Pruritus ani

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Pruritus ani
Classification and external resources
ICD-10 L29.0
ICD-9 698.0
DiseasesDB 30154
MeSH D011538

Pruritus ani (also known as anusitis) is the irritation of the skin at the exit of the rectum, known as the anus, causing the desire to scratch.[1] The intensity of anal itching increases from moisture,[2] pressure, and rubbing caused by clothing and sitting. At worst, anal itching causes intolerable discomfort that often is accompanied by burning and soreness. It is estimated that up to 5% of the population of the United States experiences this type of discomfort daily.

Causes[edit]

The irritation can be caused by intestinal parasites, anal perspiration, frequent liquid stools, diarrhea, residual stool deposits, or the escape of small amounts of stool as a result of incontinence or flatulence. Another cause is yeast infection or Candidiasis. Some diseases increase the possibility of yeast infections, such as diabetes mellitus or HIV infection. Treatment with antibiotics can bring about a disturbance of the natural balance of intestinal flora, and lead to perianal thrush, a yeast infection affecting the anus. Psoriasis also can be present in the anal area and cause irritation. Abnormal passageways (fistulas) from the small intestine or colon to the skin surrounding the anus can form as a result of disease (such as Crohn's disease), acting as channels which may allow leakage of irritating fluids to the anal area. Other problems that can contribute to anal itching include pinworms, hemorrhoids, tears of the anal skin near the mucocutaneous junction (fissures), and skin tags (abnormal local growth of anal skin). Aside from diseases relative to the condition, a common view suggests that the initial cause of the itch may have passed, and that the illness is in fact prolonged by what's known as an itch-scratch cycle.[3][4] It states that scratching the itch encourages the release of inflammatory chemicals, which worsen redness, intensifies itchiness and increases the area covered by dry skin, thereby causing a snowball effect.

If people who are allergic to Balsam of Peru ingest it, they may experience pruritis and contact dermatitis in the perianal region, possibly due to unabsorbed substances in the feces.[5][6] Balsam of Peru is used in food and drink for flavoring, in perfumes and toiletries for fragrance, and in medicine and pharmaceutical items for healing properties.[6][7][8] Balsam of Peru is also often an ingredient in hemorrhoidal suppositories and ointments, such as Anusol.[7]

Some authorities describe “psychogenic pruritus” or "functional itch disorder",[9] where psychological factors may contribute to awareness of itching.

Ingestion of helminth (worm) Enterobius vermicularis (pinworm, or threadworm) eggs leads to Enterobiasis, indicative of severe itching around the anus from migration of gravid females from the bowel. Severe cases of Enterobiasis result in hemorrhage and eczema.

Treatment[edit]

For pruritus ani of unknown cause treatment typically begins with measures to reduce irritation and trauma to the perianal area.[10] Stool softeners can help prevent constipation.[10] If this is not effective topical steroids or injected methylene blue may be tried. Another treatment option that has been met with success in small-scale trials is the application of a very mild (.006) topical capsaicin cream.[11] This strength cream is not typically commercially available and therefore must be diluted by a pharmacist or end-user. If the itchiness is secondary to another condition such as infection or psoriasis these are typically treated.[10]

See also[edit]

References[edit]

  1. ^ James, William; Berger, Timothy; Elston, Dirk (2005). Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.). Saunders. ISBN 0-7216-2921-0.
  2. ^ American Society of Colon & Rectal Surgeons (2012). Pruritus Ani. http://www.fascrs.org/patients/conditions/pruritus_ani/
  3. ^ http://www.nhs.uk/Conditions/Itching/Pages/Treatment.aspx
  4. ^ europepmc.org/abstract/MED/11430454/reload=0;jsessionid=ZNvoiLhWtmjT8N99NIGj.22
  5. ^ Richard J. G. Rycroft (2001). Textbook of Contact Dermatitis. Springer. Retrieved March 6, 2014. 
  6. ^ a b Thomas P. Habif (2009). Clinical Dermatology. Elsevier Health Sciences. Retrieved March 6, 2014. 
  7. ^ a b "Balsam of Peru contact allergy". Dermnetnz.org. December 28, 2013. Retrieved March 5, 2014. 
  8. ^ Gottfried Schmalz, Dorthe Arenholt Bindslev (2008). Biocompatibility of Dental Materials. Springer. Retrieved March 5, 2014. 
  9. ^ ".". Retrieved April 2, 2014. 
  10. ^ a b c Markell, KW; Billingham, RP (February 2010). "Pruritus ani: etiology and management.". The Surgical clinics of North America 90 (1): 125–35, Table of Contents. doi:10.1016/j.suc.2009.09.007. PMID 20109637. 
  11. ^ Topical capsaicin—a novel and effective treatment for idiopathic intractable pruritus ani: a randomised, placebo controlled, crossover study. PubMed http://www.ncbi.nlm.nih.gov/pubmed/12912865 |url= missing title (help). Retrieved February 11, 2014.