II. Epidemiology
- Pruritus Ani Prevalence: 1-5% of population in the United States
III. Causes: Perianal Pruritus
- Systemic causes
- Functional and mechanical causes
- Chronic Diarrhea
- Chronic Constipation
- Anal Fissure
- Anal Fistula
- Tight fitting clothes
- Vigorous peri-anal cleaning
- Stool Leakage
- Anal Incontinence
- Prolapsed Hemorrhoids
- Rectal Prolapse
- Anal papilloma (HPV)
- Skin Tags
- Neoplasms
- Anal Cancer
- Colorectal Cancer
- Adenomatous Polyp
- Infections
- Perianal Streptococcal Cellulitis
- Erythrasma (Corynebacterium)
- Intertrigo (Candida)
- Herpes Simplex Virus (HSV)
- Human Papillomavirus (HPV)
- Pinworms or Enterobius (Especially young children)
- Scabies
- Perirectal Abscess
- Gonorrhea
- Syphilis
- Molluscum Contagiosum
- Condyloma (Anogenital Wart)
- Dermatologic causes (Perianal Dermatitis)
- Exposures
- Systemic: Medications
- Colchicine
- Quinidine
- Neomycin
- Chemotherapy
- Topicals: Contact Dermatitis
- Topicals: Food irritants
- Tomatoes
- Chili peppers
- Caffeinated beverages
- Beer
- Citrus juices or fruit
- Milk products
- Systemic: Medications
IV. Signs
- See Anorectal Exam
- Findings suggestive of cause of Perianal Pruritus
- Complications of chronic scratching
- Excoriations
- Perianal skin lichenification
V. Labs (as indicated based on history and exam)
- Pinworm Test
- Perianal Streptococcus culture
- Anal biopsy
- Indicated only in refractory cases without clear etiology
- STD testing (indicated for receptive anal intercourse history)
VI. Evaluation
- Initiate therapy (see below) and see for follow-up after 4-6 weeks
- Conservative therapy is effective in 89% of patients
- Failure to improve (11% of cases) should prompt further evaluation for underlying cause
- Contributory underlying anorectal disease (52%)
- Lower endoscopy abnormality (35%)
- Underlying neoplasm (23%)
- References
VII. Management
- Eliminate itch-scratch cycle (especially while asleep)
- Eliminate exacerbating factors (see causes above)
- Perianal cleaning (gentle)
- Wash twice daily with water and sensitive soap
- Clean with handheld shower head, squirt bottle, sitz bath or bidet
- Medications
- Hydroxyzine (Atarax or Vistaril) 50 mg at bedtime (adults)
- Avoid in the elderly (see Beers List)
- Topical 5% Lidocaine (Xylocaine) ointment
- Avoid prolonged use
- Low potency Topical Corticosteroid
- Use briefly as last resort only
- Hydrocortisone 1% applied to area for up to 2 weeks
- Avoid high potency Corticosteroids
- Avoid use longer than 4 weeks
- Al-Ghaniem (2007) Int J Colorectal Dis 22(12):1463-7 [PubMed]
- Capsaicin 0.006% cream
- Requires compounding - dilute standard Capsaicin in white paraffin
- Lysy (2003) Gut 52(9): 1323-6 [PubMed]
- Tacrolimus 0.1% (Protopic)
- Hydroxyzine (Atarax or Vistaril) 50 mg at bedtime (adults)
VIII. References
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | Intense chronic itching in the anal area. |
| Concepts | Sign or Symptom (T184) |
| MSH | D011538 |
| ICD9 | 698.0 |
| ICD10 | L29.0 |
| SnomedCT | 201012005, 156381007, 90446007 |
| English | Pruritus Ani, PERIANAL ITCHING, PRURITUS ANI, pruritus ani (diagnosis), anal itching, pruritus ani, anal itching (symptom), rectal pruritus, anal pruritus, rectal itching, rectal itching (symptom), Perianal irritation, Perianal itching, itching in anal region, pruritus in the anal region, itching in anal region (symptom), Pruritus perineal, perianal itching, Pruritus Ani [Disease/Finding], ani pruritis, itch anal, Itching;anal, pruritus anal, anis pruritus, irritations perianal, Itching;perianal, Itching;rectal, Pruritus;perianal, itching anal, rectal itch, itching perianal, anal itch, ani pruritus, perianal pruritus, itching rectal, pruritis ani, Anal pruritus, Pruritus ani, Anal itch, Perianal itch, Pruritus ani (disorder), itch; anal, pruritus; ani, anal; itch, ani; pruritus, Pruritus ani (finding), pruritis of perianal region |
| French | PRURIT ANAL, Prurit périnéal, Irritation périnéale, Démangeaisons périanales, DEMANGEAISONS ANALES, Prurit anal, Prurit de l'anus |
| Portuguese | PRURIDO ANAL, Prurido perineal, Irritação perianal, PRURIDO PERIANAL, Prurido anal, Prurido Anal |
| Spanish | PRURITO ANAL, Prurito perineal, Irritación perianal, Prurito anal, Pruritus ani, Picor perianal, PRURITO PERIANAL, prurito anal, prurito del ano, prurito perianal, prurito del ano (hallazgo), prurito del ano (trastorno), Prurito Anal |
| German | PRURITUS ANI, Pruritis perianal, analer Juckreiz, perianale Reizung, perianales Jucken, PERIANALER JUCKREIZ, Afterjucken, Pruritus ani |
| Dutch | pruritus aan bilnaad, pruritus ani, perianale jeuk, anale pruritus, perianale irritatie, anaal; jeuk, ani; pruritus, jeuk; anaal, pruritus; ani, Perianale jeuk, Pruritus ani |
| Italian | Prurito perineale, Prurito perianale, Irritazione perianale, Prurito anale |
| Japanese | 会陰部そう痒症, ｴｲﾝﾌﾞｿｳﾖｳｼｮｳ, 肛門そう痒症, ｺｳﾓﾝｼｭｳｲｼｹﾞｷｼｮｳｼﾞｮｳ, ｺｳﾓﾝｿｳﾖｳｼｮｳ, 肛門周囲そう痒, ｺｳﾓﾝｼｭｳｲｿｳﾖｳｼｮｳ, 肛門周囲そう痒症, 肛門周囲刺激症状, ｺｳﾓﾝｼｭｳｲｿｳﾖｳ |
| Swedish | Klåda i ändtarmsmynningen |
| Czech | pruritus ani, Perianální svědění, Řitní svědění, Pruritus hráze, Anální pruritus, Perianální dráždění, svědění konečníku, svědění řiti |
| Finnish | Peräaukon kutina |
| Russian | ANUSA ZUD, АНУСА ЗУД |
| Korean | 항문가려움 |
| Polish | Świąd odbytu |
| Hungarian | Perinealis viszketés, Perianalis viszketés, Végbélviszketés, Anális viszketés, Perianalis irritatio |
| Norwegian | Pruritus ani, Analkløe, Kløe i endetarmsåpningen |
Ontology: Perianal dermatitis (C0554478)
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 275448003 |
| English | dermatitis perianal, perianal dermatitis, Perianal dermatitis, Perianal dermatitis (disorder) |
| Spanish | dermatitis perianal (trastorno), dermatitis perianal |
