Pruritus Ani – itching in the perianal area
This is an embarrassing condition where most of us have difficulty to seek for advice or discuss to other people regarding this matter. Well, it also can be very distressing. Just imagine if you are at work or in a crowd of people, scratching will drop your reputation but ignoring it means disaster. However, do not worry too much; getting some knowledge involving this will help. If nothing else can be done, then, it’s time to seek for medical advice.
What are the possible causes?
It can be either local causes (primary) or general causes (systemic). The majority of causes are probably idiopathic or psychogenic. Most of the time the “itch-scratch” vicious cycle is created and symptoms usually persist even after initial cause has been eradicated.
Local causes:
- Poor hygiene
- Sweating
- Anal fistula
- Hemorrhoids
- Anal neoplasia / cancer
- Warts
- Fungal infections
- Contact dermatitis
- Worms
- Certain antibiotics (possibly via the complication of diarrhea or fungal infection)
- Dermatological diseases include scabies, pediculosis, psoriasis and atopic eczema
General causes:
- Diabetes mellitus
- Obstructive jaundice
- Hodgkin’s disease
Symptoms:
- Whatever the cause is the itchiness usually severe at night. Most probably because we have nothing to do at night so our mind can concentrate more on the symptom.
- Excoriations (scratch mark) of the skin area
- Lichenification (skin thickening)
- Papules or nodules (localized skin thickening)
Investigations:
Most of the time, no investigation is required. However, in certain cases, the doctor will run several investigations.
- Full blood count to look for hemoglobin and white cell count
- Blood sugar level
- Perianal scrapings
- Microscopy for fungal
Treatment:
- If any primary cause is known, it should be treated specifically
- Increase hygiene
- Avoid certain food that might worsen the itchiness, especially if someone is allergic to the food (e.g.: eggs, seafood, etc)
- Wearing loose underclothes
- Cleansing after defecation with simple soap (make sure that you are not allergic to that soap)
- Application of glycerin end witch hazel
- Symptomatic relief like antihistamine (e.g.: chlorpheniramine tablet) to improve the symptom. Sedative antihistamines at night will always be a big help.
- Application of hydrocortisone cream may help
- Zinc oxide can be used for local application to soothe anal irritation
- The scratch part might be painful so analgesic should be considered
Reference:
1. Churchill’s Pocketbook of Surgery. Andrew T. Raftery. 2nd edition. 2001.
2. Oxford handbook of clinical specialties. 5th edition. 2001.
3. Oxford handbook of clinical medicine. 4th edition. 1999.
Tags: anal fistula, antihistamine, diabetes mellitus, haemorrhoids, hydrocortisone cream, hygeine, itchiness, lichenifications, pruritis ani, zinc oxide
Technorati Tags: anal fistula, antihistamine, diabetes mellitus, haemorrhoids, hydrocortisone cream, hygeine, itchiness, lichenifications, pruritis ani, zinc oxide
Thanks for writing this. I’ll be sure to take it into consideration.
After a discussion with my friends, I now have a clear picture….
It really helps to talk to people who are normally not involved in your business. They can give you a very clear picture on what’s happening….
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