Streptococcal infection as cause for chronic perianal dermatitis in children

Background. An under-recognised but frequent cause for chronic perianal dermatitis is group A P-hemolytic streptococcal infection which has a male predominance and is reported in prepubertal children. Results. We present 8 boys with an age range from 2-9 years and an 1-18 month history of persistent perianal inflammation. Symptoms included a well-demarcated perianal erythema, pruritus, painful defaecation, rectal bleeding and secondary constipation. Topical treatment was ineffective. The diagnosis of perianal dermatitis was confirmed by culture of streptococci from perianal skin. A 10-day course of oral penicillin was successful in all children. In one child a relapse occurred and was treated by oral cephalosporin. In case of relapsing infection an intrafamiliar transmission should be excluded because of contagiosity by host-to-host contact. Conclusion. A simple culture of the perianal skin swab is essential in case of perianal inflammation. It confirms the diagnosis of perianal streptococcal infection. So an early specific antibiotic treatment can be started which avoids months of trouble, unprofitable topical treatment and expensive diagnostics.