From the Research
Management of skin findings associated with imperforate anus primarily involves addressing the underlying anorectal malformation through surgical correction, followed by specific care for associated skin manifestations, as seen in a case of PELVIS syndrome where the anorectal malformation was surgically corrected and the patient showed improvement with oral propranolol for the cutaneous lesion 1.
Initial Management
Initial management includes surgical creation of a colostomy in the neonatal period, followed by definitive repair (typically posterior sagittal anorectoplasty) at 3-6 months of age.
- For perianal skin irritation and excoriation, apply zinc oxide barrier cream or petroleum jelly after gentle cleansing with warm water.
- Avoid harsh soaps and wipes containing alcohol or fragrances.
Dermatitis Management
For more severe dermatitis, short-term use of low-potency topical corticosteroids like hydrocortisone 1% cream twice daily for 3-5 days may be necessary.
- Antifungal creams such as clotrimazole or nystatin should be applied if secondary fungal infection is present.
Long-term Management
Following definitive repair, meticulous perineal hygiene is essential, with regular diaper changes and proper cleansing to prevent skin breakdown.
- Long-term management includes monitoring for constipation and fecal incontinence, which can lead to persistent skin issues. These skin manifestations occur because fecal diversion or abnormal stool patterns associated with imperforate anus can lead to chemical irritation, moisture accumulation, and altered skin barrier function in the perineal region. The use of transperineal ultrasonography can be helpful in determining the type of imperforate anus and identifying associated anomalies, such as internal fistulas 2, 3. However, the management of skin findings should prioritize the prevention of complications and the promotion of wound healing, rather than relying solely on diagnostic imaging. In cases where antibiotic treatment is considered, the current evidence does not support its routine use for preventing perianal fistula development after surgical drainage of perianal abscess 4, 5. Therefore, the focus should be on surgical correction, meticulous perineal hygiene, and monitoring for complications, rather than on antibiotic treatment.