[Concept and treatment of pruritus ani idiopathicus; vitamin A therapy of pruritus ani; pruritus ani as a physiopathological syndrome of the circumanal glands].
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Anal Canal↗
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The fecal microflora in pruritus ani.
Pruritus ani is a common condition in which there is a tendency for liquids to leak from the anal canal, resulting in perianal soiling. In order to ascertain if an abnormal fecal flora contributes to the irritant effects of fecal material, qualitative and quantitative measurement of the fecal microflora was performed in 20 patients with pruritus ani and 20 matched controls. No differences were found between the two groups. This study has failed to provide evidence for a microbiologic basis for pruritus ani.
Adult↗
Pruritus ani.
Management of pruritus ani rests on a few basic principles. The first and foremost is to listen to the patient and accept how uncomfortable and even disabling this common disorder can be. Such causes as parasites, diarrhea, trauma, hemorrhoids, and fistulas must be accurately diagnosed and treated. Contributing factors, such as poor hygiene or, paradoxically, too vigorous cleansing, must be corrected. Certain foods, such as spices and citrus fruits, need to be eliminated from the diet. Use of all over-the-counter preparations, cleaning pads, and solutions except water must be stopped. Finally, a mild steroid cream should be prescribed on a temporary basis, and the patient should be reexamined in two to three weeks. In the vast majority of cases, the physician will have a very happy and appreciative patient.
Humans↗
Pruritus ani. Classification and management.
Pruritus ani is a common dermatologic complaint that can be frustrating to treat. Effective therapy depends upon recognition of a variety of etiologic factors that may contribute to the symptom.
Humans↗
Symposium on colon and anorectal surgery. Pruritus ani: a practical approach.
Pruritus ani is a symptom of diverse cause and varied presentation which will respond in most cases to measures directed at keeping the anal area clean and dry. The role of the surgeon is to evaluate the patient to determine the status of the problem and to rule out threatening conditions, to educate the patient in his responsibility for continuing care and prevention, and to prescribe initial therapy to relieve symptoms. Follow-up evaluation is necessary to intensify treatment for the unresponsive patient, to diagnose further or identify the candidate for surgery, and to refer the patient with uncontrolled pruritus exhibiting a dermatosis for dermatological diagnosis and therapy. The crux of this practical management rests in the control of perianal moisure, the elimination of which gives an enfilading effect to therapy.
Female↗
Treatment of intractable pruritus ani.
The majority of patients with idiopathic pruritus ani respond favorably to conservative treatment. Moreover, response to specific medical therapy is almost always favorable in certain dermatologic diseases such as psoriasis, mycotic dermatitis, and contact dermatitis. When surgery is performed for anorectal disorders such as hemorrhoids and fistulas, or potentially malignant entities such as extramammary Paget's disease, the accompanying pruritus ani invariably improves as well. Only patients with chronic intractable pruritus ani are included in the current study. Methylene blue (methylthionine chloride) 0.5 percent is injected intracutaneously on the anodermal and perianal skin. With one treatment, long-term cure has been observed.
Adult↗
Treatment of persistent pruritus ani in a combined colorectal and dermatological clinic.
BACKGROUND: Pruritus ani is a common and socially embarrassing condition which is often poorly managed. It is often classified as idiopathic where the symptoms are usually transitory or secondary when a more persistent itch is experienced. The aim of this study was to establish the cause of pruritus ani in a group of patients referred to a combined colorectal and dermatological clinic, and to determine the most appropriate treatment. METHODS: Forty consecutive patients with pruritus ani were referred over a 6-month period from either the general practitioner or another hospital consultant to a combined colorectal and dermatological clinic. They were assessed by history, completion of a general health questionnaire, full examination of the skin, digital rectal examination, proctoscopy, sigmoidoscopy and patch testing. Patients were treated according to clinical findings at assessment. RESULTS: Thirty-four patients had a recognizable dermatosis, three had superficial perianal fissuring and three had a normal perineum; two required surgical intervention. Eighteen patients had a positive reaction when patch tested. All patients have shown an improvement or complete resolution of symptoms with treatment. CONCLUSION: This series has shown that the majority of patients presenting with pruritus ani have a dermatosis as the underlying cause of their symptoms and that many of them have developed contact sensitivities to the various topical medications used. These findings suggest that referral to a dermatologist in the first instance may be more appropriate.
Adolescent↗
Anorectal pain and irritation: anal fissure, levator syndrome, proctalgia fugax, and pruritus ani.
Anal fissures, proctalgia fugax, levator ani syndrome, and pruritus ani are common causes of anorectal pain and irritation. The clinician who obtains a thorough history and performs a complete examination can accurately diagnose these disorders. Ancillary tests seldom are helpful and rarely are necessary. Most patients suffering from these conditions readily respond to conservative therapy provided in the primary care practitioner's office.
Anus Diseases↗
Abnormal transient internal sphincter relaxation in idiopathic pruritus ani: physiological evidence from ambulatory monitoring.
Patients with idiopathic pruritus ani have an abnormal rectoanal inhibitory reflex and a lower threshold for internal sphincter relaxation during the saline continence test. This led to the hypothesis that these patients may exhibit abnormalities of the transient internal anal sphincter relaxation reflex. To study this, 23 men of median age 41 (range 27-64) years with idiopathic pruritus ani and 16 male controls of median age 39 (range 26-68) years were assessed using computerized ambulatory anorectal electromyography and manometry. Resting anal pressure, maximum anal squeeze pressure, internal sphincter electromyogram frequency, the number of internal sphincter relaxations and pudendal nerve terminal motor latency were similar for the two groups. The rise in rectal pressure during internal sphincter relaxation was higher in patients with pruritus than in controls (median (range) 29 (18-60) versus 18 (11-37) cmH2O, P < 0.01). Furthermore, the fall in anal pressure was greater in patients with pruritus than in controls (median (range) 39 (15-52) versus 29 (21-43) cmH2O, P < 0.01). The duration of internal sphincter relaxation was prolonged in patients compared with controls (median (range) 29 (18-55) versus 8 (5-12) s, P < 0.001). Fourteen patients reported staining of underclothes and 17 complained of perianal itch within 1 h of these episodes of abnormal internal sphincter relaxation. Pruritus ani may result from occult faecal leakage as a result of abnormal transient internal sphincter relaxation.
Adult↗
The mycotic flora in proctological patients with and without pruritus ani.
The perianal mycotic flora was studied in proctological patients with and without pruritus ani, as well as in control subjects. Four groups of patients underwent perianal mycoculture. In Group 1, 53 patients with anal pruritus were treated for benign anorectal disease. In Group 2, 24 patients with no underlying disease presented with anal pruritus. Both of these groups underwent concomitant chemical and parasitical examination of the faeces and an oral glucose tolerance test. In Group 3, 50 patients without pruritus ani at present or in the past were treated for benign anorectal diseases. In Group 4, 47 surgical patients without pruritus ani were treated for benign (9) and malignant (38) non-proctological diseases. In Group 1 the mycoculture was positive in 24/53 patients (Candida albicans 14, dermatophytes 10). In Group 2 fungal infections were seen in 16/24 patients (C. albicans 7, dermatophytes 9). No parasites or diabetes were found in either group. In Group 3 C. albicans was isolated in 14/50 patients. In Group 4 C. albicans was found in 11/47 cases (2 in benign, 9 in malignant diseases). Infection by C. albicans was observed in all groups studied, independent of the presence of disease or anal pruritus. The presence of dermatophytes was always associated with pruritus ani.
Adolescent↗
Physiological study of pruritus ani.
Physiological abnormalities in the anorectum of 34 patients with pruritus ani, and 20 age and sex matched controls were assessed. A saline infusion (1500 ml) test showed that leakage started after infusion of 600 ml in patients with pruritus ani compared with 1300 ml in controls (median values: P less than 0.001). There was an inverse relationship between the severity of the symptoms of pruritus ani and the volume of first leakage on the saline infusion test P less than 0.02. Studies to assess anal sphincter function, rectal sensation to balloon distension, rectal compliance, and perineal descent did not show any significant differences between pruritic patients and controls. However, pruritic patients without co-existing anal pathology had a significantly greater fall of anal pressure when a rectal balloon was inflated (57 per cent) when compared with controls (40 per cent) P less than 0.05.
Adult↗
Psychological assessment of patients with idiopathic pruritus ani.
BACKGROUND: The purpose of this study was to compare psychological profiles in 17 patients suffering from idiopathic pruritus ani with a control group of 28 patients showing secondary pruritus ani. METHODS: The two groups completed the Mini-Mult personality test and results were compared using chi 2 test and analysis of variance. RESULTS: The mean hypomania and depression scale scores were greater and smaller respectively in the idiopathic pruritus ani group. Nevertheless, the percentage of abnormal psychological profiles was not significantly different between the two groups. CONCLUSIONS: It seems arbitrary to systematically ascribe psychogenic aetiologies to idiopathic pruritus ani even though psychological factors may be present in individual patients.
Adult↗
Topical capsaicin--a novel and effective treatment for idiopathic intractable pruritus ani: a randomised, placebo controlled, crossover study.
PURPOSE: Pruritus ani is a common and embarrassing proctological condition which can be very difficult to treat. We report the results of a double blind placebo controlled study of treatment with capsaicin. METHODS: Firstly, a pilot open study was carried out on five patients to establish which of two doses was the most acceptable by comparing effectiveness and side effects. Secondly, a double blind, placebo controlled, crossover study of topical capsaicin was performed. This study involved two four week treatment phases separated by a one week washout phase. Forty four patients were randomised to receive locally either active capsaicin (0.006%) or placebo (menthol 1%) ointment over a four week period (22 patients per group). After four weeks of treatment and a one week washout period, the placebo group began to receive capsaicin while the treated group received placebo (menthol 1%) for another four weeks. At the end of the controlled study, responders from both groups continued with capsaicin treatment in an open labelled manner. RESULTS: Thirty one of 44 patients experienced relief during capsaicin treatment periods and did not respond to menthol; all patients not responding to capsaicin also failed on menthol (p<0.0001). In 13 patients, treatment with capsaicin was unsuccessful: eight patients did not respond to capsaicin treatment, one responded equally to capsaicin and placebo, and four others dropped out because of side effects. During the follow up period (mean 10.9 (SD 5.8) months), 29 "responders" needed a mean application of capsaicin every day (1.6 (SD 1.2); range 0.5-7 days) to remain symptom free (or nearly symptom free). CONCLUSION: Capsaicin is a new, safe, and highly effective treatment for severe intractable idiopathic pruritus ani.
Administration, Topical↗
Pruritus ani.
Although the importance of the anal zone is well known in psychoanalysis, pruritus ani has not been studied recently in the psychoanalytic literature. This paper is presented to show how bisexuality in a male patient has been analysed through pruritus ani as the main presenting symptom. After giving the case history of Fernand, pruritus ani is analysed from three main points of view: phallic, anal and oral. This is done to illustrate the connexions of the psychopathological material at the three stages and their expression through one symptom of the 'instincts and their vicissitudes'. Finally, the importance of the anal stage and its symptomatology as an attempt to diminish the affective charge brought up in the individual by the oral and phallic conflicts is discussed briefly.
Adult↗
The cause and treatment of idiopathic pruritus ani.
Six common foods can cause the clinical entity called "idiopathic" pruritus ani. They are coffee, tea, cola, beer, chocolate, and tomatoes. Pruritus ani occurs in 24 to 48 hours when a patient consumers more than a threshold amount of one or more of these foods and disappears spontaneously in a few days provided the threshold is not exceeded again.
Beverages↗
Prospective studies on the etiology and treatment of pruritus ani.
Seventy-five patients presented with the complaint of pruritus ani. The following prospective studies were employed to evaluate groups of these patients; (1) laboratory, including blood count, stool examination for ova and parasites, urinalysis, Sequential Multiple Analysis-12 serum studies, stool pH, and skin scrapings for fungi; (2) Minnesota Multiphasic Personality Inventory; (3) anal manometry; (4) elimination of dietary factors, and (5) topical ointment application. Many patients were concerned that a cancer caused the symptom. Once reassured, they tolerated the pruritus. Forty-eight to 50 per cent of these patients had poorly formed stools or incomplete stool evacuation; thus, soiling was frequent. An underlying skin problem was found in six patients with psoriasis and in one with erythrasma. Patients tended to worsen the problem by application of many medications and overzealous cleaning. Minor surgical problems of the anus should be corrected before other managements are instituted. Idiopathic pruritus ani responds to anal cleanliness, dietary discretion with avoidance of specific items by some patients, bowel habit regulation, and a mild topical hydrocortisone cream.
Administration, Topical↗
Squamous cell carcinoma of the anal margin with pruritus ani of long duration.
BACKGROUND: Anal margin is an unusual location for squamous cell carcinoma (SCC). On rare occasions, anal margin carcinoma is the cause of pruritus ani. OBJECTIVE: To describe a case of SCC of the anal margin with pruritus ani of long duration. RESULTS: A 52-year-old man had been aware of perianal itching for over 10 years. Examination of the perianal area revealed a reddish, eroded, hard nodule that was 2.0 x 1.5 x 0.3 cm in size located in the 3 o'clock position. The histopathologic diagnosis was well-differentiated SCC. The nodule was totally excised with a 1-cm margin. No recurrence or metastases were observed for 7 months. CONCLUSION: When pruritus ani does not respond to conservative therapy and when symptoms have existed for a long time, we should suspect the presence of malignancy.
Anus Neoplasms↗
Intra-dermal methylene blue, hydrocortisone and lignocaine for chronic, intractable pruritus ani.
OBJECTIVE: To assess the use of intradermal methylene blue, lignocaine and hydrocortisone in cases of chronic pruritus ani refractory to standard primary, dermatological and colorectal care. METHODS: Five ml 1% methylene blue, 100 mg hydrocortisone and 15 ml 1% lignocaine were injected into the peri-anal skin of 25 patients with chronic pruritus ani which had proved refractory to standard care. Clinical and telephone follow-up was undertaken. RESULTS: After one injection of the above solution, 16 (64%) of patients were rendered symptom free. Repeat injection in those initial nonresponders ultimately rendered 22 (88%) symptom free overall. Morbidity was 4%. Treatment failure occurred in three patients (12%). CONCLUSIONS: Methylene blue used in solution with hydrocortisone and lignocaine can achieve effective control of pruritus ani in 88% of patients who have failed to respond to standard dermatological, hygiene and surgical treatments.
Journal Article↗