Pruritus ani
Pruritus ani | |
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Specialty | Dermatology |
Pruritus ani is the irritation of the skin at the exit of the rectum, known as the anus, causing the desire to scratch.[1] The intensity of anal itching increases from moisture,[2] pressure, and rubbing caused by clothing and sitting. At worst, anal itching causes intolerable discomfort that often is accompanied by burning and soreness. It is estimated that up to 5% of the population of the United States experiences this type of discomfort daily.
Causes
If a specific cause for pruritus ani is found it is classified as "secondary pruritus ani". If a specific cause is not found it is classified as "idiopathic pruritus ani".
Some authorities describe “psychogenic pruritus” or "functional itch disorder",[6] where psychological factors may contribute to awareness of itching.
Ingestion of
Diagnosis
Diagnosis is usually done with a careful examination of the anus and the patient's history. If the presentation or physical findings are atypical, biopsies can be done.[7]
In case of long-lasting symptoms, above all in patients over 50 years of age, a colonoscopy is useful to rule out a colonic polyp or tumor, that can show pruritus ani as first symptom.[8]
Treatment
The goal of treatment is asymptomatic, intact, dry, clean perianal skin with reversal of morphological changes. For pruritus ani of unknown cause (idiopathic pruritus ani)
A successful treatment option for chronic idiopathic pruritus ani has been documented using a clean, dry and apply (if necessary) method. The person is instructed to follow this procedure every time the urge to scratch occurs. The treatment makes the assumption that there is an unidentified bacteria in the feces that causes irritation and itching when the feces makes contact with the anal and perianal skin during defecation, flatulation or anal leakage (particularly during sleep).
Cleaning the area with warm water, avoiding all soaps and even baby wipes, then drying the area, ideally with a hair dryer to avoid irritation or failing that simply patting gently with a clean, dry, towel. If persons with pruritus ani do not need to scratch after these steps they are instructed to do nothing else. If the urge to scratch is still present they are instructed to apply a topical steroid cream which has antibiotic and antifungal properties. This will address a skin condition which may have become infected. The cream may need to be applied twice a day for one to two weeks. After this, they must maintain their clean and dry regime and apply an emollient ointment (not cream) to moisturize the skin. This should be applied after each bowel movement and at night until no longer needed. At any time, persons may use antihistamine treatments orally, to control the itching.[citation needed]
For otherwise idiopathic, intractable cases, a double-blind trial with 44 patients found that capsaicin may be an effective treatment. By applying topical capsaicin mixed with paraffin wax (both available over the counter) with a concentration of 0.006% to the perianal area every 1-2 days, approximately three quarters of patients reported total (or near-total) relief of symptoms. [11]
See also
- Pruritus scroti
- Pruritus vulvae
- Perianal candidiasis
References
- ISBN 978-0-7216-2921-6. [page needed]
- ^ "Pruritus Ani". American Society of Colon & Rectal Surgeons. 2008. Archived from the original on March 21, 2008.
- ^ PMID 21602962.
- ^ "Itchy skin". NHS. 19 January 2018.
- PMID 11430454.
- PMID 17598038.
- PMID 26929750.
- ^ Pata F (2017). "Pruritus ani: the neglected stepchild of Coloproctology" (PDF). Società Italiana di Chirurgia Colo Rettale. 45: 383–395.
- ^ PMID 20109637.
- PMID 12912865.
- PMC 1773800. Retrieved 2024-02-13.
External links
- Siddiqi S, Vijay V, Ward M, Mahendran R, Warren S (September 2008). "Pruritus ani". Annals of the Royal College of Surgeons of England. 90 (6): 457–463. PMID 18765023.