OVERVIEW

What is pediatric perianal dermatitis?

Pediatric perianal dermatitis refers to skin inflammation around the anal area in infants (including newborns), which can be caused by various local irritants such as feces or wipes.

• In a narrow sense, pediatric perianal dermatitis is relatively common and acute, primarily presenting as patchy redness around the anus, sometimes accompanied by small bumps (papules). This is the main focus of this article.
• Broadly, perianal dermatitis includes all types of dermatitis or eczema-like rashes in the anal area, as well as perianal streptococcal dermatitis (specifically referring to infectious skin inflammation around the anus mainly caused by Group A beta-hemolytic streptococci, also known as perianal streptococcal cellulitis). This is a rare perianal skin infection and will not be discussed in detail here.

Overall, pediatric perianal dermatitis is easily controlled, not severe, and has no significant impact on health.

Is pediatric perianal dermatitis common?

Yes, it is common.

The skin in this area is thin and delicate, making it prone to irritation and damage.

Is pediatric perianal dermatitis the same as diaper rash?

Not exactly.

There is some overlap between the two, and occasionally perianal dermatitis may be classified as part of diaper rash.

Diaper rash, also known as diaper dermatitis, refers to skin inflammation in the diaper area, typically covering a larger area and not limited to the perianal region.

SYMPTOMS

What Does Pediatric Perianal Dermatitis Typically Look Like?

The main and basic manifestation of pediatric perianal dermatitis is patchy redness (erythema) around the anus, which is generally flat but may sometimes present with small raised bumps. Erosion (superficial skin breakdown with small cracks) may occur occasionally, while peeling, oozing, and ulcers are less common.

The borders of the redness are usually distinct but irregular. A significant proportion of perianal dermatitis cases show symmetrical distribution on both sides of the anus, which is related to contact with irritants or allergens.

The redness may cause mild itching, though it is generally not prominent. If erosion or ulcers are present, pain may occur. Non-verbal children may exhibit irritability, crying, or resistance to touching the perianal area.

What Serious Complications Can Pediatric Perianal Dermatitis Cause?

It usually does not lead to severe consequences, but secondary issues may arise, potentially delaying diagnosis and treatment. The main complications are infections, including bacterial and fungal infections.

Bacterial Infection: The primary symptoms are pustules around the anus and perianal area, sometimes accompanied by extensive bright redness and/or skin cracks. The pustules appear white, filled with thick white or yellowish-white pus. They may be numerous, sometimes merging into larger patches or forming around the edges of the redness. Superficial pustules may leave dark scabs after healing.

Fungal Infection: Primarily refers to Candida infection, as Candida is normally present on the skin but may overgrow and cause infection. Symptoms can include redness, pustules, red bumps (papules), or peeling, often in random combinations. Pure redness is rare, as other skin changes are usually present to some degree.

CAUSES

What are the causes of perianal dermatitis in children?

The main causes are local adverse factors, which can be summarized into three points: irritation, allergies, and mechanical damage.

• Irritation: Prolonged exposure to stool, which contains irritating substances like ammonia, can easily damage the skin. Infrequent diaper changes or delayed cleaning of the perianal area can worsen the irritation.
• Allergies: Using wipes containing allergens, especially scented or chemically rich wipes.
• Mechanical damage: Frequent friction (rough cleaning), using rough tissues/cloths, or prolonged skin moisture can damage delicate skin, leading to skin breakdown and impaired barrier function.

Which infants are more prone to perianal dermatitis?

• Young infants;
• Babies still using diapers;
• Infants with frequent bowel movements, excessive friction, exposure to allergenic substances (e.g., wipes), or infrequent diaper changes (especially at night).

Is perianal dermatitis in children contagious?

No, it is not contagious.

DIAGNOSIS

How is perianal dermatitis in children diagnosed? What tests are needed?

It mainly relies on the doctor's visual judgment and medical history inquiry. If the condition appears suddenly, shows no signs of infection, has identifiable causes, and presents typical symptoms, a diagnosis of perianal dermatitis in children can be made.

If infection or other issues are suspected and empirical treatment shows no improvement, microbiological tests such as fungal microscopy or bacterial culture may be required.

What diseases can perianal dermatitis in children be easily confused with?

It may be confused with anal eczema or seborrheic dermatitis.

• Anal eczema: More common in adults, usually chronic and recurring redness, possibly raised skin, sometimes with oozing, crusting, peeling, and significant itching.
• Seborrheic dermatitis: More common in infancy but chronic in the short term, mainly presenting as redness and scaling, not limited to the anus, typically occurring on the scalp, face, skin folds, and diaper area.

TREATMENT

Which department should be consulted for pediatric perianal dermatitis?

Dermatology, Pediatrics.

Can pediatric perianal dermatitis heal on its own?

Mild perianal dermatitis can heal on its own with timely protective measures.

How is pediatric perianal dermatitis treated?

Treatment involves two aspects: protection and medication. Protection is more important and serves as an effective measure for treatment and preventing recurrence.

• Protection:
  • Keep the local skin clean, dry, and breathable.
  • Avoid suspected irritants, allergens, or mechanical damage, especially reducing prolonged stool retention and irritation.
  • Use care products such as zinc oxide or petroleum jelly, preferably with simple ingredients.
• Medication:
  • For cases that do not improve with protection or involve large areas, topical corticosteroids are the main treatment. Considering medication safety, mild corticosteroids (e.g., desonide cream, hydrocortisone butyrate cream) are generally recommended, while potent or super-potent corticosteroids are not advised. Short-term, small-area, and minimal use of mild corticosteroids has almost no side effects.
  • For suspected bacterial infections, topical mupirocin ointment or fusidic acid cream may be considered.
  • For suspected fungal infections, topical ketoconazole cream or miconazole cream may be considered.

How soon can pediatric perianal dermatitis improve after medication? When should medical attention be sought?

The treatment duration depends on the response, typically until the perianal skin returns to normal, which usually takes a few days.

Medical attention should be sought if the condition recurs, shows no improvement or worsens after several days of treatment, or if other types of rashes (especially signs of infection) appear.

Is pediatric perianal dermatitis easy to treat? Can it be completely cured? Is it prone to recurrence?

It depends.

Pediatric perianal dermatitis can be cured through protection and medication. If the underlying causes are effectively avoided, recurrence is less likely.

DIET & LIFESTYLE

What dietary precautions should be taken for pediatric perianal dermatitis?

Perianal dermatitis has almost no relation to diet. The only thing to note is avoiding foods that may cause diarrhea, as diarrhea increases the risk of stool irritating the perianal skin.

What lifestyle precautions should be taken for pediatric perianal dermatitis?

The precautions are aimed at protecting against perianal dermatitis, including:

• Keep the local skin clean, dry, and breathable.
• Avoid potential irritants, allergens, or mechanical damage, especially reducing prolonged stool contact and irritation.
• Use care products such as zinc oxide or petroleum jelly.
• For recurrent perianal dermatitis, it is also recommended to reapply care products after cleaning.

Additionally, avoid improper treatments, especially comfrey oil/comfrey ointment, various antibacterial creams, products without the "National Drug Approval" mark, and various folk remedies.

PREVENTION

Can perianal dermatitis in children be prevented?

Yes. Possible preventive measures include:

• Changing diapers frequently;
• Ensuring local ventilation (exposing the buttocks when convenient);
• Avoiding potentially allergenic wipes;
• Gently cleaning the skin without using rough towels or tissues;
• Regular use of care products (such as zinc oxide or petroleum jelly).