Review
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Oct 25, 2018; 7(4): 89-104
Published online Oct 25, 2018. doi: 10.5409/wjcp.v7.i4.89
Perianal infectious dermatitis: An underdiagnosed, unremitting and stubborn condition
Elena Daniela Serban
Elena Daniela Serban, 2nd Department of Pediatrics, “Iuliu Hatieganu” University of Medicine and Pharmacy, Emergency Hospital for Children, Cluj-Napoca 400177, Romania
Author contributions: Serban ED contributed to the paper’s conception and design, the data collection, extraction, analysis and evaluation, the interpretation of results, and the manuscript’s preparation, critical revision, editing and final submission.
Conflict-of-interest statement: The author declares there are no potential conflicts of interest relevant to this publication.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Elena Daniela Serban, MD, PhD, Associate Professor, Pediatric Gastroenterologist, 2nd Department of Pediatrics, “Iuliu Hatieganu” University of Medicine and Pharmacy, Emergency Hospital for Children, 5 Crisan Street, Cluj-Napoca 400177, Romania. daniela.serban@umfcluj.ro
Telephone: +40-264-532216 Fax: +40-264-590478
Received: June 24, 2018
Peer-review started: June 25, 2018
First decision: August 2, 2018
Revised: August 23, 2018
Accepted: October 8, 2018
Article in press: October 9, 2018
Published online: October 25, 2018
Processing time: 122 Days and 13.7 Hours
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.