HistoryThis section has been translated automatically.
DefinitionThis section has been translated automatically.
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.
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PathogenThis section has been translated automatically.
Mostly β-hemolytic group A streptococci (GABHS: 70%);
Rare group B streptococci (GBBHS: 26%), C, D or G (Šterbenc A et al. 2016).
EtiopathogenesisThis section has been translated automatically.
Infection with streptococci.
- Favouring factors:
- skin injuries
- shared bath water.
ManifestationThis section has been translated automatically.
Infants aged between 1 and 10 years.
Clinical featuresThis section has been translated automatically.
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.
DiagnosisThis section has been translated automatically.
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 diagnosisThis section has been translated automatically.
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 therapyThis section has been translated automatically.
Internal therapyThis section has been translated automatically.
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/forecastThis section has been translated automatically.
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.
LiteratureThis section has been translated automatically.
- Amren DP et al (1966) Perianal cellulitis associated with group A streptococci. Am J Dis Child 112: 546-552
- Heidelberger A et al (2000) Perianal streptococcal dermatitis. dermatologist 51: 86-89
- Herbst R et al (2003) Perineal streptococcal dermatitis/disease: recognition and management. At J Clin Dermatol 4: 555-560
- 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
- Lazarov A (1999) Perianal contact dermatitis caused by nail lacquer allergy. At J Contact Dermat 10: 43-44
- Lunghi F et al (2001) Two familial cases of perianal streptococcal dermatitis. Cutis 68: 183-184
- Mempel M et al (2015) Selected bacterial infections of the skin in childhood. dermatologist 66: 252-257
- Meury SN et al (2008) Randomized, comparative efficacytrial of oral penicillin versus cefuroxime for perianal streptococcal dermatitis in children. J Pediatr 153:799-802
- Neri I et al (1996) Perianal streptococcal dermatitis in adults. Br J Dermatol 135: 796-798
- Olson D et al (2011) Outcomes in children treated for perineal group A beta-hemolytic streptococcal dermatitis. Pediatric Infect Dis J 30:933-996
- Peltola H (2000) Images in clinical medicine. Bacterial perianal dermatitis. N Engl J Med 342: 1877
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.
Incoming links (6)Anal dermatitis cumulative toxic; Anal eczema contact allergic; Anal fissure; Diaper dermatitis; Perianal streptococcal dermatitis; Streptococcus;
Outgoing links (15)Anal dermatitis cumulative toxic; Balanitis; Bowen's disease; Calcineurin inhibitors; Candidoses; Clioquinol; Erythromycin; Glucorticosteroids topical; Inverted psoriasis; Octenidine; ... Show all
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