Perianal cellulitis

Published on 11/06/2015 by admin

Filed under Pediatrics

Last modified 22/04/2025

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Streptococcal perianal cellulitis. Superficial erosions and erythema of perianal skin.

Streptococcal perivaginal cellulitis. Child also had perianal cellulitis.

CLINICAL FEATURES

Perianal cellulitis presents with tender perirectal erythema and pain on defecation.

Pruritus is common. Superficial erosions and fissures of the perianal skin may be seen. Blood-streaked stools also occur. Lesions may extend beyond the perianal area and involve perivaginal skin.

Infants and toddlers often present with constipation. Perianal cellulitis was historically virtually always caused by streptococci, but perianal cellulitis caused by Staphylococcus aureus is becoming more common. Pustules extending to the buttocks are seen more commonly in staphylococcal disease.

Guttate psoriasis may follow streptococcal perianal cellulitis. Bacterial culture of the perianal area should be performed.

TREATMENT

Traditionally, oral penicillin V 30–60 mg/kg/day or amoxicillin 50 mg/kg/day was the treatment of choice for streptococcal disease, but with the emergence of S. aureus being seen in this setting, cephalexin 25–50 mg/kg/day may be a better initial choice, with further therapy dependent on clinical course and culture and sensitivity results.