Pruritus, Perianal

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

In patients with idiopathic perianal pruritus, examination may reveal

• Erythema

• Excoriations

• Lichenified, eczematous skin

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)

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