Perianal infectious dermatitis: An underdiagnosed, unremitting and stubborn condition

Table 4 Case reports with perianal infectious dermatitis: Therapy and follow-up of patients

Name, yr, country	Case age, sex	Therapy of PID and results	Follow-up of PID
Hirschfeld, 1970, United States[59]	1-2. 6 yr, F and 3 yr brother	Oral Pen
	3-4. 5 yr and 3 yr brothers (unrelated family)
Farmer, 1987, United Kingdom[65]	1. 4 yr, M	1. Oral Pen: prompt and complete recovery
	2. 5 yr, F	2. Oral Pen, 1 wk: asymptomatic
Rehder, 1998, United States[61]	1. 3 yr, M	1. Oral Pen, 2 wk	1. 2 wk later, erythema and GAS positive: erythromycin, for 1 mo; no recurrence (including culture)
	2. 3 yr, M	2. Oral Pen, 2 wk	2. No recurrence (including cultures)
	3. 4 yr, M	3. Oral Pen, 3 wk	3. Perianal cultures positive after 2 and 3 wk: erythromycin, 10 d: negative culture
	4. 1 yr, F	4. Oral Pen, 3 wk: both conditions cleared	4. All negative
Honig, 1988, United States[62]	4; 15 mo, 6, 8 and 12 yr; 3 M	Oral Pen, 10 d; PID cleared in 3 cases within 10-14 d	The 4th case with PID history of 2 Y: 10 d of erythromycin, cleared PID and negative culture; psoriasis cleared 14-35 d after institution of therapy
Marks, 1988, United States[63]	5 yr, M	Oral Pen, 14 d; rash progressively healed (completely in 17 d)
Duhra, 1990, UK[29]	5 yr, M	Oral Pen, 3 wk: clearance of penile lesion (2 wk), but not perianal, also with positive GAS	Other 2 wk of oral Pen cleared PID and GAS
Goodyear, 1991, United Kingdom[30]	4 yr, M	Oral Pen, 10 d; completely resolved in 2 wk	Follow up 2 mo later: clinically well
Medina, 1992, Spain,[31]	4 Y, M	Topical mupirocin, 10 d: Completely resolved	Negative cultures 1 wk and 1 mo later
Montemarano, 1993, United States[32]	3 Y, M	Oral erythromycin, 10 d: Rapid cure
Guppy, 1993, Australia[33]	1. 7 yr, M	1. Oral Pen, 10 d	1. After stopping Pen, rectal bleeding: Cefaclor, 10 d, no recurrence
	2-3. His 2 brothers, 5 and 2.5 yr	2. Oral Pen, 10 d	2. No recurrence
		3. Oral Pen, 10 d, initially improved	3. 3 mo later: Persistent perianal infection: erythromycin
	4. 4 yr, M	4. Oral Pen, 2 wk, incomplete resolution	4. Erythromycin, 4 wk: Complete resolution
Paradisi M, 1993, Italy[34]	3 yr, M	Topical erythromycin, 15 d: Complete clinical and bacteriologic resolution	No recurrence
van Zeijl, 1996, Netherlands[36]	4; 3 M (1, 6 and 8 yr, the last 2 brothers); 1 F (2 yr)	Oral Pen, 10 d ± mupirocin or fucidin Oral amoxicillin + fucidin
Saxen, 1997, Finland[37]	1. 3 yr, M	1. Oral Pen, 10 d: clearance within 2 d	1. 1 wk after stopping Pen: PID recurrence, with GAS positive; oral cephalexin: good results
Berlin, 1997, United States[38]	3 yr, M	IV antibiotics (not mentioned)	Symptoms resolved entirely after 2 wk
Bugatti, 1998, Italy[39]	12 yr, M	Amoxicillin, 10 d: Rapid resolution of symptoms
Adams, 1999, Canada[40]	1 yr, M	Oral Pen and topical mupirocin, 10 d
Roos, 1999, Sweden[41]	5 yr, M	Cefadroxil plus topical fucidin, 10 d	No recurrence
Velez, 1999, Spain[42]	2 yr, M	Cefaclor, 10 ds: complete healing	2 wk after therapy: Acral (hands and feet) scarlatiniform desquamation
Herbst, 2000, Germany[9]	4 yr, M,	Oral Pen and topical fucidin, 2 wk: Complete healing (including culture)
Brilliant, 2000, United States[43]	1. 4 yr, M	1. Oral amoxicillin, dramatic improvement 1 d
	2-3. 2 mo and 30 mo	2-3. Same effective therapy
	4. 4 yr, F	4. Same effective therapy
Balasubramanian, 2000, India[44]	1. 13 mo, M	Oral Pen, 10 d; symptoms clearance in 3 d
	2.11 mo, M
	3. 13 mo, F
Heidelberger, Germany, 2000[45]	1. 6 yr, M	1: Oral Pen, 10 d
	2. 9 yr, M	2. Same plus topical clioquinol; in both cases, all lesions disappeared
Nowicki, 2000, United States[46]	7 yr, M	Oral Pen: Symptoms and signs disappeared	1 wk following Pen, peeling from his fingers tip (toes not involved)
Soulliet, 2000, France[13]	7 yr, F	Amoxicillin, 10 d; perianal lesions cleared by day 2
Lunghi, 2001, Italy[47]	Brother (4 yr) and sister (6 yr)	IM Pen, 4 wk, plus local mupirocin	Complete resolution (with negative culture) within 4 wk; no relapse in 4 mo
Huang, 2003, Taiwan[49]	6 yr, M	Oral Pen and topical mupirocin, 14 d: clinical healing after 4 d	After starting Pen: desquamation of fingers and perioral skin
Reimer, 2004, Sweden[50]	1. 4 yr, M	Oral Pen in all cases: quickly healed
	2. 6 yr, M
	3. 4 yr, F
Takeshita, 2006, Japan[51]	1. 2 yr, F	Oral antibiotics: rapid resolution of the condition
	2. 6 mo, M
Usuki, 2006, Japan[52]	5 yr, F	Oral and topical antibiotics
Ulger, 2007, Turkey[53]	3 yr, M	Oral Pen, 2 wk; topical corticosteroids for GP; all lesions healed	No recurrence
Greisser, 2008, Swiss[54]	7 yr, M	Oral amoxicillin, 6 d: Rapid improvement	No recurrence
Ledoux, 2009, France[55]	4 yr, M	Josamycin 1 mo and desonide for GP: All symptoms subsided	No relapse in 6 mo
Rasi, 2009, Iran[56]	4 yr, M	Oral amoxicillin, 10 d: Clinical response within 3 d, healed in 3 wk; GAS negative after 3 wk	No improvement of psoriatic lesions
Block, 2013, United States[57]	1. 2 mo, F	Amoxicillin, 10 d, in both patients	No recurrence in both cases
	2. 4 mo, F
Theotokatou, 2014, Greece[58]	1. 8 yr, M	Oral cefuroxime and topical mupirocin for both brothers: effective by day 4
	2. 10 yr, M, brother
Zhang 2016, Canada[3]	1. 4 yr, M	1. Oral cefuroxime, 7 d plus topical fucidin	1. 3 mo later: Throat and anus GAS negative; PID cleared
	2. 4 yr, M	2. Oral cefuroxime, 7 d plus betamethasone for GP	2. 2 wk later, perianal GBS positive: topical Fucidin; 3 mo later: GBS negative and cleared GP
	3. 3 yr, F	3. Oral cefuroxime, 7 d plus topical fucidin; persistent erythema and discharge	3. Vulvar culture: GCS and GBS, perianal culture: GCS; culture from vaginal introitus: positive GAS: oral amoxicillin, 10 d
Garritsen, 2017, Netherlands[60]	19 mo, M	Oral Pen plus mometasone for GP; 4 wk: PID and GP significantly improved
Serban, present study, Romania	1. 9 yr 4 mo, M	1. Spiramycin and topical mupirocin, 2 wk: improvement after 2 d; perianal culture negative on day 7; completely healed after 12 d	1. No recurrence after 2 yr
	2. 9 yr 6 mo, M	2. Spiramycin, 2 wk: improvement since day 2; negative perianal culture on day 7; completely healed after 1 wk	2. No recurrence after 7 mo
	3. 11 yr 9 mo, M	3. Spiramycin and topical bacitracin plus neomycin, 3 wk: improvement after 5 d; negative perianal culture on day 7; healed completely after 2 wk	3. No recurrence after 2 mo

F: Female; GAS: Group A beta-hemolytic streptococci; GBS: Group B beta-hemolytic streptococci; GCS: Group C beta-hemolytic streptococci; GP: Guttate psoriasis; IM: Intramuscular; IV: Intravenous; M: Male; Pen: Penicillin; PID: Perianal infectious dermatitis.