Perianal Dermatology

Adrián E. Ortega, MD, FASCRS

Xavier Delgadillo, MD, EBSQ-C

The proctodeum represents the embryologic fusion of the integumentary tissues surrounding the anus to hindgut giving rise to the perianal, anal canal, and distal rectal regions in humans. It is a diminutive zone encompassing less than 1% of the total body. The anorectum represents remarkable feet of evolutionary engineering. The proctodeum is an important anatomic transition zone that is host to diseases of the anorectum as well as the surrounding external skin and soft tissues. Colorectal surgeons are significantly more familiar with the former than the latter.

The perianal region shares pathologic characteristics with the anorectum, anogenital, and largest human organ—the dermis. Several hundred pathologic conditions affect the dermis. Strictly dermal afflictions come to the attention of primary care physicians and ultimately to dermatologists. However, any dermal condition approaching the anus within a few centimeters becomes the concern of the contemporary colon and rectal surgeon. Clinical educators in the specialty are acutely aware of the relative lack of emphasis given to physical diagnosis of perianal diseases. Misdiagnosis is common rather than the exception.

This issue of the Clinics in Colon and Rectal Surgery focuses on the evaluation and management of common problems seen in the contemporary practice of colorectal surgery. It emphasizes practical approaches to common diseases. It also recognizes that the world is becoming a much smaller community. Diseases endemic in developing countries are increasingly presenting throughout the planet. Moreover, anorectal conditions may be the first harbinger of systemic diseases. Diagnoses of the past are re-emerging in different social contexts as the human condition continues to evolve. The mastery of perianal dermatology offers a significant opportunity to impact the lives of millions of patients annually by dedicated and interested colorectal physicians and surgeons.

The guest editors are grateful to all the expert contributors who shared their collective knowledge, perspectives, and experience on perianal dermatology.