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For further information, see CMDT Part 6-59: Anogenital Pruritus
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Essentials of Diagnosis
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Anogenital itching, chiefly nocturnal
Skin findings are highly variable, ranging from none to excoriations and inflammation of any degree, including lichenification
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General Considerations
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May be due to
Intertrigo
Psoriasis
Lichen simplex chronicus
Seborrheic or contact dermatitis (from soaps, wipes, colognes, douches, and topical treatments)
Irritating secretions (eg, diarrhea, leukorrhea, or trichomoniasis)
Local disease (candidiasis, dermatophytosis, erythrasma) and, at times, oxyuriasis (pinworm infestation)
In pruritus ani, hemorrhoids are often found, and leakage of mucus and bacteria from the distal rectum onto the perianal skin may be important in cases in which no other skin abnormality is found
In women, pruritus vulvae does not usually involve the anal area, though anal itching usually spreads to the vulva
In men, pruritus of the scrotum is most commonly seen in the absence of pruritus ani
Up to one-third of causes of anogenital pruritus may be due to nerve root impingements in the lumbosacral spine
Squamous cell carcinoma of the anus and extramammary Paget disease are rare causes of genital pruritus
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Differential Diagnosis
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Urinalysis and blood glucose testing may lead to a diagnosis of diabetes mellitus
Microscopic examination or culture of tissue scrapings may reveal yeasts or fungi
Stool examination may show pinworms
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Pramoxine cream or lotion or hydrocortisone-pramoxine (Pramosone), 1% or 2.5% cream, lotion, or ointment is helpful in managing pruritus in the anogenital area; the ointment or cream should be applied after a bowel movement
Topical doxepin cream 5% is similarly effective, but it may be sedating
The use of strong corticosteroids on the scrotum may lead to persistent severe burning on withdrawal of the drug
Balneol Perianal Cleansing Lotion, or Tucks premoistened pads, ointment, or cream may be very useful for pruritus ani
In men with scrotal or anal pruritus, capsaicin cream 0.006% twice daily may be beneficial
In cases where topical therapies have failed, gabapentin or pregabalin ...