The perianal skin tends to itch, which can have a number of reasons (see table: Some causes of pruritus ani). This condition is also known as pruritus. Occasionally the irritation is interpreted by the patient as pain, which is why other causes of perianal pain (eg. As abscess or cancer) should be excluded.

(See also Clarification of Anorektalkrankheiten.) The perianal skin tends to itch, which can have a number of reasons (see table: Some causes of pruritus ani). This condition is also known as pruritus. Occasionally the irritation is interpreted by the patient as pain, which is why other causes of perianal pain (eg. As abscess or cancer) should be excluded. Etiology Anal itching is usually idiopathic (the majority) hygiene associated Insufficient cleaning can be irritating stool and sweat residue on the anal skin back. Too much cleaning, often with sanitary towels and strong soaps, can cause dryness or irritation or occasionally to a hypersensitivity reaction to the touch. Large external hemorrhoids can complicate cleaning after defecation, and large internal hemorrhoids can to drain mucus or fecal contamination and cause irritation. Other causes are rarely identified, but a variety of factors is involved (see table: Some causes of pruritus ani). In very young and elderly bowel and bladder incontinence predisposes to local irritation and secondary Candida infections. Once itching occurs from any cause, a vicious cycle of itching and scratching can begin causing more and more itching scratching. Often the skin is sore and secondarily infected, resulting in even more itching. Likewise, topical treatments for itching and infections can sensitize, causing further itching. Some causes of pruritus ani cause suspicious findings Diagnostic procedure anorectal disorders Inflammatory bowel disease (eg. As Crohn’s disease) Purulent discharge rectal pain (sometimes) and / or abdomen (often) Occasionally draining fistula occasionally diarrhea anoscopy, sigmoidoscopy or colonoscopy hemorrhoids (internal or external) (with internal hemorrhoids, bleeding a small amount of blood au f the toilet paper or in the toilet bowl) With external hemorrhoids, a painful, swollen lump on the anus Clinical Evaluation Usually anoscopy or sigmoidoscopy infections Bacterial infections (secondary Clinical after scratching) Inflamed, been scratch area assessment Candida A rash around the anus clinical evaluation Sometimes examination of skin scrapings pinworms Usually in children Sometimes when several family members Microscopic examination of a transparent patch that was applied to the anal area to check on the eggs of pinworms (s. Diagnosis of pinworms) Scabies Intense itching, usually worse at night may itch in other parts of the body may pink, thin, slightly raised lines or bumps (courses) on affected areas Clinical evaluation study of skin scrapings skin disorders Atopic dermatitis Itchy, erythematous, oozing and crusted rash clinical evaluation Perianal carcinoma (z. B. Bowen’s disease, Paget’s disease extramammary) Scaly or crusty lesion biopsy psoriasis Typical psoriatic plaques Occasionally plaques on other areas of the skin Clinical Evaluation Soft fibroma small flap of tissue at the anus Clinical evaluation pharmaceutical antibiotics Current or recent use of antibiotics attempt to eliminate Food and dietary supplements beer, caffeine, chocolate, pepper, milk products, nuts, tomatoes, citrus fruits, spices, or vitamin C tablets symptoms attempt to eliminate hygiene Associated problems Excessive sweating Excessive sweating described only after taking the substance from the person, especially when wearing tight and / or synthetic clothes test measures to limit sweating (eg. B. Wear lightweight cotton underwear, underwear change frequently) Excessively meticulous or aggressive cleaning the anal area Poor cleaning Improper cleaning practices by the patient described attempt a change in cleaning practices skin irritants local anesthetics, ointments, soaps and sanitary napkins using a potentially irritating or sensitizing substance by the patient described attempt to eliminate Clarification history For those annulment of the disease process is important to note whether the problem is acute or recurrent. The patient should be questioned about topical agents that he has used in the anal area, including sanitary napkins, ointments (including those for the treatment of itching), sprays and soaps. Food and medication profile should be reviewed on causative agent (see table: Some causes of pruritus ani), and in particular acidic or spicy foods. The general understanding of hygiene must be checked by asking about the frequency of showers and baths. A review of organ systems should investigate symptoms of the causative diseases, including urinary and fecal incontinence (local irritation), anal pain or bruises, blood on the toilet paper (hemorrhoids), bloody diarrhea and abdominal cramps (inflammatory bowel disease) and skin plaques (psoriasis). The history should identify previous illnesses associated with pruritus ani, in particular previous history of anorectal surgery, hemorrhoids and diabetes. Physical examination The general examination you should get a picture of hygiene understanding and notice any signs of anxiety or compulsive behavior. The physical examination focuses on the anal area, especially in search of perianal skin lesions, signs of fecal contamination or spots (indicating poor hygiene) and hemorrhoids. The external inspection should also monitor the integrity of the perianal skin, whether matte or thickened (resulting in chronic suggesting) appears, and the presence of skin lesions, fistulas, abrasions or signs of local infection. The sphincter tone is judged by the patient contracted the sphincter during digital rectal examination. The patient should then be asked to press as during a bowel movement, wordurch show prolapsed internal hemorrhoids. A anoscopy may be necessary to further investigate the anorectal area on hemorrhoids. A dermatological examination can reveal Skabiesgänge in the interdigital spaces or on the scalp or other signs of systemic causal skin disease. Warning The following findings are of particular importance: Draining fistula Bloody diarrhea Large external hemorrhoids prolapsed internal hemorrhoids Perianal faecal pollution Dull or thickened perianal skin interpretation of the findings hygiene problems, the use of topical agents and local interference (for example, candida infection, Hemorrhoids.) be disclosed in general history and physical examination. In adults with acute itching without apparent cause ingested substances should be considered. An attempt to eliminate these substances in the diet can be useful. In children with suspected pinworms should be investigated. In adults with chronic itching without apparent cause an overly aggressive anal hygiene may be involved. Tests In many patients, is appropriate an attempt with an empirical, non-specific therapy, unless there were special findings stated. In case of visible lesions of unknown origin z. As a biopsy and / or culture should be considered. When a suspected pinworms, which mostly occur in children aged Schult is, the eggs can be detected by taping the perianal skin folds with a piece of tape in the early morning. The band is placed with the sticky side down on a glass slide and examined microscopically. Systemic therapy causes and parasitic and fungal infections need to be treated specifically. Foods and topically active substances, which are suspected to be the cause of the pruritus ani, should be omitted. General measures The clothes should be loose, v. a. Also sleepwear. After a bowel movement, the patient should clean the anal area with a soft, water-soaked cotton cloth or a commercial perianal cleansing preparation hemorrhoids. Soaps and wipes should be avoided. Frequent dusting with normal talc or corn starch reduces the moisture in the Analgebiet. 1% Hydrokortisonacetatsalbe, 4 times applied for a short duration (<1 week) daily can alleviate the symptoms. Occasionally potent topical corticosteroids are required. Summary Common causes include pinworms in children and hygiene problems associated with adults. Food and detergents or soaps can cause anal itching. Appropriate behavior, not irritating Hygiene (d. E. Not too little, but not too strong, without strong soaps and chemicals) and the reduction of local humidity help alleviate the symptoms.


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