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LETTER TO EDITOR
Year : 2020  |  Volume : 21  |  Issue : 2  |  Page : 156-157

Infantile pyramidal perianal protrusion – Description of a case with dermoscopy findings


1 Bhojani Clinic, Matunga, Mumbai, Maharashtra, India
2 Dr, Save's Clinic, Andheri, Mumbai, Maharashtra, India

Date of Submission09-Nov-2019
Date of Acceptance01-Jan-2020
Date of Web Publication01-Apr-2020

Correspondence Address:
Resham Vasani
Bhojani Clinic, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijpd.IJPD_111_19

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How to cite this article:
Vasani R, Save S. Infantile pyramidal perianal protrusion – Description of a case with dermoscopy findings. Indian J Paediatr Dermatol 2020;21:156-7

How to cite this URL:
Vasani R, Save S. Infantile pyramidal perianal protrusion – Description of a case with dermoscopy findings. Indian J Paediatr Dermatol [serial online] 2020 [cited 2020 May 26];21:156-7. Available from: http://www.ijpd.in/text.asp?2020/21/2/156/281723



Sir,

Infantile perianal pyramidal protrusion (IPPP) is an uncommon benin cutaneous entity. It presents as an asymptomatic pyramidal soft tissue protrusion with a pink/rose red/purplish red surface alon the midline, usually anterior to the anus with the major axis consistent with median raphe. It is usually a solitary swellin in females and observed durin infancy.[1]

An 18 month old female had an as=ymptomatic swellin present just in front of the anus since the past 6 months. She had developed redness and itchin around the swellin since a week. There was a history of intermittent constipation. Rest of the past, personal and family history was unremarkable. There was no history suestive of sexual abuse. Physical examination revealed an elonated pink to flesh colored, pear shaped elonated sessile projection present in the midline, extendin from just below the vainal vestibule up to the upper border of the anus [Figure 1]. The skin surroundin the projection showed a shiny erythematous plaque. The remainin physical examination was normal. Dermoscopy showed the white structureless area with a vascular pattern composed of red linear dotted vessels alon the lenth of the lesion [Figure 2]. Rest of the eneral and systemic examination of the patient was normal. Considerin the physical findins, a dianosis of IPPP with candidal intertrio was made. The parents were counseled reardin the benin, self limitin nature of the condition and advised reular follow up. Considerin the history of constipation, they were advised to provide a liberal intake of fluids and foods with a hih fiber content to the child. The patient’s intertrio completely responded to the application of 1% clotrimazole cream twice daily for 2 weeks. The appearance of the lesion after the resolution of the intertrio is shown in [Figure 3].
Figure 1: Elongated sessile projection in midline extending from below the vaginal vestibule up to the upper border of the anusthe

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Figure 2: Dermoscopy - DermLite DL4N - Polarized Mode - White structureless area with red linear dotted vessels along the length of the lesion

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Figure 3: The appearance of lesions after resolution of intertrigo

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IPPP is a fairly recent entity, described by Kayashima et al. in 1996.[1] Althouh the pathoenesis of IPPP is poorly understood, three types of IPPP based on their oriin have been described, namely: (a) embryonic or constitutional or familial (conenitally weak perineum thouht to be a remnant of the uroenital septum), (b) acquired (secondary to constipation/mechanical irritation of perianal area), and (c) as a sequelae to anoenital lichen sclerosus.[2] They are usually solitary and have a pyramidal shape except in conenital cases where it can have a leaf like appearance.[3] Hen’s crest, tonue tip, peanut, or ciar shapes have also been described. At times, the protrusion can occur posterior to the anus and co occurrence of anterior and posterior perianal protrusions have been described.[3] Hence, the infantile perianal protrusion is a better term for this entity. The histopatholoical findins are usually nonspecific.[2]

The differential dianosis includes other perineal lesions such as hemorrhoids, hemaniomas, lesions of Crohn’s disease, and skin tas. These lesions can be of medicoleal sinificance when mistaken for condyloma acuminata or suestive of trauma resultin from sexual abuse.[4],[5]

Althouh the dianosis can be ascertained by a carefully asked medical history and physical examination, some presentations may require further evaluation. In such situations, dermoscopy may provide a useful alternative to an invasive biopsy. Till date, there has been just one report documentin the dermoscopic features of IPPP, where it revealed patchy structureless white areas suestive of fibrosis alon with red lobular and dotted vessels correspondin to the dilated capillaries, consistent with the findins in our case.[2] These dermoscopic findins can be corroborated by doin doppler ultrasound, which reveal hypoechoic areas, suestin increased blood flow in the dilated capillaries.[5],[6]

In case of functional IPPP, a conservative treatment is usually adopted, and resolution may be observed after several weeks. Dietary chanes are advised alon with entle local care of the skin. Cases of IPPP associated with LSA may be treated with topical steroids.[2]

Thus, the familiarity of this condition and its dermoscopy findins allow the prompt dianosis and avoid unnecessary intervention by the treatin dermatoloist.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have iven his/her/their consent for his/her/their imaes and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be uaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kayashima K, Kitoh M, Ono T. Infantile perianal pyramidal protrusion. Arch Dermatol 1996;132:1481 4.  Back to cited text no. 1
    
2.
Lamberti A, Filippou , Adinolfi A, Fimiani M, Rubeni P. Infantile perianal pyramidal protrusion: A case report with dermoscopy and ultrasound findins. Dermatol Pract Concept 2015;5:125 8.  Back to cited text no. 2
    
3.
Patrizi A, Raone B, Neri I, D’Antuono A. Infantile perianal protrusion: 13 new cases. Pediatr Dermatol 2002;19:15 8.  Back to cited text no. 3
    
4.
Zavras N, Christianakis E, Tsamoudaki S, Velaoras K. Infantile perianal pyramidal protrusion: A report of 8 new cases and a review of the literature. Case Rep Dermatol 2012;4:202 6.  Back to cited text no. 4
    
5.
Leun AK. Concomitant anterior and posterior infantile perianal protrusions. J Natl Med Assoc 2010;102:135 6.  Back to cited text no. 5
    
6.
Jasaitiene D, Valiukeviciene S, Linkeviciute , Raisutis R, Jasiuniene E, Kazys R. Principles of hih frequency ultrasonoraphy for investiation of skin patholoy. J Eur Acad Dermatol Venereol 2011;25:375 82.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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