Guttate psoriasis triggered by perianal streptococcal dermatitis in a four-year-old boy,☆☆

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Abstract

Perianal streptococcal dermatitis (PSD) is a superficial bacterial infection usually with group A beta-hemolytic streptococci. PSD is often misdiagnosed for long periods and patients are subjected to treatments for a variety of differential diagnoses without success. We report a 4-year-old boy with PSD who presented to our clinic with guttate psoriasis for 2 reasons: first, to make dermatologists aware of PSD and second, to emphasize the necessity to examine patients, particularly pediatric patients, with guttate psoriasis very thoroughly and swab both the pharynx and perianal and/or perigenital areas even when they are, or seem to be, asymptomatic for bacterial infections. Once PSD has been diagnosed, systemic antibiotic therapy with penicillin, erythromycin, roxithromycin, or azithromycin (probably augmented by topical mupirocin ointment) should be the treatment of choice. Therapy should be monitored by posttreatment perianal and throat swabs as well as a urine analysis to monitor for poststreptococcal glomerulonephritis. (J Am Acad Dermatol 2000;42:885-7.)

Section snippets

CASE REPORT

A 4-year-old boy had a 6-week history of a mildly pruritic rash on his trunk and scalp. He had no other symptoms, including a sore throat or other infection, and appeared to be otherwise healthy. His family history was negative for either psoriasis or atopic dermatitis. On physical examination, he had plaques typical for guttate psoriasis on his trunk (Fig 1), upper extremities, and scalp.

. Four year-old boy with guttate psoriasis for 6 weeks.

Examination of his throat was normal. When his

DISCUSSION

Perianal streptococcal dermatitis (PSD) associated with guttate psoriasis has to our knowledge been reported by 3 authors to date.2, 3, 4 We report this case for 2 reasons: first, to make dermatologists aware of this condition, and second, to emphasize the necessity to examine patients, particularly pediatric patients, with guttate psoriasis very thoroughly and swab both the pharynx and perianal and/or perigenital areas, even when they are, or seem to be, asymptomatic for bacterial infections.

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This supplement is made possible through an educational grant from Ortho Dermatological to the American Academy of Dermatology.

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Reprint requests: Rudolf A. Herbst, MD, Department of Dermatology and Allergology, Hannover Medical University, Ricklinger Strasse 5, D 30449 Hannover, Germany. E-mail: [email protected] .

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