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.