Infantile Perianal Pyramidal Protrusion

Infantile Perianal Protrusion: 13 New Cases

“…In all reported cases, this fold was observed in the midline anterior to the anus (1–4). In our cases, however, IPPP was located anterior to the anus in eight cases and posteriorly in three; a double IPPP anterior and posterior to the anus was present in two patients.…”

“…In 1989 McCann et al (2) first described a perianal protrusion in 18 prepubertal girls without a history of sexual abuse, and until now, 77 patients, mainly girls, affected by IPPP have been reported in the literature (1–5). The marked predilection of IPPP for girls is confirmed in our study, where all patients were female (1–5). The pathogenesis of IPPP is still unknown, although Mérigou et al (4) suggested that an area of constitutional weakness is present in the perineum in females and may explain why such a condition is seen mostly in girls (4).…”

“…In acquired cases of IPP, constipation, diarrhea, fistulas, and anal fissures have been hypothesized to play a role, as has the mechanical irritation caused by wiping after defecation (1,4). In our patients a past history of constipation, a condition not uncommon among young children, was present in six cases and an anal fissure was present in three cases, associated in two patients with constipation and as an isolated finding in one patient.…”

“…Biopsy specimens were not taken from any of our patients affected by constitutional or functional IPPP, but biopsies were performed by Konta et al (5) in four cases and Kayashima et al (1) in another two cases. In three of the four children biopsied by Konta et al, the epidermis and dermis were essentially normal, whereas in their fourth case and in the two patients biopsied by Kayashima et al (1), there was an inflammatory change in the dermis and acanthosis in the epidermis. In the latter cases, this inflammation was considered as secondary to the clinical inflammation.…”

Infantile perianal pyramidal protrusion treated by topical steroid application

“…The term infantile perianal pyramidal protrusion (IPPP) was first proposed by Kayashima 1 in 1996. Since its initial description, 92 cases have been reported in the English literature.…”