Perianal streptococcal dermatitis in adults

Abstract

Perianal streptococcal dermatitis (PSD) in adults is still not well documented. After demonstrating systemic therapy to be efficient in adults—analogous to the therapeutic approach to the well-known disease in children—the question remained whether local therapy is also sufficient. We therefore treated adult PSD patients with mupirocin 2% locally. After diagnosis, patients were treated with mupirocin 2% locally for 2 weeks. Additional concomitant anorectal diseases were treated according to standard guidelines and the patients’ clinical course was followed. A “control” group of patients without erythema, eczema or other symptoms of PSD was examined for the presence of β‑haemolysing Streptococci (BHS) by perianal swab in order to investigate the prevalence of asymptomatic colonization. Demographic and microbiological data were assessed and compared between and within treatment and control groups. 129 PSD patients >17 years (mean 48 years) were diagnosed between February 2012 and March 2014. In most cases, group B BHS (GBBHS) were found. In 99 patients, local treatment was administered for 14 days. In 69 of 75 patients (92%) with a post-treatment swab, this swab was negative. Whereas 35 patients (35.4%) had no further anorectal complaints, 57 patients (57.6%) required continuing treatment of their concomitant anorectal disease. In the “control” group, GBBHS were found in 10%. PSD should be included into differential diagnoses of refractory eczema in adult patients and is mainly caused by GBBHS. As a local skin infection, PSD can be treated effectively with mupirocin 2% locally. However, pregnant women, immunodeficient patients as well as patients with systemic signs and symptoms of infection must be addressed differently and a systemic therapy remains standard in these special cases. This paper sheds new light on the treatment concept of perianal streptococcal dermatitis, up to now recognized as a disease of children. As a result of this paper, adult patients with persisting eczema despite proper anorectal treatment should be screened routinely for perianal streptococcal dermatitis and can be treated locally.