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Key Features

  • Characterized by perianal itching and discomfort

  • May be caused by poor anal hygiene associated with

    • Fistulas

    • Fissures

    • Prolapsed hemorrhoids

    • Skin tags

    • Minor incontinence

  • Conversely, overzealous cleansing with soaps may contribute to local irritation or contact dermatitis

Clinical Findings

  • In patients with idiopathic perianal pruritus, examination may reveal

    • Erythema

    • Excoriations

    • Lichenified, eczematous skin

Diagnosis

  • Following must be excluded

    • Contact dermatitis

    • Atopic dermatitis

    • Bacterial infections (Staphylococcus or Streptococcus)

    • Parasites (pinworms, scabies)

    • Candidal infection (especially in diabetics)

    • Sexually transmitted disease (condylomata acuminata, herpes, syphilis [condylomata lata], molluscum contagiosum)

    • Other skin conditions (psoriasis, Paget disease, lichen sclerosis)

Treatment

  • After bowel movements, the perianal area should be cleansed with nonscented wipes premoistened with lanolin followed by gentle drying

  • A piece of cotton ball should be tucked next to the anal opening to absorb perspiration or fecal seepage

  • A short course of high-potency topical corticosteroid may be tried, although efficacy has not been demonstrated

  • Diluted capsaicin cream (0.006%) led to symptomatic relief in 75% of patients in a double-blind crossover study

  • Anal ointments and lotions may exacerbate the condition and should be avoided

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