent application of a treatment that is wrong. The unremitting course of PID makes early recognition and antibiotic therapy crucial. Recurrence rates of PID remain high. Awareness of this condition should improve patient outcomes.