Pruritus, Perianal

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