Pruritus ani

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Classification according to ICD-10
L29.0 Pruritus ani
ICD-10 online (WHO version 2019)

As pruritus ani (dt. Itching of the anus , of lat. Prurire , dt. Itch and ani , genitive of anus , dt. After ) is referred to in the medical a dermatological condition characterized by a chronic , unpleasant itching or a burning sensation in the Anal area is marked. The pruritus ani is proctology the most common symptom , but not an independent disease. Almost 100 different causes have been described in the literature for anal itching. There is also idiopathic pruritus ani , to which no other disease can be assigned as a tangible cause and which is essentially of psychological origin.

Diagnosis and treatment can in principle be carried out by general practitioners (family doctor), dermatologists (dermatologist) or proctologists. Proctologists specialize in treating diseases of the rectum. Therefore, they are usually very familiar with the diagnosis and treatment of pruritus ani .

Epidemiology

An estimated 1 to 5% of the population complain of anal itching. Men are affected about four times as often as women. The symptom occurs primarily between the ages of 40 and 60.

causes

When making the diagnosis, the focus is on determining the primary disease or cause that triggers the anal itching. The anal itching can have a variety of causes, which may also coexist. In these cases the anal itching is polyetiological . An example of this haemorrhoids, which, due to the disturbed fine continence, a cumulative toxic anal eczema triggers, which is then treated with a hemorrhoid means, in turn, as a potential allergen , a contact allergy anal eczema can cause. Almost 100 different possible causes of anal itching are described in the literature, which can be divided into different groups.

Anorectal diseases

In over 50% of cases, anus or rectum disease is the cause of the anal itching. In the first place is the hemorrhoid disease. In addition to hemorrhoids, anal fissures are often a cause of itching. But much more serious diseases such as colorectal cancer or anal cancer can also be the cause of pruritus ani . The treatment of anorectal diseases leads in many cases to a cure or at least significant relief of the itching.

Perianal infections and parasitoses

Mycoses (fungal infections), especially dermatophytoses , are responsible for up to 15% of cases of pruritus ani . The pathogens include Candida albicans , especially in diabetics, after the systemic administration of antibiotics or steroids . In addition, viral and bacterial infections in the perianal area, for example with Staphylococcus aureus or beta-hemolyzing streptococci , which are often sexually transmitted, can lead to protracted, persistent itching. Especially in children, parasitosis with pinworms can lead to itching in the area of ​​the anus.

Allergies

An allergic contact dermatitis which is a erythema has, scaly skin and bubble formation may result, are triggered in the region of the anus by a variety of allergens. These include creams, soaps, dyes on printed toilet paper and wet wipes. In one study, 69% of the patients with pruritus ani reacted positively to the therapeutic agents that were prescribed for them in the patch test . Ointments typically have fewer preservatives and other additives with allergenic potential. They should therefore be preferred to creams.

nutrition

There are no controlled studies of what foods and diets lead to pruritus ani . Especially hot spices, but also beverages containing caffeine and alcohol , milk products , chocolate , peanuts , lemon , grapes and tomatoes can be the cause of anal itching according to the literature. There have been various speculations about the effect of these foods, ranging from a reduction in the tone of the sphincter muscles , an excessive anal reflex , to irritation of the perianal skin from undigested food.

Skin disorders

Many patients who suffer from pruritus ani have psoriasis : Depending on the study carried out, 5 to 55%. A lichen sclerosus or Bowen's disease may result in the region of the anus to itch.

dress

There is no solid evidence that clothing has an immediate effect in causing anal itching. However, heat and sweat can intensify the itching, so that seasonal itching can be caused by excessive perspiration and insufficient vapor permeability of clothing. In such cases, dermatologists recommend underwear that is as breathable and breathable as possible. Under certain circumstances, detergent residues containing enzymes can also trigger the itching.

Systemic diseases

In principle, any disease can also lead to anal itching. It is most common in diabetes mellitus , liver or kidney disease , leukemia , lymphoma , iron deficiency anemia, and hyperthyroidism . In addition, psychological factors such as anxiety , stress , depression or certain personality traits can trigger pruritus ani .

Idiopathic pruritus ani

In most cases of ani pruritus , the causal disease or malfunction can be identified. If after anamnesis , detailed examination and research the cause could not be found, one speaks of idiopathic pruritus ani . In such patients, excluding all potential irritants, refraining from scratching and applying general treatment and control measures often lead to successful therapy.

Inadequate or excessive anal hygiene

Excessive hygiene through too frequent washing of the anal region, especially with soaps or washing lotions, can lead to irritation and itching of the sensitive anoderm.

Poor anal hygiene, which leads to stool debris in the anus area, can be the cause of pruritus ani . In a patch test study, own feces in the anal area caused skin irritation in a third of patients with pruritus ani . More than half of the subjects who did not suffer from pruritus ani showed anal symptoms. In comparison, only 4% of all patients developed irritation on the skin of one arm in this test.

diagnosis

The primary goal of diagnosis is to identify the underlying condition of pruritus ani and to stop the anal itching by treating it appropriately.

The diagnosis is sometimes difficult and very complex due to the various causes that can lead to the symptom of pruritus ani . Since many patients are not aware of the connection between perianal itching and other skin diseases, this aspect is of particular importance in the anamnesis . These include atopy , hives, and other allergies. In many cases, those affected have treated themselves with over-the- counter drugs . These agents can themselves be the cause of changes in skin morphology and itching, or at least contribute to this symptom. The same goes for prescribed antibiotics and steroids.

treatment

Treatment of pruritus ani depends on the underlying disease that is causing the itching.

further reading

Individual evidence

  1. ↑ KW Markell, RP Billingham: Pruritus ani: etiology and management. In: The Surgical clinics of North America. Volume 90, Number 1, February 2010, pp. 125-135, ISSN  1558-3171 . doi : 10.1016 / j.suc.2009.09.007 . PMID 20109637 . (Review).
  2. ^ A b W. F. Caspary, T. Wehrmann: Dünn- und Dickdarm. In: H. Greten, F. Rinninger, T. Greten (Eds.): Internal medicine. 13th edition, Georg Thieme Verlag, 2010, ISBN 3-13-162183-4 , p. 791. Restricted preview in the Google book search
  3. ↑ G. Pommer, J. Stein: Diseases of the anorectum. In: WF Caspary, J. Mössner, J. Stein: Therapy of gastroenterological diseases. Gabler, 2004, ISBN 3-540-44174-3 , p. 357. limited preview in Google book search
  4. ↑ a b c d e f g h i j k l S. Siddiqi, V. Vijay et al: Pruritus ani. In: Annals of the Royal College of Surgeons of England. Volume 90, Number 6, September 2008, pp. 457-463, ISSN  1478-7083 . doi : 10.1308 / 003588408X317940 . PMID 18765023 . PMC 2647235 (free full text). (Review).
  5. ↑ a b G. Zuccati, T. Lotti and others: Pruritus ani. In: Dermatologic therapy. Volume 18, Number 4, 2005 Jul-Aug, pp. 355-362, ISSN  1396-0296 . doi : 10.1111 / j.1529-8019.2005.00031.x . PMID 16297009 . (Review).
  6. ^ R. Hanno, P. Murphy: Pruritus ani. Classification and management. In: Dermatologic Clinics . Volume 5, Number 4, October 1987, pp. 811-816, ISSN  0733-8635 . PMID 3315360 . (Review).
  7. ↑ a b c S. Dasan, SM Neill u. a .: Treatment of persistent pruritus ani in a combined colorectal and dermatological clinic. In: British Journal of Surgery . Volume 86, Number 10, October 1999, pp. 1337-1340, ISSN  0007-1323 . doi : 10.1046 / j.1365-2168.1999.01231.x . PMID 10540145 .
  8. ^ A b G. L. Daniel, WE Longo, AM Vernava: Pruritus ani. Causes and concerns. In: Diseases of the Colon and Rectum . Volume 37, Number 7, July 1994, pp. 670-674, ISSN  0012-3706 . PMID 8026233 .
  9. ↑ a b c d e L. E. Smith, D. Henrichs, RD McCullah: Prospective studies on the etiology and treatment of pruritus ani. In: Diseases of the Colon and Rectum . Volume 25, Number 4, 1982 May-Jun, pp. 358-363, ISSN  0012-3706 . PMID 7044727 .
  10. ↑ a b c d e A. Bowyer, I. McColl: A study of 200 patients with pruritus ani. In: Proceedings of the Royal Society of Medicine. Volume 63 Suppl, 1970, pp. 96-98, ISSN  0035-9157 . PMID 5525836 . PMC 1811396 (free full text).
  11. ^ S. Alexander: Dermatological aspects of anorectal disease. In: Clinics in gastroenterology. Volume 4, Number 3, September 1975, pp. 651-657, ISSN  0300-5089 . PMID 1102158 .
  12. ↑ G. Dodi, E. Pirone et al. a .: The mycotic flora in proctological patients with and without pruritus ani. In: The British Journal of Surgery . Volume 72, Number 12, December 1985, pp. 967-969, ISSN  0007-1323 . PMID 3910158 .
  13. ^ CI Harrington, FM Lewis et al. a .: Dermatological causes of pruritus ani. In: BMJ. Volume 305, Number 6859, October 1992, p. 955, ISSN  0959-8138 . PMID 1458094 . PMC 1883530 (free full text).
  14. ^ WG Friend: The cause and treatment of idiopathic pruritus ani. In: Diseases of the Colon and Rectum . Volume 20, Number 1, 1977 Jan-Feb, pp. 40-42, ISSN  0012-3706 . PMID 832560 .
  15. ↑ P. Doucet: Pruritus ani. In: The International journal of psycho-analysis. Volume 69, 1988, pp. 409-417, ISSN  0020-7578 . PMID 3215720 .
  16. ↑ RM Caplan: The irritant role of feces in the genesis of perianal itch. In: Gastroenterology. Volume 50, Number 1, January 1966, pp. 19-23, ISSN  0016-5085 . PMID 5900950 .