Pruritus Ani Disease

DESCRIPTION

Intense chronic itching in the anal and perianal skin. Usual course - acute. Chronic pruritus ani is a symptom, not a diagnosis or disease.

System(s) affected: Skin/Exocrine
Genetics: No known genetic pattern
Incidence/Prevalence in USA: Common
Predominant age: All ages
Predominant sex: Male > Female (4:1)

SIGNS AND SYMPTOMS

Primary
- Rectal itching
- Anal erythema
Secondary
- Secondary infections with yeast, fungus, and/or bacteria are possible after prolonged scratching
- Anal itching
- Anal fissures
- Maceration
- Lichenification
- Excoriations

CAUSES

Dermatologic disorders
- Allergies (soap, topical anesthetics, oral antibiotics)
- Fistulas
- Fissures
- Neoplasms
- Psoriasis
- Eczema
- Seborrheic dermatitis
- Contact dermatitis
Infections
- Pinworms and other worms
- Scabies
- Pediculosis
- Candidiasis
- Tinea
Other
- Poor hygiene (fecal material allowed to dry on the skin)
- Diabetes mellitus
- Chronic liver disease
- Diarrheic alkalotic irritation
- Trauma from scented toilet paper

RISK FACTORS

Overweight
Hairy, tendency to perspire a great deal
Anxiety-itch-anxiety cycle

LABORATORY

Glycosuria
Hyperglycemia
Skin scraping, yeast
Fungi
Parasites
Stool - ova plus parasites

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Excoriation of epithelial layer of skin

SPECIAL TESTS

Blood sugar levels

IMAGING

N/A

DIAGNOSTIC PROCEDURES

Inspection
Anoscopy biopsy (to exclude neoplasia)

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Treat predisposing factors, such as parasites, diabetes, liver disease, cryptitis, scabies, pediculosis
Resist overly meticulous use of soap and rubbing
Avoid tight clothing and under clothing
Cleanse anal area after bowel movements with moistened absorbent cotton and plain water; baby wipes may be a convenient alternative
Dust anal area with non-medicated talcum powder
If unable to completely empty rectum with defecation, use small plain water enema (infant bulb syringe) after each bowel movement. This may prevent postevacuation soilage and irritation.

SURGICAL MEASURES

N/A

ACTIVITY

Avoid getting overheated

DIET

If suspicious of food allergy, eliminate as a trial: Coffee, beer, cola, vitamin C tablets in excessive doses, spices, citrus fruits

PATIENT EDUCATION

See information in General Measures

PREVENTION/AVOIDANCE

Avoid topical agents
Avoid laxatives
Avoid tight underclothing made from synthetic material
Practice good hygiene
Use talcum powder
Possibly lactobacillus acidophilus (tablets or in milk); possibly malt soup extract
Eat yogurt when taking broad-spectrum antibiotics

POSSIBLE COMPLICATIONS

Secondary bacterial infection
Chronicity
Excoriation
Lichenification

EXPECTED COURSE AND PROGNOSIS

Depends upon etiology; usually good
May be persistent and recurrent

ASSOCIATED CONDITIONS

Diabetes mellitus
Psoriasis
Hyperhidrosis
Parasite infestations
Hemorrhoids

AGE-RELATED FACTORS

Pediatric:

Usually secondary to enterobiasis, anal fissures, other local inflammatory lesions, or coarse or moist undergarments. Nocturnal itching may be due to pinworms.
Exposure to sunlight or dry heat may be helpful for infants with inflamed anal area

Geriatric:Common in this age group
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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