What is Perianal Streptococcal Dermatitis?
Perianal streptococcal dermatitis is a skin infection that usually affects children between 6 months and 10 years old. It’s more accurately described as cellulitis, a skin disease caused by a specific bacteria known as group A beta-hemolytic streptococci. This condition generally looks like redness around the anus with clear boundaries. Additional symptoms may include shallow skin breakdowns, anal tears, skin scratches, or pus-like discharge. Doctors can confirm the diagnosis by taking a swab from the affected area and testing it. Treatment typically includes oral antibiotics and creams to clean the area. If a child is having changes in bathroom habits and complaints about the area around their bottom, it’s important to consider perianal streptococcal dermatitis as a possible explanation.
What Causes Perianal Streptococcal Dermatitis?
The name ‘Perianal streptococcal dermatitis’ (PSD) can be a little misleading. ‘Dermatitis’ refers to a condition where the outer layer of the skin is irritated and inflamed. While PSD does involve skin irritation, it’s mostly caused by an infection from bacteria called group A beta-hemolytic streptococci (GABHS).
So, it’s more accurate to say that PSD is a type of cellulitis, a skin infection, rather than a type of dermatitis, an inflamed skin condition.
Risk Factors and Frequency for Perianal Streptococcal Dermatitis
Perianal streptococcal dermatitis often affects children between the ages of 6 months and 10 years old, making it largely considered a pediatric disease. However, it can also occasionally appear in adults. More boys get this than girls, with the ratio ranging between 3 to 1 and 2 to 1. Interestingly, it is more common during winter and spring months.
- Perianal streptococcal dermatitis typically affects children between 6 months and 10 years old.
- Boys are more likely to get it than girls, with a ratio of 3 to 1 or 2 to 1.
- The condition is more common in winter and spring months.
- While it’s mainly a pediatric disease, some adults can also get it.
Signs and Symptoms of Perianal Streptococcal Dermatitis
An accurate and timely diagnosis of perianal streptococcal dermatitis, a skin infection near the anus, heavily depends on a thorough history and physical exam. It’s important to note that when dealing with a child, the parents’ inputs are necessary. Taking the time to conduct a thorough history and physical exam can make the diagnosis process pretty straightforward. If a child is experiencing perineal (the area between the anus and genitals) pain and changes in bowel habits, doctors should strongly suspect perianal streptococcal dermatitis.
Common symptoms of perianal streptococcal dermatitis are:
- Pain near the anus
- Pain during bowel movements leading to constipation
- Itching
- Blood in stool
- Purulent exudate (Pus)
- No systemic symptoms like fever or body pains
To diagnose PSD, doctors need to examine the anus, perineum, and genitals. A common sign is reddening of the skin near the anus with clear borders. Other signs that may signal PSD include superficial skin erosions, anal fissures (small tears or cuts in the anus), excoriations (scratches or abrasions), and pus discharge. Once a doctor suspects PSD, they will need to conduct a definite test to confirm it.
Testing for Perianal Streptococcal Dermatitis
If your doctor suspects that you have perianal streptococcal dermatitis, which is a skin infection near the anus caused by streptococcal bacteria, they will swab the affected area, especially if there’s any fluid or ooze, to collect a sample. The sample is then sent to a lab to grow the bacteria and confirm the diagnosis. There are certain blood tests that detect the body’s immune response to the bacteria, but these are not reliable enough to diagnose this condition.
During your follow-up appointments, your doctor might also ask for a urine sample. This isn’t to aid in diagnosing the skin infection but to watch out for a kidney condition called post-streptococcal glomerulonephritis. This complication can occur after a streptococcal infection, so it’s a good idea to keep an eye out for it when treating perianal streptococcal dermatitis.
Treatment Options for Perianal Streptococcal Dermatitis
Once a diagnosis of perianal streptococcal dermatitis – which is an infection of the skin around the anal area – has been made, managing the condition is typically straightforward. For milder cases, some medical sources suggest using skin ointments that kill bacteria. However, the recommended first step in treatment is usually oral antibiotics.
The most effective treatment plans often use both systemic (affecting the whole body) and topical (applied to the skin) antibiotics. Systemic antibiotics can include drugs like penicillin V, erythromycin, azithromycin, clarithromycin, clindamycin, penicillinase-resistant penicillin, or cephalosporins. For best results, these oral antibiotics should be used in combination with a topical antiseptic such as chlorhexidine, or a topical antibiotic like mupirocin.
Treatment usually lasts for 14 to 21 days. During this period, it’s important to take samples from the infected area for laboratory testing. This helps to confirm that the bacteria causing the infection have been effectively cleared from the body.
What else can Perianal Streptococcal Dermatitis be?
If you experience skin irritation, your doctor might consider that it could be due to one of these conditions:
- Irritant dermatitis, often resulting from excessive wiping or manipulation
- Candidiasis, a fungal infection often colloquially known as “yeast infection”
- Seborrheic dermatitis, a skin condition that mainly affects your scalp
- Atopic dermatitis, commonly called eczema
- Psoriasis, an autoimmune disease that causes red, itchy, and scaly skin
- Allergic contact dermatitis, a skin rash caused by contact with an allergen
- Pinworm infection, a common type of intestinal infection
- Inflammatory bowel disease, a group of disorders that cause inflammation in the digestive tract
- Histiocytosis, a rare disease that involves an overproduction of cells that can damage organs
- Sexual abuse, which might lead to various physical signals
What to expect with Perianal Streptococcal Dermatitis
Perianal streptococcal dermatitis, a skin condition, can usually be cleared up within 14 to 21 days with the correct use of antibiotics. However, because children sometimes struggle with maintaining good hygiene practices and habits, there is a chance the condition might return. It’s important for kids and their parents to understand the need for proper hand hygiene and the importance of stopping the spread of the bacteria from one area to another, which health experts call “autoinoculation”.
Possible Complications When Diagnosed with Perianal Streptococcal Dermatitis
The main issue with perianal streptococcal dermatitis (PSD) is that if it’s not identified and treated promptly, it can lead to lengthy discomfort. There are also very rare instances where PSD can result in inflammation of the rectum and the formation of an abscess. If the condition lasts for a long time, it can increase the chance of bacteria spreading to people close to the patient, especially family members like parents and siblings.
There’s a possibility that PSD could lead to rheumatic fever, but there are currently no reported cases of this happening. Infections caused by GABHS (Group A Beta-Hemolytic Streptococcus), such as PSD, could potentially lead to post-streptococcal nephritis, a problem affecting the kidneys. As such, it’s really important to carry out follow-up urine tests to keep an eye on kidney function.
Potential Complications:
- Long-term discomfort due to delayed treatment
- Rare conditions like rectum inflammation and abscess formation
- Possible bacterial spread to close contacts
- Potential onset of rheumatic fever (not yet reported)
- Possibility of kidney issues (post-streptococcal nephritis)
Preventing Perianal Streptococcal Dermatitis
Perianal streptococcal dermatitis, a skin condition, isn’t that difficult to treat. But, it requires careful guidance from your doctor. The patient and their parents or caregivers, need to understand why follow-up appointments are so important. These appointments typically include a repeat swab test from the back side area to make sure that the bacteria causing the problem (known as GABHS) is completely gone. This step will help prevent any chance of the skin condition coming back.
At the follow-up appointment, a urine sample will also be collected to test for kidney inflammation that might be caused by the strep bacteria, a condition referred to as post-streptococcal nephritis. Lastly, it’s crucial patients and their families are taught correct hygiene practices to stop the bacteria from spreading. Following these steps carefully will ensure the fastest and most complete recovery.
