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EXPERIENCE AND REASON: Paul J. Honig, Ilona J. Frieden, Ho Jin Kim, and Albert C. Yan Streptococcal Intertrigo: An Underrecognized Condition in Children Pediatrics 2003; 112: 1427-1429 [Abstract] [Full text] [PDF]

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Streptococcal intertrigo

Caroline B. Hall   (22 January 2004)

Streptococcal Intertrigo

Albert C Yan, Ilona J. Frieden, Ho Jin Kim, Paul J. Honig   (17 February 2004)

Streptococcal intertrigo 22 January 2004
Caroline B. Hall, Professor of Pediatrics and Medicine in Infectious Disease University of Rochester Send letter to journal: Re: Streptococcal intertrigo CarolineHall{at}urmc.rochester.edu Caroline B. Hall	To the Editor. - I appreciated seeing Dr. Honig and colleagues’ article on streptococcal intertrigo(1) for such lesions are common and, indeed, often unrecognized. Dr. Burtis B. Breese described these lesions in 1978 in his book on streptococcal diseases.(2) Included are pictures of lesions in areas which are not only undiagnosed as being streptococcal, but are frequently not noted as being present. Perhaps the most common of these are the lesions that occur behind the pinna of the ear.(2) They are often overlooked because they look similar to the reddened, irritated areas that occur in the crease behind the ear from accumulated debris of shed epithelial tissue, soap and moisture after baths in difficult to dry areas. Parents usually do not note these hidden lesions, nor do our physical examinations commonly include the maneuver of bending the pinna forward. Clues that these areas of intertrigo are actually streptococcal impetigo-like lesions are:2 1. They have a crust which when lifted slightly exudes a small amount of honey-colored material. 2. The redness surrounding streptococcal lesions do not have indurated bases. 3. Frequently small satellite lesions are nearby. The best diagnostic kit, as illustrated by Dr. Honig and coworkers, is the astute eye. Caroline Breese Hall, MD Departments of Pediatrics and Medicine University of Rochester School of Medicine and Dentistry 601 Elmwood Ave, Box 689 Rochester, NY 14642 Telephone: (585) 275-5242 Fax: (585) 275-8699 E-mail: Caroline_Hall@urmc.rochester.edu REFERENCES 1. Honig P, Frieden I, Kim H, et al. Streptococcal intertrigo: an underrecognized condition in children. Pediatr 2003; 112: 1427-1429. 2. Breese BB and Hall CB. Beta Hemolytic Streptococcal Diseases. In: Breese BB and Hall CB, eds., Boston: Houghton Mifflin Professional Publishers, 1978:179-180.
Streptococcal Intertrigo 17 February 2004
Albert C Yan, Assistant Professor, Pediatrics and Dermatology Children's Hospital of Philadelphia, Ilona J. Frieden, Ho Jin Kim, Paul J. Honig Send letter to journal: Re: Streptococcal Intertrigo yana{at}email.chop.edu Albert C Yan, et al.	We appreciate the astute observations made by Dr. Caroline Hall. In our experience, cases of streptococcal intertrigo frequently lack the honey- colored crusting because of the moist, macerating environment of intertriginous areas. Crusting could, however, occur more on other less occluded sites such as the periauricular areas. Dr. Barton Schmitt recently suggested the use of rapid strep testing. Although we are unaware of the sensitivity and specificity of such a test for this condition, we suspect that it could provide a quick and easy method for confirming the diagnosis. The influx of correspondence on this subject has been greatly appreciated regarding the experience of other clinicians with this condition. Perhaps constant reminders of certain conditions are important so as not to forget them.