Perianal streptococcal dermatitis: an important differential diagnosis in pediatric patients

Perianal streptococcal dermatitis is an infectious disease that predominantly affects younger children and is mostly caused by Group A beta-hemolytic streptococci. Although patients are mostly seen primarily by their pediatrician or family physician, the diagnosis is not infrequently established just after referral to a dermatologist or colorectal surgeon. We report a case series of 124 children, aged 14 years or younger, who were seen at our office for anorectal complaints between February 2003 and September 2006. Twenty-one of 124 patients (16 percent) were diagnosed with perianal streptococcal dermatitis on the basis of a positive perianal swab by microbiologic analysis. Perianal streptococcal dermatitis was the most frequent infectious disease in that age group in our practice. Sixteen (of 21, 76 percent) patients were male, and the mean age was 6.3 years. One course of systemic antibiotic treatment augmented by additional local antiseptic ointment in selected cases cured all patients within 10 to 14 days. One patient presented with a new perianal streptococcal dermatitis episode five months after treatment and was successfully retreated with an oral antibiotic. With this report, we wish to alert the colorectal community of the diagnosis because it may be underdiagnosed in our practices and thereby lead to prolonged discomfort, protracted disease, and potentially harmful sequelae for these typically very young patients.