Pruritus ani is perianal itching, irritation, or superficial burning. This disorder is more common in males than in females and occurs in adults and children.
Factors that contribute to pruritus ani include overcleaning of the perianal area (harsh soap, vigorous rubbing with a washcloth or toilet paper); minor trauma caused by straining to defecate; poor hygiene; sensitivity to spicy foods, coffee, alcohol, food preservatives, perfumed or colored toilet paper, detergents, or certain fabrics; specific medications (antibiotics, antihypertensives, or antacids that cause diarrhea); excessive sweating (in occupations associated with physical labor or high stress levels); anal skin tags; systemic disease, especially diabetes; certain skin lesions, such as those associated with squamous cell carcinoma, basal cell carcinoma, Bowen’s disease, Paget’s disease, melanoma, syphilis, and tuberculosis; fungal or parasitic infection; and local anorectal disease (fissure, hemorrhoids, and fistula).
The key symptom of pruritus ani is perianal itching or burning after a bowel movement, during stress, or at night. In acute pruritus ani, scratching produces reddened skin, with weeping excoriations; in chronic pruritus ani, skin becomes thick and leathery, with excessive pigmentation.
A detailed patient history is essential. Rectal examination rules out fissures and fistulas; biopsy rules out cancer. Allergy testing may also be helpful.
After elimination of the underlying cause, treatment is symptomatic, such as advising the patient to avoid scratching or rubbing the itchy areas. Lukewarm baths and a skin-soothing oatmeal or cornstarch bath may be comforting. Temporary relief may be obtained with cold compresses. Topical antihistamines are also useful.
❑ Make sure that the patient understands his condition and the causes.
❑ Recommend keeping fingernails short to avoid skin damage from inadvertent scratching. Suggest using cool, light, loose bedclothes and avoiding wearing rough clothing, particularly wool, over the irritated area.
❑ Advise the patient to avoid prolonged exposure to excessive heat and humidity.
❑ Advise the patient to avoid self-prescribed creams or powders, perfumed soaps, colored toilet paper, and moistened wipes because they may be irritating.
❑ Teach the patient to keep the perianal area clean and dry. Suggest witch hazel pads for wiping and cotton balls tucked between the buttocks to absorb moisture.
Read excerpts from these other book chapters related to Cysts:
Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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