"The time to diagnosis of perianal streptococcal dermatitis is ≥3 weeks in 65% of cases." Because perianal cellulitis is commonly misdiagnosed, it is imperative that the proper diagnosing procedures are followed when encountering these symptoms, as delayed detection can result in severe complications.Within the pediatric population, it is common for the management of rashes to occur under the collaboration of an inter-professional team. Due to the diverse causes of rashes in the pediatric population, it may be necessary to refer pediatric patients to a pediatrician or a dermatologist to prevent misdiagnosis of perianal streptococcal dermatitis. Across the different disciplines of care, nurses have an opportunity to provide education on proper hygiene techniques to reduce the risk of recurrent infection. Pharmacists can provide patient and caretaker counseling on the selected medication therapy and improve medication adherence. By working together as an inter-professional team, all types of clinicians can improve patient health outcomes by raising awareness and reducing both time to diagnosis and the rate of recurrence of perianal streptococcal dermatitis infection. Differential diagnosis
Due to the non-specific presentation of the symptoms of perianal streptococcal dermatitis, it is frequently misdiagnosed by clinicians. To reach the correct diagnosis of perianal streptococcal dermatitis often ranges from weeks to months and can extend to even longer. During this time, the patient can undergo treatment for a variety of differential diagnoses.
Perianal cellulitis, also known as perianitis or perianal streptococcal dermatitis, is a bacterial infection affecting the lower layers of the skin (cellulitis) around the anus. It presents as bright redness in the skin and can be accompanied by pain, difficulty defecating, itching, and bleeding. This disease is considered a complicated skin and soft tissue infection (cSSTI) because of the involvement of the deeper soft tissues.Perianal cellulitis is most commonly caused by group A beta-hemolytic streptococcus bacteria (Streptococcus pyogenes), which resides normally ("in small numbers") in the human throat and on the human skin. Other less common causes may include infection with group B beta-hemolytic streptococci (Streptococcus agalactiae), a bacteria found in the human vagina of some, or Staphylococcus aureus, a common component of the bacterial community in the human nose and/or skin.Perianal cellulitis occurs mainly in male children between six months and 10 years of age, however, there are documented cases of perianal cellulitis in adults as well. Oral antibiotics are the first line treatment for perianal cellulitis and may be used in combination with topical antibiotics. Since the infection occurs within the deeper layers of skin, using a topical treatment by itself may not be effective. In about 20% of cases, recurrence of perianal streptococcal dermatitis infection occurs within 3.5 months. Routine hygiene practices should also be encouraged in children and adults in order to reduce the risk of recurrent infection. Signs and symptoms
Perianal cellulitis manifests as multiple symptoms that are inconsistent with a systemic disease.