Perianal streptococcal dermatitis L30.3

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Perianal streptococcal dermatitis; Perianal streptococcal dermatitis in children; Perianal streptogenic dermatitis; Streptogenic perianal dermatitis

History
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Amren, 1966

Definition
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Chronic streptococcal infection, mainly in children, less frequently in adults, limited to the perianal region, which occurs under the picture of a weeping anal eczema.

Pathogen
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Mostly β-hemolytic group A streptococci (GABHS: 70%);

Rare group B streptococci (GBBHS: 26%), C, D or G (Šterbenc A et al. 2016).

Etiopathogenesis
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Infection with streptococci.

  • Favouring factors:
    • Traumas
    • skin injuries
    • shared bath water.

Manifestation
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Infants aged between 1 and 10 years.

Clinical features
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Rarely any fever. Usually non-infiltrated or only slightly infiltrated, easily delimited perianal erythema of 0.5-3.0 cm Ø or red, weeping papules which occasionally secrete pus. Severe, persistent itching and defecation pain. Bloody stool deposits in 30-40% of cases.

There is often association with impetigo in other parts of the body.

Rare picture of balanitis or vulvovaginitis.

Diagnosis
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Clinic, smear and bacteria culture. The diagnosis is often missed; in children, for example, it takes an average of 1-12 months until the diagnosis is made.

Smears from the throat and nasal atria are very useful.

Differential diagnosis
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Remark: When making a differential diagnosis, it should always be considered that 1. perianal streptococcal dermatitis is rare and 2. it occurs predominantly in infants. This restricts the differential diagnosis listed here.

  • Atopic anal eczema: diffuse intertriginous eczema reaction; other signs of atopic dermatitis
  • Psoriasis inversa: mostly sharply defined intertriginous red plaques, weepingContact allergic anal eczema:; mostly in adults; other signs of psoriasis.
  • Tinea intertriginosa: circulatory plaques at the edges, central healing tendency
  • Intertriginous candidiasis: Circinary weeping plaques, desquamation
  • M. Bowen: Slowly growing red plaque, usually no major complaints (older age).
  • Paget's disease: slow-growing red plaque, usually no significant symptoms (older age).
  • Cumulative toxic anal eczema : diffuse intertriginous eczema reaction; medical history with local septic therapy.

External therapy
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Rinse with polihexanide (Serasept) or octenidine (Octenisept) and local application of Clioquinol cream 2-10% (e.g. Linola-Sept).

Internal therapy
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Therapy of choice is penicillin (e.g. Megacillin oral). Adults and children > 12 LJ: 3 times/day 0.5 million to 1.5 million IU p.o. Therapy duration 10-14 days. Children 6-12 LJ: 3 times/day 0.6 million IU p.o. for 10-14 days. Children < 6 LJ: 3 times/day 0.3 million IU p.o.

Alternative: treatment with erythromycin 3 times/day 500 mg p.o. for two weeks.

Alternative: Cephalosporins like cefuroxime or ceftriaxone for 12-14 days.

Note: Some studies indicate that the recurrence rate is higher when oral penicillins and aminopenicillins are used than when 2nd or 3rd generation cephalosporins are used.

Progression/forecast
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The clinical picture is characterized by a high (between 20 and 40%) recurrence rate within 6 weeks after completion of treatment. This is higher when oral penicillins are used than when cephalosporins are used (see above).

If the consequent antibiotic/antiseptic therapy does not lead to healing, the following procedure is recommended: Intermittent (1-3 days each) anti-inflammatory therapy with a steroid externum (class 1-2 according to Niedner) or a local calcineurin inhibitor.

Literature
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  1. Amren DP et al (1966) Perianal cellulitis associated with group A streptococci. Am J Dis Child 112: 546-552
  2. Heidelberger A et al (2000) Perianal streptococcal dermatitis. dermatologist 51: 86-89
  3. Herbst R et al (2003) Perineal streptococcal dermatitis/disease: recognition and management. At J Clin Dermatol 4: 555-560
  4. Kahlke V et al (2013) Perianal streptococcal dermatitis in adults: its association with pruritic anorectal diseases is mainly caused by group B streptococci. Colorectal Dis 15:602-607
  5. Lazarov A (1999) Perianal contact dermatitis caused by nail lacquer allergy. At J Contact Dermat 10: 43-44
  6. Lunghi F et al (2001) Two familial cases of perianal streptococcal dermatitis. Cutis 68: 183-184
  7. Mempel M et al (2015) Selected bacterial infections of the skin in childhood. dermatologist 66: 252-257
  8. Meury SN et al (2008) Randomized, comparative efficacytrial of oral penicillin versus cefuroxime for perianal streptococcal dermatitis in children. J Pediatr 153:799-802
  9. Neri I et al (1996) Perianal streptococcal dermatitis in adults. Br J Dermatol 135: 796-798
  10. Olson D et al (2011) Outcomes in children treated for perineal group A beta-hemolytic streptococcal dermatitis. Pediatric Infect Dis J 30:933-996
  11. Peltola H (2000) Images in clinical medicine. Bacterial perianal dermatitis. N Engl J Med 342: 1877
  12. Šterbenc A et al (2016) Microbiological characteristics of perianal streptococcal dermatitis:
    aretrospective study of 105 patients in a 10-year period. Acta Dermatovenerol Alp Pannonica Adriat 25:73-76.

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020