Dermatology Question of the Week: Pediatric Problems
Question:
A 2-year-old girl is brought to the dermatologist for evaluation of a growth near her anus pictured below.
Which of the following statements is true? (hint: more than 1 may be correct)
A. This is suspicious for child abuse
B. This is an example of genital warts in a child
C. This is associated with constipation
D. This has been associated with lichen sclerosus et atrophicus
E. This is associated with Crohn's disease
Rationale:
Pictured above is an entity known as pyramidal perianal protrusion (PPP). Although the exact cause is unknown, it is thought to be related to a embryologic weakness in the tissue and a result of chronic irritation, increased pressure, or a sequela of inflammation. These occur most commonly in females. Most studies show improvement over time and the suspected trigger for this condition should be appropriately diagnosed and managed.
Correct answers: C. associated with constipation & D. associated with LS&A
Multiple case studies report associated constipation and improvement in size and symptoms after treating the underlying constipation. Similarly, there are several cases showing concomitant lichen sclerosus et atrophicus with PPP.
Incorrect answers:
A & B - genital warts in infants/young children can be concerning for child abuse however there are sexual and nonsexual ways that the HPV is transmitted including birth. Appropriate history and examination of the child and caregivers is necessary to determine the etiology and level of clinical suspicion. The picture above shows a classic location and appearance for infantile / childhood pyramidal perianal protrusion.
E - Crohn's disease can be associated with fissures and skin tags of the perianal area. However, it is not associated with PPP.
Additional reading at Chapter 15: Pediatric Dermatology
References:
1.
I am a general dermatologist practicing at an academic medical center in Danville, PA. I see both adult and pediatric patients and also perform various surgical procedures. I have a special interest in Hidradenitis Suppurativa (HS) and am the founder of our HS specialty clinic where we treat patients medically and surgically (deroofing, excision, staged CO2 excision with marsupialization, Nd:YAG). I am actively involved in resident education and am passionate about medical education. Additional interests include autoimmune bullous disorders, dermatomyositis, and procedural dermatology.
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