Infantile Perianal Pyramidal Protrusion: Report of a Case and Review of the Literature

Abstract

Infantile perianal pyramidal protrusion is an important, relatively newly recognized condition, which is thought to be under-reported in the pediatric literature. Previous reports refer to these lesions as skin tags or skin folds. More recently, the name infantile perianal pyramidal protrusion has been suggested, based on the characteristic presentation of the lesion in prepubertal children, especially girls. Recognition of these lesions has many implications regarding proper diagnosis and management. They may easily be mistaken for condyloma accuminata or as a sign of trauma, leading to an investigation of sexual abuse. This situation may be avoided with awareness of this entity in combination with thorough history taking and a classic presentation. We present a classic presentation of infantile perianal pyramidal protrusion and further discuss this condition.

Infantile Perianal Pyramidal Protrusion: A Report of 8 New Cases and a Review of the Literature

“…According to Mérigou et al [7], constitutional IPPPs develop due to a weakness in the area of the perineum in females, which may explain why such conditions are seen mostly in girls. However, this hypothesis does not explain the presence of IPPPs in boys [8]. The congenital origin of IPPP is based on the discovery of these lesions in newborns and infants [3].…”

“…Konta et al [3] suggested that congenital IPPP may be ‘a remnant of a projected tip of the urogenital septum’. In the acquired type, constipation seems to play a role as IPPP regresses after appropriate management [7, 8, 9]. However, it is not clear whether regression is due to the treatment of constipation or constipation is a consequence of the development of IPPP [8].…”

“…In the acquired type, constipation seems to play a role as IPPP regresses after appropriate management [7, 8, 9]. However, it is not clear whether regression is due to the treatment of constipation or constipation is a consequence of the development of IPPP [8]. The presence of diarrhea, fistulas, and fissures could also implicate the formation of IPPP because of mechanical stimulation of the perineum [5].…”

“…In the case of a LSA-related IPPP, histology shows patchy lichenoid infiltrates with vacuolar alteration and homogenization areas of the collage in the papillary dermis [9]. The differential diagnosis of IPPP includes sexual abuse, rectal prolapse, perianal lesions of Crohn's disease, hemangiomas, and hemorrhoid disease [1, 3, 8, 10]. …”

Infantile pyramidal protrusion localized at the vulva as a manifestation of lichen sclerosus et atrophicus

“…1 Infantile pyramidal protrusion usually resolves spontaneously within several weeks. 1,5,6 The pathogenesis of this entity is unknown, but may be a peculiar form of reaction, influenced by a constitutional weakness in the perineal region in females. 3 This weakness does not explain the occurrence in the male patient.…”