Infantile Perianal Pyramidal Protrusion, presenting as a skin tag

A report describes a case of a 10-month-old girl who was referred to Pediatric Gynecology after her parents noticed an expanding genital bulge. Parents reported first seeing that skin tag in the perineal area at birth; however, the area became more swollen over the next few months and did not regress despite recommended sitz baths and barrier creams. The patient's medical history was unremarkable except for rising constipation since the introduction of solid food at six months of age. There were no doubts about sexual abuse. Her mother denied any history of human papillomavirus infection.

Physical examination showed normal prepubertal genitalia. Inspection of the perineum displayed an elongated, pyramidal flesh-colored lesion extended from just below the vaginal vestibule to the superior border of the anal verge. There were no signs of bleeding or excoriations. 

The patient received dietary modifications and daily Miralax for managing her constipation for the next two months, which decreased the lesion in size by approximately 50%.

Scaparotti A, Huguelet PS. It Is Not Just a Skin Tag: Infantile Perianal Pyramidal Protrusion. The Journal of Pediatrics. 2017;181:321. DOI:https://doi.org/10.1016/j.jpeds.2016.10.038