Therapeutic management of anal eczema: an evidence‐based review

Abstract

AimTo conduct a systematic review of treatments for anal eczema (AE).MethodsWe conducted a Medline search for clinical trial data for the treatment of perianal diseases including AE, including papers not published in the English language. We assessed the study reports using the system recommended by the Oxford Centre for Evidence-based Medicine. No meta-analysis was attempted.ResultsThe evidence base for topical treatments used to treat AE is very poor: there are very few studies and many of those that exist are of poor quality. The best evidence was found for medications that are yet to be licensed for AE. Among products with existing licences for the treatment of eczema, our assessment found some evidence to support the continued use of mild-to-moderate corticosteroids first line in most patients.DiscussionFeatures of the perianal region, and the fact that it is almost always occluded, mean that not all medications recommended in the general treatment guidelines for eczema are appropriate for AE. However, there are no specific treatment guidelines for these patients. This may in part be because of the lack of high-quality evidence-based medicine in this therapy area. Many frequently prescribed medications were developed and licensed many years ago, in an era when clinical trial design was not expected to be as rigorous as it is today.ConclusionThis review highlights the need to conduct more high-quality clinical trials in patients with AE in order that specific guidelines for the management of this difficult proctological condition can be prepared.

Evaluation, management and future perspectives of anal pruritus: a narrative review

“…Literature data are contradicting which of the types is more common [ 6 , 9 ]. There are up to 100 conditions leading to perianal itching, which makes differential diagnostics and treatment quite challenging (most frequent can be seen in Table 1 ) [ 10 – 13 ]. In view of that, a thorough history and digital examination is of great importance.…”

German S1 guidelines for the diagnosis and treatment of perianal dermatitis (anal eczema)

“…While some ingredients contained in topical preparations do not constitute causal treatment of perianal dermatitis per se, they may still offer temporary symptom relief. For example, menthol, camphor or phenol have a cooling effect that may cause transient alleviation of anal pruritus [48]. Application to erosive lesions may be associated with a burning sensation.…”

S1‐Leitlinie Diagnostik und Therapie des Analekzems

“…Einige Inhaltsstoffe topischer Präparate stellen zwar keine kausale Behandlung von analen Ekzemerkrankungen dar, können die Symptome jedoch vorübergehend reduzieren. So sind beispielsweise Menthol, Kampfer und Phenol kühlende Substanzen, die eine passagere Linderung des analen Pruritus bewirken können [48]. Bei der Applikation auf erodierte Haut kann ein Brennen auftreten und diese Topika können darüber hinaus zu einem Austrocknen der Haut führen.…”