Pruritis ani is defined as an intense itch in the peri-anal area. About 25% of individuals have no identifiable cause. It presents a diagnostic challenge, due to the multitude of causative factors, and is estimated to affect 5% of the population, more so men than women. Causative factors include faecal soilage and skin infections, however, malignant conditions such as Bowen’s disease have been implicated. It is important to take a thorough and focused history, as symptoms are often abated by removal of causative agents. Physical examination should not be limited to the peri-anal area, as clues may be garnered from peripheral manifestation of systemic conditions. Focus of management involves eliminating risk factors, improving peri-anal hygiene and encouraging compliance to treatment. Novel treatments include capsaicin cream and methylene blue.
Get full access to this article
View all access options for this article.
References
1.
Al-GhnaniemRShortKPullenA, et al. (2007) 1% hydrocortisone ointment is an effective treatment of pruritus ani: A pilot randomized controlled crossover trial. International Journal of Colorectal Disease22(12): 1463–1467. DOI: 10.1007/s00384-007-0325-8.
2.
Andersen HH, Akiyama T, Nattkemper LA, et al. (2018) Alloknesis and hyperknesis--mechanisms, assessment methodology, and clinical implications of itch sensitization. Pain 159: 1185–1197. DOI: 10.1097/j.pain.0000000000001220.
3.
AnsariP (2016) Pruritus ani. Clinics in Colon and Rectal Surgery29(1): 038–042. DOI: 10.1055/s-0035-1570391.
4.
AsgeirssonTNunooRLuchtefeldMA (2011) Hidradenitis suppurativa and pruritus ani. Clinics in Colon and Rectal Surgery24(1): 071–080. DOI: 10.1055/s-0031-1272826.
5.
BatheAMatterneUDewaldM, et al. (2009) Educational multidisciplinary training programme for patients with chronic pruritus. Acta Dermato-Venereologica89(5): 498–501. DOI: 10.2340/00015555-0684.
6.
Bello BL and Umanskiy K (2020) Anal Conditions: Pruritus Ani. In Clinical Decision Making in Colorectal Surgery. Cham: Springer, pp. 159–167. DOI: 10.1007/978-3-319-65942-8_20.
7.
De VriesHJZingoniAWhiteJA, et al. (2014) 2013 European guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. International Journal of STD & AIDS25(7): 465–474. DOI: 10.1111/jdv.17269.
8.
FriendWG (1977) The cause and treatment of idiopathic pruritus ani. Diseases of the Colon & Rectum20(1): 40–42. DOI: 10.1007/BF02587451.
9.
Garcovich S, Maurelli M, Gisondi P, et al. (2021) Pruritus as a Distinctive Feature of Type 2 Inflammation. Vaccines 9: 303. DOI: 10.3390/vaccines9030303.
10.
Gié O (2010) Pruritus Ani. In Anorectal and Colonic Diseases. Berlin, Heidelberg: Springer, pp. 417–424. DOI: 10.1007/978-3-540-69419-9_25.
11.
Gilissen L, Schollaert I, Huygens S, et al. (2021) Iatrogenic allergic contact dermatitis in the (peri) anal and genital area. Contact Dermatitis 84(6): 431–438. DOI: 10.1111/cod.13764.
12.
JongenJEbersteinAPeleikisH-G, et al. (2008) Perianal streptococcal dermatitis: An important differential diagnosis in pediatric patients. Diseases of the Colon & Rectum51(5): 584–587. DOI: 10.1007/s10350-008-9237-0.
13.
KahlkeVJongenJPeleikisH, et al. (2013) Perianal streptococcal dermatitis in adults: Its association with pruritic anorectal diseases is mainly caused by group B streptococci. Colorectal Disease15(5): 602–607. DOI: 10.1111/codi.12089.
14.
KimJKimDLeeY (2019) Long-term follow-up of intradermal injection of methylene blue for intractable, idiopathic pruritus ani. Techniques in Coloproctology23(2): 143–149. DOI: 10.1007/s10151-019-01934-x.
15.
LysyJSistiery-IttahMIsraelitY, et al. (2003) Topical capsaicin—a novel and effective treatment for idiopathic intractable pruritus ani: A randomised, placebo controlled, crossover study. Gut52(9): 1323–1326. DOI: 10.1136/gut.52.9.1323.
16.
MarkellKWBillinghamRP (2010) Pruritus ani: Etiology and management. The Surgical Clinics of North America90(1): 125–135. DOI: 10.1016/j.suc.2009.09.007.
17.
NasseriYYOsborneMC (2013) Pruritus ani: Diagnosis and treatment. Gastroenterology Clinics42(4): 801–813. DOI: 10.1016/j.gtc.2013.09.002.
18.
OrtegaAEDelgadilloX (2019) Idiopathic pruritus ani and acute perianal dermatitis. Clinics in Colon and Rectal Surgery32(5): 327–332. DOI: 10.1055/s-0039-1687827.
19.
OueidatDJurjusA (2014) Pruritus ani: More than a decade of personal experience in Lebanon. Le Journal Medical Libanais. The Lebanese Medical Journal62(4): 203–206. DOI: 10.12816/0008288.
20.
PolatMÖztasPIlhanMN, et al. (2008) Generalized pruritus. American Journal of Clinical Dermatology9(1): 39–44. DOI: 10.2165/00128071-200809010-00004.
SamalaviciusNPoskusTGuptaR, et al. (2012) Long-term results of single intradermal 1% methylene blue injection for intractable idiopathic pruritus ani: A prospective study. Techniques in Coloproctology16(4): 295–299. DOI: 10.1007/s10151-019-01934-x.
23.
Schmelz M (2015) Itch and pain differences and commonalities. Pain control 285–301. DOI: 10.1007/978-3-662-46450-2_14.
24.
Schut C, Mollanazar NK, Kupfer J, et al. (2016) Psychological interventions in the treatment of chronic itch. Acta Derm Venereol 96(2): 157–161. DOI: 10.2340/00015555-2177.
25.
SiddiqiSVijayVWardM, et al. (2008) Pruritus ani. The Annals of The Royal College of Surgeons of England90(6): 457–463. DOI: 10.1308/003588408X317940.
26.
SilvestriDLBarmettlerS (2011) Pruritus ani as a manifestation of systemic contact dermatitis: Resolution with dietary nickel restriction. Dermatitis22(1): 50–55. DOI: 10.2310/6620.2011.10062.
27.
SongS-GKimS-H (2011) Pruritus ani. Journal of the Korean Society of Coloproctology27(2): 54–57. DOI: 10.3393/jksc.2011.27.2.54.
28.
SutherlandAFaragherIFrizelleF (2009) Intradermal injection of methylene blue for the treatment of refractory pruritus ani. Colorectal Disease11(3): 282–287. DOI: 10.1111/j.1463-1318.2008.01587.x.
29.
SuysE (2012) Randomized study of topical tacrolimus ointment as possible treatment for resistant idiopathic pruritus ani. Journal of the American Academy of Dermatology66(2): 327–328. DOI: 10.1016/j.jaad.2011.05.024.
30.
TeyHLWallengrenJYosipovitchG (2013) Psychosomatic factors in pruritus. Clinics in Dermatology31(1): 31–40. DOI: 10.1016/j.jaad.2011.05.024.
31.
UcakHDemirBCicekD, et al. (2013) Efficacy of topical tacrolimus for the treatment of persistent pruritus ani in patients with atopic dermatitis. Journal of Dermatological Treatment24(6): 454–457. DOI: 10.1016/j.clindermatol.2011.11.004.
32.
ZuccatiGLottiTMastrolorenzoA, et al. (2005) Pruritus ani. Dermatologic Therapy18(4): 355–362. DOI: 10.1111/j.1529-8019.2005.00031.x.
