ABSTRACT
A 6-year-old boy presented with a recent onset of an itchy, red and uncomfortable rash in his perianal area. Pain had been increasing in severity especially when passing a bowel movement. This resulted in stool withholding and constipation. When his perianal area was examined, the doctor noticed the rash shown in Image 17. https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig17.jpg"/>
What is the diagnosis?
What would confirm your diagnosis?
How is this condition treated?
38This child has perianal streptococcal dermatitis. It usually presents as a bright red, sharply demarcated rash involving the perianal mucosa that is caused by group A beta-haemolytic streptococci. Typically the rash starts at the anus and spreads centrifugally and sometimes upward to the vulva or to the scrotum and penis as well. 1 Most children present with rectal itching or rectal pain as their chief complaint. Children may also present with blood-streaked stools. 2
A culture by swabbing the affected skin would confirm the diagnosis. However, you need to alert the laboratory to the site of the culture since the culture would overgrow with coliforms from the stool. It should not be labelled as a stool culture but rather as a bacterial wound culture for group A streptococcus. 1 The laboratory technician can subsequently reculture those colonies that resemble streptococcus.
The treatment is the same as for streptococcal pharyngitis – usually penicillins and their derivatives. As the inflammation calms down, the child should be able to pass his or her bowel movements and pain should resolve. Glycerin suppositories and stool laxatives do help.
