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Pruritus Ani
Aka: Pruritus Ani- Epidemiology
- Prevalence: 1-5% of population in the United States
- Causes
- 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
- Infections
- 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 (perianal wart)
- Dermatologic causes
- Psoriasis
- Contact Dermatitis (see below)
- Hidradenitis Suppurativa
- Seborrheic Dermatitis
- Intertrigo
- Neurodermatitis
- Bowen Disease or Squamous Cell Carcinoma
- Extramammary Paget Disease
- Atopic Dermatitis
- Lichen Planus
- Lichen Sclerosis
- 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
- Signs
- See Anorectal Exam
- Findings suggestive of cause
- Intertrigo
- Prolapsed Hemorrhoid
- Anal Fissure
- Perianal Condyloma
- Fistula
- Complications of chronic scratching
- Excoriations
- Perianal skin lichenification
- Labs (as indicated based on history and exam)
- Pinworm Test
- Anal biopsy
- Indicated only in refractory cases without clear etiology
- 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
- Initiate therapy (see below) and see for follow-up after 4-6 weeks
- Management
- Eliminate itch-scratch cycle (especially while asleep)
- Eliminate exacerbating factors (see causes above)
- Critical to keep the perianal area dry
- Avoid excessive wiping and Alcohol wipes
- Wear loose clothing
- Dietary changes (eliminate coffee, milk, beer, nuts)
- 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)
- Topical 5% Lidocaine (Xylocaine) ointment
- Low potency Topical Corticosteroid
- Use briefly as last resort only
- Hydrocortisone 1% applied to area for 2-4 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]
- References