Idiopathic perianal pruritus: washing compared with topical corticosteroids

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  1. K O Öztaşi,
  2. P Öztaş2,
  3. K Önderane
  1. 1Department of Dermatology, Gazi University Faculty of Medicine, Ankara, Turkey
  2. 2Dermatology Clinic, Ankara Numune Didactics Hospital, Ankara, Turkey
  1. Correspondence to:
 Dr Murat Orhan Öztaş
 Gazi Universitesi Tıp Fakültesi, Dermatoloji Anabilim Dalı, Beşevler, Ankara, Turkey; moztasgazi.edu.tr

Abstract

Background: Idiopathic perianal pruritus is a poorly managed status. Topical corticosteroids are effective in idiopathic perianal pruritus, just they may crusade some side furnishings. In this written report, the effectiveness of topical steroids were compared with perianal cleansers in the treatment of idiopathic perianal pruritus.

Patients and methods: Seventy ii patients with the complaint of perianal pruritus were evaluated; threescore of the 72 patients were found to exist idiopathic. Twenty eight patients were treated with topical steroids and 32 patients were treated only with a liquid cleanser.

Results: At the stop of this ii week flow, cleansers were establish to be every bit effective as topical corticosteroids.

Conclusion: This report shows that perianal cleansers can exist used as a safe commencement stride treatment in idiopathic perianal pruritus.

  • idiopathic perianal pruritus
  • topical corticosteroid
  • cleanser

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  • idiopathic perianal pruritus
  • topical corticosteroid
  • cleanser

Perianal pruritus is a common symptom, defined as an unpleasant cutaneous sensation that induces scratching of the skin around the anal orifice.1 Itchiness of the perianal skin can be a dermatological, proctological, or psychological disorder.2 Persistent perianal pruritus is a generally poorly managed, common, and socially embarrassing condition.three There are many different causes of perianal pruritus such as haemorrhoids, anal fistula and fissures, inflammatory bowel disease, dermatoses (atopic dermatitis, psoriasis, lichen planus, Bowen'due south disease, extramammary Paget's disease, allergic contact dermatitis), local infections (candidiasis, dermatophyte infections, parasites, condyloma lata), benign and malignant anal tumours, generalised pruritus, foods (spices, citrus fruits, coffee, tea, chocolate, tomatoes), and psychogenic causes (table 1). The well-nigh hard patients are the ones with extensive pruritus without physical signs.3– v When no demonstrable cause is found, it is ofttimes described as idiopathic perianal pruritus.three There are many treatment modalities for idiopathic perianal pruritus, including topical corticosteroids, topical not-steroid anaesthetics, and systemic antihistamines.6, 7 Topical corticosteroids are known to be effective for non-fungal types of perianal pruritus.6 In this study, we tried to compare the effectiveness of topical steroids and perianal cleansing in the handling of idiopathic perianal pruritus.

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Table 1

Aetiological factors in perianal pruritus

PATIENTS AND METHODS

Seventy two patients who presented to Gazi University Hospital Department of Dermatology with the complaint of perianal pruritus over a 24 month period were evaluated. All of the patients were get-go examined dermatologically. From perianal scrapings, native preparations were performed for fungal investigation. Perianal swabs for bacterial cultures were besides performed. Consummate blood counts, fasting glucose levels, liver and kidney role (alanine aminotransferase, aspartate aminotransferase, γ-glutamyltransferase, lactate dehydrogenase, blood urea nitrogen, creatinine), and total cholesterol and triglyceride levels were recorded. Investigation of faeces for parasites was also performed. In eleven patients, allergic contact dermatitis was suspected clinically and patch tests with both European Standard Series and personal items were performed. In 12 patients the causes of perianal pruritus were detected, and these patients with a defined cause were not included in our written report. Sixty patients were classified as having "idiopathic perianal pruritus patients". Xx eight patients (group I) were treated with topical steroids (Advantan cream) twice daily for two weeks, and 32 patients (group II) were treated merely with a liquid cleanser (Protex liquid cleanser) twice daily for 2 weeks. At the finish of the ii calendar week period, the patients were re-examined. In both examinations (before and afterward treatment), patients were requested to score their pruritus in the range of 0–x (0: no pruritus, 10: the most severe pruritus).

The χ2 test was used for statistical significance. Statistical assay was performed using software SPSS 11.0 (Statistical Package for Social Science 11.0); a p value less than 0.05 was considered significant.

RESULTS

In 12 patients, the cause of perianal pruritus was detected (haemorrhoids, n = 4; anal fissure, north = 1; Enterobius vermicularis infestation, n = 1; dermatophyte infection, n = 1; condyloma accuminata, n = one; perianal molluscum contagiosum, due north = 1; diabetes mellitus, n = 1; and psychogenic factors, n = two) and these patients were excluded from the study (table 2). In 11 patients, allergic contact dermatitis was suspected clinically and patch tests with both European Standard Serial and personal items were performed. No allergic or irritant reaction was seen in these patients.

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Table 2

Detected causes of perianal pruritus in our study

The mean (SD) age of the idiopathic perianal pruritus patients was 34.78 (16.68); 35 patients were male (58.3%) and 25 were female person (41.7%). Twenty 8 patients (mean (SD) age 35.43 (16.32), 16 male, 12 female person) were treated with topical steroid (Advantan foam; Schering) twice daily and treatment was constructive in 26 (92.3%). Thirty two patients (mean (SD) age 34.20 (15.35), nineteen male, 13 female) were treated with a liquid cleanser (Protex liquid cleanse; Colgate-Palmolive) and treatment was effective in 29 (ninety.6%). The difference between the effectiveness of these 2 treatment modalities was not statistically significant (χii p>0.05).

Give-and-take

Perianal pruritus is an extremely mutual symptom and is associated with a wide range of mechanical, dermatological, infectious, systemic, and other atmospheric condition.viii

Inspection, palpation, and anoscopic examination should be performed to observe out the aetiology. In this study, a total of 72 patients suffering from perianal pruritus were examined. The aetiology of perianal pruritus was institute in only 12 (20%) of our patients.

Haemorrhoids and anal fissures are important causes of perianal pruritus. Daniel et al diagnosed haemorrhoids in 20% and anal fissures in 12% of patients with perianal pruritus.eight, 9 During our study, we diagnosed haemorrhoids in four patients and anal crack in one patient, which were excluded from statistically analysed "idiopathic perianal pruritus" group.

There are many other organic and metabolic factors of perianal pruritus such as intestinal parasites, perianal fungal, bacterial and viral infections, and diabetes mellitus. It is of import to treat the underlying aetiological factors, if detected In our study, "Enterobius, vermicularis infestation" was detected in a 5.five year old girl. In i patient, perianal molluscum contagiosum was present. Perianal condyloma accuminata was diagnosed in another patient. Diabetes mellitus was diagnosed in ane patient and in some other dermatophyte infection was found with direct microscopic investigation.

Psychological bug are well known causes of perianal pruritus. Laurent et al showed that the mean hypomania and low scale scores were greater and smaller respectively in the idiopathic perianal pruritus patients.10 In two of our patients, low was diagnosed subsequently psychiatric consultation.

At that place are many other factors known to initiate or aggravate perianal pruritus. It is very of import to remember that some foods, such every bit spices, citrus fruits, coffee, tea, chocolate, and tomatoes tin can crusade perianal pruritus.4, 5 Such foods should be eliminated from the diets of patients as function of the treatment.5, xi, 12

Faecal contamination is also very important in perianal pruritus.thirteen, 14 Faeces contain endopeptidases of bacterial origin, in improver to potential allergens and bacteria. Although Silverman et al could not show a microbiological basis for perianal pruritus,15 these enzymes are capable of both itching and inflammation.13 At that point, nosotros decided to investigate the role of decreasing faecal contaminants with cleansers and find out the effectiveness of washing in the handling of perianal pruritus.

If a specific crusade of perianal pruritus is identified, advisable therapy such every bit antifungals, antibiotics, and antihelmintics should be given.6 In that location are many treatment modalities for idiopathic perianal pruritus, including topical corticosteroids, topical non-steroid anesthetics, and systemic antihistamines.vi, 7 Topical corticosteroids are widely used and they are one of the nearly effective treatment regimens for perianal idiopathic pruritus.6

In this report, we tried to compare the effectiveness of perianal cleansing and topical corticosteroids in the handling of idiopathic perianal pruritus. Symptoms of 26 (92.nine%) patients in group I, and 29 (90.6%) patients in group Two improved. No side effects in either group were detected at the end of the handling period. Although topical corticosteroids are i of the nearly effective treatment regimens for perianal idiopathic pruritus, the skin of anogenital area is particularly vulnerable to atrophy afterwards the use of such medications.six, 16 Although we did not notice such complications, topical corticosteroids, peculiarly if used for a long period, can cause cloudburst, bacterial and fungal infections, allergic contact dermatitis, telengectasia, purpura, and/or scar formation.17

In determination, this report shows that perianal cleansing is equally constructive equally topical corticosteroids in the treatment of idiopathic perianal pruritus, and mild cleansers can exist used as a safe first step treatment for controlling perianal itching.

Components of topical steroid and liquid cleanser

  • Advantan cream: methylprednisolone aceponate 0.ane%.

  • Protex liquid cleanser: sodium lauryl ether sulphate; DMDM hidantoine; glycerin; cocodiethanolamide; triclosan; aloe vera extract; cocoamidoprpyl betaine; citric acid; EDTA; NaCl.

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    Aucoin EJ. Pruritus ani. Postgrad Med 1987;82:76–80.

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    Johnson RA. Diseases and disorders of the anogenitalia of males. In: Freedberg IM, Eisen AZ, Wolff K, et al, eds. Fitzpatrick'southward dermatology in general medicine. 5th Ed. New York: Mc Graw–Hill, 1999:1348–76.

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    Pfenninger JL, Zainea GG. Common anorectal conditions: part I. Symptoms and complaints. Am Fam Physician 2001;63:2391–eight.

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    Laurent A, Boucharlat J, Bosson JL, et al. Psychological cess of patients with idiopathic pruritus ani. Psychother Psychosom 1997;66:163–half-dozen.

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    Giordano 1000, Rebesco B, Torelli I, et al. Pruritus ani. Minerva Chir 1999;54:885–91.

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    Smith LE, Henrichs D, McCullah RD. Prospective studies on the etiology and handling of pruritus ani. Dis Colon Rectum 1982;25:358–63.

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    Ive FA. The umbilical, perianal and genital regions. In: Champion RH, Burton JL, Burns DA, et al, eds. Textbook of dermatology. sixth Ed. Oxford: Blackwell-Scientific discipline, 1998:3163–238.

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    Kocsard Due east. Pruritus ani. A symptom of fecal contamination. Cutis 1981;27:518.

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    Silverman SH, Youngs DJ, Allan A, et al. The fecal microflora in pruritus ani. Dis Colon Rectum 1989;32:466–8.

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    Lyell A. Psychogenic and neurogenic peel disorders. In: Orkin Grand, Maibach Hullo, Dahl MV, eds. Dermatology. 1st Ed. Connecticut: Appleton & Lange, 1991:70–vii.

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    Habif TP. Topical therapy and topical corticosteroids. Clinical dermatology. third Ed. Missouri: Mosby, 1996:25–44.

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