Treatment of persistent pruritus ani in a combined colorectal and dermatological clinic

Dasan, Sunil; Neill, Sallie; Donaldson, D.; Scott, H. J.

doi:10.1046/j.1365-2168.1999.01231.x

Cited by 63 publications

(49 citation statements)

References 16 publications

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“…However, aggressive cleaning of the perianal area with alkaline soaps leads to chronic pruritus [88] . The vast majority of patients with pruritus ani can be treated by conservative management [89,91] . Instructions for patients, well described by Hicks and colleagues (Table 2) [88] , are removal of irritants, improving perianal hygiene [92] , avoiding scratching, wearing loose cotton underwear, adjusting the diet by adding a bulking agent to induce soft and non-irritating stools, and discontinuing offending agents, such as coffee, tea, cola, beer, chocolate, and tomatoes [88] .…”

Section: Treatmentmentioning

confidence: 99%

“…Nighttime sedating antihistamines or tricyclic antidepressants may be helpful. Refractory patients with intractable symptoms should be referred to a dermatologist [91] . Various therapies have been used with inconsistent results or insufficient data to judge efficacy, such as injection of methylene blue, surgical debridement, radiation therapy, ultraviolet phototherapy, cryotherapy, and intralesional corticosteroids [93][94][95][96] .…”

Section: Treatmentmentioning

confidence: 99%

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What every gastroenterologist needs to know about common anorectal disorders

Schubert¹,

Sridhar²,

Schade³

et al. 2009

WJG

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Anorectal complaints are very common and are caused by a variety of mostly benign anorectal disorders. Many anorectal conditions may be successfully treated by primary care physicians in the outpatient setting, but patients tend not to seek medical attention due to embarrassment or fear of cancer. As a result, patients frequently present with advanced disease after experiencing significant decreases in quality of life. A number of patients with anorectal complaints are referred to gastroenterologists. However, gastroenterologists' knowledge and experience in approaching these conditions may not be sufficient. This article can serve as a guide to gastroenterologists to recognize, evaluate, and manage medically or nonsurgically common benign anorectal disorders, and to identify when surgical referrals are most prudent. A review of the current literature is performed to evaluate comprehensive clinical pearls and management guidelines for each topic. Topics reviewed include hemorrhoids, anal fissures, anorectal fistulas and abscesses, and pruritus ani.

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Section: Treatmentmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

What every gastroenterologist needs to know about common anorectal disorders

Schubert¹,

Sridhar²,

Schade³

et al. 2009

WJG

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“…2 Persistent perianal pruritus is a generally poorly managed, common, and socially embarrassing condition. 3 There are many different causes of perianal pruritus such as haemorrhoids, anal fistula and fissures, inflammatory bowel disease, dermatoses (atopic dermatitis, psoriasis, lichen planus, Bowen's disease, extramammary Paget's disease, allergic contact dermatitis), local infections (candidiasis, dermatophyte infections, parasites, condyloma lata), benign and malignant anal tumours, generalised pruritus, foods (spices, citrus fruits, coffee, tea, chocolate, tomatoes), and psychogenic causes (table 1). The most difficult patients are the ones with extensive pruritus without physical signs.…”

mentioning

confidence: 99%

“…[3][4][5] When no demonstrable cause is found, it is often described as idiopathic perianal pruritus. 3 There are many treatment modalities for idiopathic perianal pruritus, including topical corticosteroids, topical non-steroid anaesthetics, and systemic antihistamines. 6 7 Topical corticosteroids are known to be effective for non-fungal types of perianal pruritus.…”

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confidence: 99%

Idiopathic perianal pruritus: washing compared with topical corticosteroids

Öztaş

Önder

2004

Postgraduate Medical Journal

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Background: Idiopathic perianal pruritus is a poorly managed condition. Topical corticosteroids are effective in idiopathic perianal pruritus, but they may cause some side effects. In this study, the effectiveness of topical steroids were compared with perianal cleansers in the treatment of idiopathic perianal pruritus. Patients and methods: Seventy two patients with the complaint of perianal pruritus were evaluated; 60 of the 72 patients were found to be idiopathic. Twenty eight patients were treated with topical steroids and 32 patients were treated only with a liquid cleanser. Results: At the end of this two week period, cleansers were found to be as effective as topical corticosteroids. Conclusion: This study shows that perianal cleansers can be used as a safe first step treatment in idiopathic perianal pruritus.

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“…In de literatuur worden psoriasis [Smith 1982], hemorroïden en contactallergie [Weichert 2004, Gopal 2002, Dasan 1999] als oorzaak van pruritus ani beschreven, net als bacteriële (streptokokken)infectie [Sheth 2007, Giordano 1999, hivgerelateerde infecties, erythrasma [Smith 1982], eczeem, lichen sclerosus [Zuccati 2005, Heard 2004, Weichert 2004, Gopal 2002, Harrington 1992, ziekte van Paget [Khoubehi 2001, Shutze 1990], fl uor vaginalis en seksueel overdraagbare aandoeningen [Zuccati 2005]. Proctologische aandoeningen die met anale jeuk gepaard kunnen gaan zijn fi ssura ani, fi stels en ziekte van Crohn.…”

Section: Nootunclassified

NHG-Farmacotherapeutische richtlijn Pruritus ani

Verduijn¹,

Folmer²,

Draijer³

2008

HUWE

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maceratie de irritatie en infectie bevorderen. Het gevaar van maceratie van de huid kan versterkt worden door occlusie van de anale huid, zoals bij gebruik van vaseline. Bij kinderen zijn oxyuren (Enterobius vermicularis) de meest voorkomende oorzaak; de jeuk komt dan vooral 's nachts en bij defecatie voor (zie NHG-Farmacotherapeutische richtlijn Worminfecties). Ook bij volwassenen komen oxyuren voor. Bij kinderen (tussen 6 maanden en 10 jaar) kan de jeuk ook veroorzaakt worden door perianale streptokokkendermatitis (impetigo). Bij volwassenen is een dermatomycose (veelal een candida-infectie), al dan niet uitgelokt door fecale verontreiniging, een regelmatig voorkomende oorzaak. Voorts kunnen hemorroïden, fissura ani, fistels en locale irritatie door feces (bijvoorbeeld door diarree of door 'fecal soiling' zoals bij incontinentie bij ouderen, kinderen of bij volwassenen met een verstandelijke beperking), door zeep, (vochtig) toiletpapier, fluor en urine-incontinentie een rol spelen. Ook wordt ontoereikende of juist overmatige anale hygiëne wel beschreven als etiologische factor. Tevens kan er sprake zijn van een combinatie van factoren die zorgen voor (het in stand houden van) de jeuk. Minder frequent voorkomende oorzaken zijn atopische en seborroïsche dermatitis, psoriasis en (contact)eczeem. Zelden voorkomende oorzaken waarbij pruritus ani als primaire klacht gepresenteerd wordt, zijn proctitis, inflammatoire darmziekten, (seksueel overdraagbare) infecties, erythrasma, lichen sclerosus, diabetes mellitus, ziekte van Paget (een zeldzame vorm van huidkanker die er uitziet als een rode, ontstoken, vocht afscheidende huidvlek) en tumoren. Warmte, transpiratie en lang zitten kunnen (vooral bij adipositas) de klachten verergeren. 2 Voedingsmiddelen zijn vrijwel nooit de oorzaak van pruritus ani. Lokaal gebruik van corticosteroïden rond de anus kan sneller dan bij toepassing elders op de huid zorgen voor atrofie en maceratie, en daardoor pruritus ani veroorzaken of verergeren. Rond de anus kan door warmte en transpiratie een soort occlusie-effect optreden. Bij het Nederlands Bijwerkingencentrum Lareb is pruritus ani vooral gemeld als vermoede bijwerking na gebruik van corticosteroïden en antibiotica. 3 Pruritus ani recidiveert regelmatig. Er zijn patiënten die jarenlang klachten houden.

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Treatment of persistent pruritus ani in a combined colorectal and dermatological clinic

Cited by 63 publications

References 16 publications

What every gastroenterologist needs to know about common anorectal disorders

What every gastroenterologist needs to know about common anorectal disorders

Idiopathic perianal pruritus: washing compared with topical corticosteroids

NHG-Farmacotherapeutische richtlijn Pruritus ani

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