Cow’s Milk Allergy Is a Major Contributor in Recurrent Perianal Dermatitis of Infants

Mostafa Abdel-Aziz El-Hodhod,Ahmad Mohamed Hamdy,Mohamed O Elmaraghy,Marwa Talaat El-Deeb

doi:10.5402/2012/408769

Abstract

Background. Recurrent perianal inflammation has great etiologic diversity. A possible cause is cow's milk allergy (CMA). The aim was to assess the magnitude of this cause. Subjects and Methods. This follow up clinical study was carried out on 63 infants with perianal dermatitis of more than 3 weeks with history of recurrence. Definitive diagnosis was made for each infant through medical history taking, clinical examination and investigations including stool analysis and culture, stool pH and reducing substances, perianal swab for different cultures and staining for Candida albicans. Complete blood count and quantitative determination of cow's milk-specific serum IgE concentration were done for all patients. CMA was confirmed through an open withdrawal-rechallenge procedure. Serum immunoglobulins and CD markers as well as gastrointestinal endoscopies were done for some patients. Results. Causes of perianal dermatitis included CMA (47.6%), bacterial dermatitis (17.46%), moniliasis (15.87%), enterobiasis (9.52%) and lactose intolerance (9.5%). Predictors of CMA included presence of bloody and/or mucoid stool, other atopic manifestations, anal fissures, or recurrent vomiting. Conclusion. We can conclude that cow's milk allergy is a common cause of recurrent perianal dermatitis. Mucoid or bloody stool, anal fissures or ulcers, vomiting and atopic manifestations can predict this etiology.

Highlights

Perianal dermatitis is probably the most common cutaneous disorder of the genitoanal area [1]
Breastfed infants are less likely to develop moderate to severe diaper dermatitis relative to formula-fed infants [2, 13]
This follow-up clinical study was carried out on 63 infants with perianal dermatitis that persisted for more than 3 weeks and with history of recurrence. They represented 5.16% of 1220 patients presenting with the main complaint of perianal inflammation

Summary

Introduction

Perianal dermatitis is probably the most common cutaneous disorder of the genitoanal area [1]. Diaper dermatitis is observed most frequently in infants at 9–12 months of age [2]. It has a multifactorial etiology and high chronicity [3, 4]. A possible cause is cow’s milk allergy (CMA). This follow up clinical study was carried out on 63 infants with perianal dermatitis of more than 3 weeks with history of recurrence. Predictors of CMA included presence of bloody and/or mucoid stool, other atopic manifestations, anal fissures, or recurrent vomiting. We can conclude that cow’s milk allergy is a common cause of recurrent perianal dermatitis. Anal fissures or ulcers, vomiting and atopic manifestations can predict this etiology

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Conclusion