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Itchy perianal erythema

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This young patient had a perianal rash that did not respond to topical clotrimazole. What is your diagnosis?


 

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A mother brought her 3½-year-old son into the office for a worsening rash in the perianal area (FIGURE 1). Mother and child had been in the office 2 weeks earlier for the rash, and the physician had prescribed topical clotrimazole cream for a presumed case of Candida infection. Despite using the cream as directed, the child’s rash worsened.

The child’s mother told the treating physician (SS) that his rash was painful and itchy. She also said he’d had a few blood-streaked stools.

The little boy had no significant medical history and was not taking any medications. The child otherwise felt well and was afebrile. An examination revealed sharply demarcated, bright red perianal erythema. The rash was moist, with a slight mucoid discharge. The area was not tender on palpation. The remainder of the little boy’s physical examination was unremarkable.

FIGURE 1
Perianal rash

This 3½-year-old boy had itchy perianal erythema that did not respond to topical clotrimazole cream.

What is your diagnosis?
How would you manage this condition?

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