Infantile perianal pyramidal protrusions (IPPP) typically occur in prepubertal children, more often girls, as fleshy acrochordon-like protrusions of tissue along the midline anterior to the anus. These lesions may be easily mistaken for condyloma acuminata or signs of trauma, leading to erroneous investigations of sexual abuse. Papules are solitary and located on the perineum, often along the median raphe. Most patients present in infancy or early childhood with a recent history of swelling of the lesion. IPPP may be congenital. Individual lesions resolve spontaneously with time, usually within several weeks.

Three subtypes are distinguished:

1. Constitutional
2. Related to constipation
3. Related to lichen sclerosus

The cause for the predominance of cases of IPPP in females is unknown. One possibility is that the lesions are more noticeable in female infants and children, leading to a higher rate of medical evaluation. Another possibility is anatomical, in that a constitutional weakness may exist in the perineal region of females compared with males.

Affected children often have a history of constipation, which may in turn may be a presenting symptom of lichen sclerosus. Other associations include local irritation secondary to wiping.