Infantile Perianal Pyramidal Protrusion

A 3-mm long, double-tipped, polypoid lesion appeared just anterior to the anus on an 8-month-old girl 2 days earlier. The lesion was excised in the office: a local anesthetic was administered, and the base was lightly electrodesiccated. Antibiotic ointment was applied until the area healed. Pathologic findings identified an infantile perianal pyramidal protrusion.

Robert P. Blereau, MD, of Morgan City, La, writes that this lesion is similar to an acrochordon, or skin tag. Its location in the midline anterior to the anus may be related to the anatomic characteristics of the perineum and median raphe.¹ These lesions are seen more often in girls.

The differential diagnosis includes perianal eruptions associated with child abuse, genital warts, granulomatous lesions of inflammatory bowel disease, acrochordons, and rectal prolapse. Wiping of the affected area may increase the size or swelling of the protrusion.

There is no specific treatment; usually, conservative follow-up is recommended. A large lesion may be excised to make the patient more comfortable, as in this case.