ALTHOUGH THERE ARE some dermatological disorders that may affect the quality of life, the life-threatening dermatoses of the anorectal region are infrequently seen. When observed, bacterial infections would be the most serious, often being life threatening. For this reason, making the correct diagnosis and providing appropriate care is significant. Some of these disorders may be treated only with surgical treatment.

Emergency dermatoses in the anorectal region are listed in Table 28.1.

STAPHYLOCOCCAL CELLULITIS

The anorectal region can be susceptible to infection with Staphylococcus aureus. The high temperature, pressure, friction, and humidity of this area encourage colonization by staphylococci. Severe involvement with furunculosis and abscesses suggests an overlap with hidradenitis suppurativa. Cellulitis and abscess formation can complicate cysts, sinuses, and fistulas.

Anorectal infections in patients with malignant disease are serious and potentially life threatening. Although some cases of anorectal cellulitis may respond to antimicrobials alone, necrotizing fasciitis and Fournier gangrene have a high risk. Swelling and fluctuation signifying abscess formation may develop. It is difficult to decide on the timing of surgery. Perianal infiltration, ulceration, or abscess occurs in 5% of hematological malignancies and may rarely be the presenting feature.

STREPTOCOCCAL DERMATITIS/PERIANAL CELLULITIS

This syndrome is mostly seen in children between the ages of 1 and 8. Boys are affected more frequently than girls. Group A β hemolytic streptococci is the main cause (rarely S. aureus). An association with acute guttate psoriasis has also been reported.