Pruritus ani

Background

Causes

1. Anorectal disease
2. Poor hygiene
3. Local infection
   1. Pinworms, strep
4. Local irritants
5. Dermatologic conditions
6. Systemic illness
7. Psychogenic factors

Associations

1. Anal Fissure
2. Anal Fistula
3. Hemorrhoids
4. Rectal Prolapse

Clinical Features

• Skin appears normal with early, mild cases
• Acute, severe exacerbations a/w reddened, edematous, excoriated, skin

Differential Diagnosis

Anorectal Disorders

• Anal fissure
• Anal fistula
• Anal malignancy
• Anal tags
• Anorectal abscess
• Coccydynia
• Colorectal malignancy
• Condyloma acuminata
• Constipation
• Crohn's disease
• Cryptitis
• GC/Chlamydia
• Fecal impaction
• Hemorrhoids
  • Internal hemorrhoid
  • External hemorrhoid
• Levator ani syndrome
• Pedunculated polyp
• Pilonidal cyst
• Proctalgia fugax
• Proctitis
• Pruritus ani
  • Enterobius (pinworms)
• Rectal foreign body
• Rectal prolapse
• Syphilitic fissure

Non-GI Look-a-Likes

• Prostatitis

Treatment

• Treat underlying cause
• To avoid scratching at night pt can wear gloves at bedtime
• Sitz baths 15min TID
• Zinc oxide can provide protective covering for the skin and may enhance healing

See Also

• Anorectal Disorders

References

Tintinalli