title: Perianal and periumbilical dermatitis: Report of a woman with group G streptococcal infection and review of perianal and periumbilical dermatoses.
abstract: OBJECTIVE
  We describe a woman with perianal and periumbilical dermatitis secondary to group G Streptococcus, summarize the salient features of this condition, and review other cutaneous conditions that clinically mimic streptococcal dermatitis of the umbilicus.
  
  
  BACKGROUND
  Periumbilical and perianal streptococcal dermatitis are conditions that commonly occur in children and usually result from beta-hemolytic group A Streptococcus. Rarely, non-group A streptococcal and staphylococcal infections have been reported in adults.
  
  
  METHODS
  A 31-year-old woman developed perianal and periumbilical group G streptococcal dermatitis. Symptoms were present for six months and were refractory to clotrimazole 1 percent and betamethasone dipropionate 0.05 percent cream.
  
  
  RESULTS
  The etiology of perianal and periumbilical dermatitis is unclear, but is perhaps explained by virulence of previously asymptomatic colonized bacteria. Perianal streptococcal dermatitis is more common in children. A number of adult infections have been reported, most of which were secondary to group A beta-hemolytic Streptococcus. Men are more often affected than women. Group G Streptococcus is rarely the infective etiology of perianal streptococcal dermatitis. This condition presents as a superficial well demarcated erythematous patch on clinical examination. Diagnosis is ascertained by diagnostic swabs and serological tests: antistreptolysin O (ASO) or anti-DNase titer. Treatments include oral amoxicillin, penicillin, erythromycin, and mupirocin ointment.
  
  
  CONCLUSIONS
  Our patient expands on the clinical presentation typical of streptococcal dermatitis. We describe a rare occurrence of an adult woman infected with non-group A Streptococcus. Several conditions can mimic the presentation of perianal streptococcal dermatitis. Although rare, group G Streptococcus should be considered in the setting of virulent infections usually attributed to group A species. Streptococcal dermatitis can be added to the list of conditions affecting the umbilicus.
authors.affiliation: Medical School, Baylor College of Medicine, Houston, Texas.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Kallini
authors.forename: Philip R
authors.initials: PR
authors.lastname: Cohen
mesh_terms: D000328:Adult; D001003:Anal Canal; D002179:Candidiasis, Cutaneous / Q000175:diagnosis; D002710:Chlorhexidine / Q000627:therapeutic use; D003877:Dermatitis, Contact / Q000175:diagnosis; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004890:Erythema / Q000209:etiology; D005260:Female; D006801:Humans; D007402:Intertrigo / Q000175:diagnosis; D016712:Mupirocin / Q000627:therapeutic use; D011537:Pruritus / Q000209:etiology; D017192:Skin Diseases, Bacterial / Q000175:diagnosis / Q000382:microbiology*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology*; D013291:Streptococcus / Q000145:classification / Q000302:isolation & purification*; D014472:Umbilicus; D014845:Vulvar Diseases / Q000175:diagnosis / Q000382:microbiology
chemical_list: D016712:Mupirocin; D002710:Chlorhexidine