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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
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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)
Examination may reveal erythema, excoriations, or lichenified, eczematous skin
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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