1. Anal pruritus is estimated to affect up to 5% of the population, with a male to female ratio of 4:1
2. In up to 25% of cases the anal pruritus is idiopathic
3. Even mild degrees of faecal soiling, which the patient may not be aware of, may be enough to cause an itch-scratch cycle
4. Dietary associations with pruritus anti include caffeine, alcohol, chocolate, tomatoes, spices and citrus fruit
5. Important to educate the patient about the recurring, benign nature of this irritating condition and to ensure adherence to the following simple, yet essential, measures to eliminate irritants and resolve symptoms
6. Management strategies
- Normalisation of bowel motions
- Cleaning after defaecation: rubbing or scrubbing the area should be actively discouraged
- Clothing
- Soaps and cleansers: do not use soaps
- Do not scratch: easy to say than done. May need help with topical steroid. Suggested regimen: start with methylprednisolone fatty ointment --> reducing to a moderate potency preparation such as betamethasone validate and then 1% hydrocortisone cream. Not curative. May need to return to high potency steroid from time to time
- topical capsaicin in a 0.006% preparation (only available in a compound pharmacy. needs to be mixed with white paraffin )
References:
http://www.racgp.org.au/download/documents/AFP/2010/June/201006maclean.pdf
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