Dermatology and Pruritus Ani
Pruritus ani is a dermatologic condition characterized by burning or itching at the perianal area, which is categorized as either primary (idiopathic) or secondary. Multiple etiologies have been recognized, but the majority of patients do not have a singl
- PDF / 998,064 Bytes
- 16 Pages / 595.28 x 790.87 pts Page_size
- 81 Downloads / 196 Views
Key Concepts • Pruritus ani is a dermatologic condition characterized by itching or burning at the perianal area. • Pruritus ani can be either primary (idiopathic) or secondary. • Primary pruritus ani is the most common form of pruritus ani. The most common causes of secondary pruritus ani are local irritants and common anorectal conditions. • All chronic perianal dermatoses require a detailed history and physical exam, including all past diagnostic tests and forms of treatment. • The single most valuable diagnostic test in patients with recurrent or ongoing pruritus ani is skin biopsy. • Treatment options for pruritus ani are numerous. Management should focus on the underlying or suspected etiology, following an evidenced-based stepwise diagnostic and treatment algorithm.
Introduction Dermatologic diseases of the anus are a group of inflammatory, infectious, and neoplastic conditions that are difficult to diagnose and challenging to manage. While patients often do not openly discuss the associated symptoms with medical professionals, these conditions can often have a significant impact on their quality of life. Patients presenting with anal dermatologic disease are often seen by a diverse group of providers, including general practitioners, gastroenterologists, dermatologists, and colorectal surgeons. Some providers such as primary care physicians may encounter these conditions less commonly, thus making efficient and evidence-based treatment strategies highly important. In 1660, Samuel Hafenreffer defined “itch” as “an unpleasant sensation that elicits the desire or reflex to scratch” [1]. More specifically, pruritus ani is defined as a dermatologic condition characterized by persistent and unpleasant itching
or burning sensation in the perianal region [2]. The incidence of pruritus ani is estimated to range from 1 to 5 % in the general population, with men being affected more than women in a 4:1 ratio and most commonly diagnosed in the fourth–sixth decades of life [3–5]. Pruritus ani can be classified into primary or idiopathic (accounting for 50–90 % of cases) and secondary [6]. It may be caused by a wide spectrum of conditions, among which perianal eczema is probably the most common. Because pruritus ani often has a multifactorial etiology and high chronicity, most patients have symptoms for many years, as well as a long list of prescribed or over-the-counter treatments. Appropriate management can be difficult and requires a detailed evaluation in search for its etiology.
Pathophysiology of Perianal Signs and Symptoms The sensation of itch is elicited as a surface phenomenon mediated by nonmyelinated C-fibers in the epidermis and subdermis and can be also classified as pruritoceptive (C-fiber mediated), neuropathic (i.e., after herpes zoster infection), and central or neurogenic. Itch has long been considered as a sub-modality of pain. The intensity hypothesis postulates that neurons are activated by both painful and pruritogenic stimuli, but weaker activation of nociceptive receptors can also result in itch [7]. Recent
Data Loading...
