Courtesy of O. Dale Collins, MD
It has recently been suggested to summarize GABHS-induced (Group A Beta hemolytic Streptococcus) vulvovaginal and penile infections together with PSD under the inclusive term 'perineal streptococcal disease' because these conditions coincide, share important clinical characteristics and, therefore, represent manifestations of the same disease.
Children 1-8 years of age may develop redness, tenderness and pain on defecation in the perianal area. Adults may be affected as well [BJD 1996;135;796]. A culture showing infection by group A beta hemolytic streptococcus is diagnostic. Perianal dermatitis has been known to precipitate guttate psoriasis. It has also been reported to precipitate a fever, acral desquamation and extension of the erythema to the genitalia and proximal thighs [PD 1999;16;23]. It is assumed in this patient that the group A beta Strep produced a pyrogenic exotoxin. In one report, half of children has positive throat cultures.
An oral antibiotic such asa penicillin or erythromycin is effective. Mupirocin has also been used. Relapse is common.
Painful perianal and gluteal cleft rash in a teenage boy. History is that is started after some insect bites. Culture showed heavy Group A beta hemolytic Strep and light E. Coli.
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