title: Recurrent toxin-mediated perineal erythema: eleven pediatric cases.
abstract: BACKGROUND
  Recurrent toxin-mediated perineal erythema is a cutaneous disease mediated by superantigens made by staphylococci and streptococci, which, to our knowledge, has only been reported in young adults. We describe recurrent toxin-mediated perineal erythema in 11 children and outline the differences between recurrent toxin-mediated perineal erythema and Kawasaki disease in this age range.
  
  
  METHODS
  Eleven children (7 male and 4 female) presented with the sudden appearance of asymptomatic erythema, which was salmonlike in color and rapidly desquamating, involving the perineum in 10 patients and extending to the perianal area in 1 patient. At the onset of the rash, all patients were in good health, although 9 had mild fever for 1 to 2 days before its appearance. Physical examination also revealed an erythema of the hands and feet in 4 patients and strawberry tongue in 7. Two patients had a facial impetigo, and another showed a perianal streptococcal dermatitis. A group A beta-hemolytic streptococcus was isolated from the throat in 10 cases and from a perianal culture in 1 case. In 8 cases, resolution was spontaneous, but all patients were treated with systemic antimicrobial therapy for 10 days. Three patients had a personal history of cutaneous rashes on the perineal area during the last years before consultation. Rash recurrence was observed in 3 of the 11 patients at the follow-up examination. Conclusion Recurrent toxin-mediated perineal erythema can be observed not only in young adults but also in childhood.
authors.affiliation: Clinica Dermatologica Via Massarenti 1, 40138 Bologna, Italy. annalisa.patrizi@unibo.it
authors.forename: Annalisa
authors.initials: A
authors.lastname: Patrizi
authors.forename: Beatrice
authors.initials: B
authors.lastname: Raone
authors.forename: Francesco
authors.initials: F
authors.lastname: Savoia
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Ricci
authors.forename: Iria
authors.initials: I
authors.lastname: Neri
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004890:Erythema / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D009080:Mucocutaneous Lymph Node Syndrome / Q000175:diagnosis; D010502:Perineum; D012008:Recurrence; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism; D013211:Staphylococcus aureus / Q000276:immunology / Q000378:metabolism; D013290:Streptococcal Infections / Q000150:complications / Q000188:drug therapy / Q000276:immunology / Q000378:metabolism; D013291:Streptococcus / Q000276:immunology / Q000378:metabolism; D018089:Superantigens / Q000276:immunology
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D018089:Superantigens