Anal eczema

from Wikipedia, the free encyclopedia
Classification according to ICD-10
L30.8 Other specified dermatitis
L23.8 Allergic contact dermatitis due to other agents
L24.9 Toxic contact dermatitis, unspecified cause
L20.8 Other atopic [endogenous] eczema
ICD-10 online (WHO version 2019)

An anal eczema , in Switzerland also anitis or Perianitis called, is a rash of anoderm or the anal or perianal skin that be acute, subacute or chronic can. In addition to the course of the disease, a distinction is made between:

  • cumulative toxic anal eczema,
  • contact allergic anal eczema and
  • atopic anal eczema.

Anal eczema is not an independent disease, but a consequence of various dermatological, proctological or microbiological processes that are usually caused by other diseases of the anus or rectum . It has a high prevalence (frequency of illness), with a high number of unreported cases, mainly due to a feeling of shame . Anal diseases are still largely a taboo subject. In the case of chronic forms of anal eczema, the likelihood that the disease has several causes, i.e. it is polyetiological, is particularly high.

Cumulative toxic anal eczema

description

Wetting of the anus, which can lead to excruciating itching ( pruritus ani ), together with softening dermatitis are the main symptoms of cumulative-toxic anal eczema. In its acute form, the cumulative-toxic anal eczema is known colloquially as " wolf ". In this form, the skin is extensively reddened, with sharp edges. The chronic form is also characterized by a sharp delimitation, but there are also punctiform or flat skin erosions ( rhagades ). The severe itching can also lead to line-like scratch marks. About 30% of all anal eczema are of the cumulative toxic type.

causes

Cumulative toxic anal eczema can have a variety of causes. These include hemorrhoid disease , parasitosis , incorrect anal hygiene , hyperhidrosis (profuse sweating) and anatomical malformations such as a funnel anus . Some authors assume that hemorrhoid disease is the cause of cumulative toxic anal eczema in around 80% of cases. It is caused by the disturbed fine continence, which enables mucus to escape from the rectum, which irritates the distal skin areas. In its acute form, it is caused, among other things, by inadequate hygiene, profuse sweating in the area of ​​the anal folds, diarrhea and by prolonged mechanical stress, for example after long marches (literally: " running the wolf "). It is often overlaid by a contact allergy .

treatment

Since in many cases a hemorrhoid disease with hemorrhoids of the second to fourth degree is the cause of the cumulative-toxic anal eczema, a diagnosis and treatment of this disease can often lead to a cure for this form of anal eczema. The symptoms of inflammation can be treated locally with glucocorticoids for a short time . Prolonged use should be avoided as this can lead to atrophy of the anoderm (breakdown of the anal skin). For longer periods of time, topical agents are recommended that sensitize the skin as little as possible and have anti-inflammatory properties. This includes, for example, ammonium bituminosulfonate (ichthyol). The salary base should also have the least possible irritating potential. Skin creams and other water-oil emulsions, as well as topicals containing polyethylene glycol , should be avoided. Sitz baths with synthetic tannins, showering the anus (anal showers) without soaps and cleaning with olive oil can alleviate the suffering.

Contact allergic anal eczema

Contact allergic anal eczema is a special form of contact allergy that is responsible for around 40% of all anal eczema. It can be triggered by a large number of allergens such as dibucaine , mafenid , 4-hexylresorcinol , policresulen , quinine or menthol . These compounds can be found in skin care products , intimate sprays , toilet paper (especially in moist ones ) and proctologics .

treatment

Even if a contact allergic anal eczema is suspected, all drugs that the patient uses in the anal area should be discontinued. Acute weeping eczema can be treated briefly with topical glucocorticoids. For cleaning, substances with the lowest possible allergenic potential, such as olive oil or water without soap, are recommended. In the chronic form, ointments that are as indifferent as possible and fatty, for example based on petroleum jelly , are recommended. Here too, glucocorticoids can be prescribed for a limited time by the attending physician. Contact allergic anal eczema can be treated permanently with ointments that have a low allergenic potential and anti-inflammatory properties, such as ichthyol. A change in diet , which mainly consists of avoiding spicy foods or foods that contain high levels of fruit acid , can also help to improve and cure the condition.

Atopic anal eczema

Atopic anal eczema is responsible for around 20 to 30% of all anal eczema. The anal area is a typical predilection for atopic eczema.

Differential diagnosis

The following diseases, among others, must be excluded in the differential diagnosis :

Complications

Squamous cell carcinoma may develop from chronically inflamed anal eczema . In treatment-resistant anal eczema, carcinoma of the anal canal should always be considered as a possible cause.

further reading

Individual evidence

  1. ↑ J. Mentha, A. Neiger, R. Mangold: Inflammation of the anus and hemorrhoids. In: Praxis Schweiz Rundsch Medicine. 30, 1961, pp. 752-757.
  2. ↑ A. Neiger: Atlas of practical proctology. 3rd edition, Verlag Hans Uber, 1987
  3. ↑ a b H. Rohde: Lehratlas der Proktologie. Georg Thieme, 2006, ISBN 3-13-140881-2 , p. 47. Restricted preview in the Google book search
  4. ↑ Entry anal eczema. In: Encyclopedia of Dermatology, Venereology, Allergology, Environmental Medicine. Springer, 2009, online version, accessed on November 6, 2017
  5. ^ V. Wienert: Diagnosis and therapy of anal eczema. In: Hautarzt 36, 1985, pp. 232-233. doi : 10.1055 / s-2004-831833
  6. ^ S. Proske, BH Lenhard, W. Hartschuh: The anal eczema and its benign simulators. In: dermatologist. 55, 2004, pp. 259-264. doi : 10.1007 / s00105-004-0700-0
  7. ↑ W. Hartschuh, J. Schauber: Proktologie. In: dermatologist. Volume 61, Number 1, January 2010, pp. 11-12, ISSN  1432-1173 . doi : 10.1007 / s00105-009-1887-x . PMID 20091389 .
  8. ↑ EP: Anal diseases are often still a taboo subject.  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. (PDF; 126 kB) In: Medical Tribune . Volume 41, number 23 of June 3, 2009, p. 8.@1@ 2Template: Toter Link / extranet.medical-tribune.de  
  9. ↑ a b c Altmeyer's encyclopedia online version: Entry on eczema, anal eczema, cumulative-toxic. Springer Verlag 2017
  10. ↑ JJ Kirsch: What are hemorrhoids? Confusing claims. In: Deutsches Ärzteblatt . Volume 102, Number 27, 2005, pp. A-1969 / B-1664 / C-1568.
  11. ↑ A. Herold: Therapy of hemorrhoid disease. In: The surgeon . Volume 77, Number 8, August 2006, pp. 737-747, ISSN  0009-4722 . doi : 10.1007 / s00104-006-1215-2 . PMID 16865351 .
  12. ↑ DK Mehta, RSM Ryan, HV Hogerzeil: WHO Model Formulary 2004. (PDF; 4.2 MB) World Health Organization, p. 362.
  13. ↑ a b Peter Altmeyer's encyclopedia, online version: Entry on eczema, anal eczema, contact allergy. , Encyclopedia of dermatology, venereology, allergology, environmental medicine. Springer, 2017 accessed on November 6, 2017.
  14. ↑ Peter Altmeyer's Encyclopedia, online version: Entry on eczema, anal eczema, atopic. , Encyclopedia of dermatology, venereology, allergology, environmental medicine. Springer, 2017, accessed November 6, 2017.
  15. ^ V. Wienert, C. Breitkopf: Guidelines of the German Dermatological Society (DDG) - Analekzem.  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. (PDF; 176 kB) As of July 2009.@1@ 2Template: Dead Link / www.awmf.org  
  16. ↑ B. Sommer, M. Hagedorn: [Development of squamous cell carcinoma in chronic anal eczema and therapeutic consequences]. In: dermatologist. Volume 47, Number 11, November 1996, pp. 850-853, ISSN  0017-8470 . PMID 9036139 .
  17. ^ P. Fritsch: Dermatology, Venereology. Edition 2, Verlag Springer, 2004, ISBN 3-540-00332-0 , p. 817. limited preview in Google book search

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