Gastroenterology Book

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Pruritus Ani

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  1. Causes
    1. Systemic causes
      1. Diabetes Mellitus
      2. Hyperbilirubinemia
      3. Leukemia
      4. Aplastic Anemia
      5. Thyroid disease
    2. Functional and mechanical causes
      1. Chronic Diarrhea
      2. Chronic Constipation
      3. Anal Fissure
      4. Anal fistula
      5. Tight fitting clothes
      6. Vigorous peri-anal cleaning
      7. Stool Leakage
        1. Anal Incontinence
        2. Prolapsed Hemorrhoids
        3. Rectal prolapse
        4. Anal papilloma
    3. Infections
      1. Erythrasma (Corynebacterium)
      2. Intertrigo (Candida)
      3. Herpes Simplex Virus (HSV)
      4. Human papillomavirus (HPV)
      5. Pinworms (Enterobius)
      6. Scabies
      7. Perirectal Abscess
      8. Gonorrhea
      9. Syphilis
    4. Dermatologic causes
      1. Psoriasis
      2. Seborrheic Dermatitis
      3. Intertrigo
      4. Neurodermatitis
      5. Bowen's Disease
      6. Atopic Dermatitis
      7. Lichen planus
      8. Lichen Sclerosis
    5. Exposures
      1. Systemic: Medications
        1. Colchicine
        2. Quinidine
      2. Topicals: Contact Dermatitis
        1. Soaps, deodorants or perfumes
        2. Alcohol-based anal wipes
        3. Allergy to dyes or perfumes in toilet paper
        4. Fabric softener intolerance
      3. Topicals: Food irritants
        1. Tomatoes
        2. Caffeinated beverages
        3. Beer
        4. Citrus juices or fruit
        5. Milk products
  2. Examination
    1. See Anorectal Exam
  3. Management
    1. Eliminate itch-scratch cycle (especially while asleep)
    2. Eliminate exacerbating factors (see causes above)
    3. Medications
      1. Hydroxyzine (Atarax) at bedtime
      2. Topical Corticosteroid (short-term use only)
      3. Topical 5% Lidocaine (Xylocaine) ointment
  4. References
    1. Pfenninger (2001) Am Fam Physician 63(12):2391

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