Skip to main content
SpringerLink
Log in

Perianal Dermatology and Pruritus Ani

  • Reference work entry
The ASCRS Textbook of Colon and Rectal Surgery

Abstract

Perianal skin is subject to virtually all of the diseases that affect skin in other areas of the body. The differential diagnosis of perianal skin is presented in Table 16-1. This list includes a variety of diagnoses, which almost never present as isolated perianal disease, but there are common diseases such as psoriasis that may present in isolation without obvious ties to other areas of the body unless a careful search is made. Successful treatment of perianal disease requires accurate diagnosis to eliminate diseases that have specific cause and treatment (e.g., psoriasis, candida, Bowen’s disease). Recognition of important treatable causes requires a disciplined, organized approach to diagnosis with frequent use of biopsy. This chapter’s objective is to lay out a strategy to facilitate accurate diagnosis and successful treatment of perianal and anal skin conditions. Implicit in this strategy is the ability to properly examine the anus with appropriate instruments and bright light and to understand diseases peculiar to the anal area, hence, the importance of the colorectal surgeon who has the skills to accomplish this task. The importance of complete, accurate evaluation is emphasized by a St. Louis University series in which a study of 209 patients with the presenting symptom of pruritus over a 2-year period revealed that 75% of patients had coexisting anal or colorectal pathology. The diagnoses included 11% with rectal cancer, 6% with anal canal cancer, and 2% with colon cancer, although the majority of patients had hemorrhoids or fissure.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Daniel GL, Longo WE, AM Vernava 3rd. Pruritus ani. Causes and concerns. Dis Colon Rectum 1994;37(7):670–674.

    Article  CAS  Google Scholar 

  2. Corman ML. Colon and Rectal Surgery. 2nd ed. Philadelphia: Lippincott; 1989:287.

    Google Scholar 

  3. Verbov J. Pruritus ani and its management: a study and reappraisal. Clin Exp Dermatol 1984;9(1):46–52.

    Article  CAS  PubMed  Google Scholar 

  4. Quine WV. Quiddities: An Intermittently Philosophical Dictionary. Cambridge: Harvard University Press; 1987.

    Google Scholar 

  5. Bernhard JD. Itch: mechanisms and management of pruritus. New York: McGraw‐Hill; 1994.

    Google Scholar 

  6. Stamos MJ, Hicks TC, eds. Pruritus Ani: Diagnosis and Treatment. New York: Thieme Medical Publishers; 1998.

    Google Scholar 

  7. Sherertz EF. Clinical pearl: symptomatic dermatographism as a cause of genital pruritus. J Am Acad Dermatol 1994;31(6): 1040–1041.

    Article  CAS  PubMed  Google Scholar 

  8. Bernhard JD, Kligman AM, Shelley WB. Dermographic pruritus: invisible dermographism. J Am Acad Dermatol 1995;33(2 pt 1):322.

    Article  CAS  PubMed  Google Scholar 

  9. Caplan RM. The irritant role of feces in the genesis of perianal itch. Gastroenterology 1966;50(1):19–23.

    CAS  PubMed  Google Scholar 

  10. Smith LE, Henrichs D, McCullah RD. Prospective studies on the etiology and treatment of pruritus ani. Dis Colon Rectum 1982;25(4):358–363.

    Article  CAS  PubMed  Google Scholar 

  11. Allan A, Ambrose NS, Silverman S, Keighley MR. Physiological study of pruritus ani. Br J Surg 1987;74(7):576–579.

    Article  CAS  PubMed  Google Scholar 

  12. Farouk R, Duthie GS, Pryde A, Bartolo DC. Abnormal transient internal sphincter relaxation in idiopathic pruritus ani: physiological evidence from ambulatory monitoring. Br J Surg 1994;81(4):603–606.

    Article  CAS  PubMed  Google Scholar 

  13. Eyers AA, Thomson JP. Pruritus ani: is anal sphincter dysfunction important in aetiology? Br Med J 1979;2(6204):1549–1551.

    Article  CAS  PubMed  Google Scholar 

  14. Dodi G, Pirone E, BettinA, et al. The mycotic flora in proctological patients with and without pruritus ani. Br J Surg 1985;72(12):967–969.

    Article  CAS  PubMed  Google Scholar 

  15. Alexander S. Dermatological aspects of anorectal disease. Clin Gastroenterol 1975;4(3):651–657.

    CAS  PubMed  Google Scholar 

  16. Pirone E, Infantino A, MasinA, et al. Can proctological procedures resolve perianal pruritus and mycosis? A prospective study of 23 cases. Int J Colorectal Dis 1992;7(1):18–20.

    Article  CAS  PubMed  Google Scholar 

  17. Bowyer A, McColl I. A study of 200 patients with pruritus ani. Proc R Soc Med 1970;63(suppl):96–98.

    PubMed  Google Scholar 

  18. Weismann K, Sand Petersen C, Roder B. Pruritus ani caused by heto‐hoemolytic streptocacel Acta Derm Venereal 1996;76:415.

    CAS  Google Scholar 

  19. Bowyer A, McColl I. Erythrasma and pruritus ani. Acta Derm Venereol 1971;51(6):444–447.

    CAS  PubMed  Google Scholar 

  20. Sindhuphak W, Mac Donald E, Smith EB. Erythrasma. Overlooked or misdiagnosed? Int J Dermatol 1985;24(2):95–96.

    Article  CAS  PubMed  Google Scholar 

  21. Baral J. Pruritus ani and Staphylococcus aureus. J Am Acad Dermatol 1983;9(6):962.

    Article  CAS  PubMed  Google Scholar 

  22. Dasan S, Neill SM, Donaldson DR, Scott HJ. Treatment of persistent pruritus ani in a combined colorectal and dermatological clinic. Br J Surg 1999;86(10):1337–1340.

    Article  CAS  PubMed  Google Scholar 

  23. Habif TP. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 3rd ed. St. Louis: Mosby; 1996.

    Google Scholar 

  24. Harrington CI, Lewis FM, McDonagh AJ, Gawkrodger DJ. Dermatological causes of pruritus ani. BMJ 1992;305(6859):955.

    Article  CAS  PubMed  Google Scholar 

  25. Bruynzeel DP. Dermatological causes of pruritus ani. BMJ 1992;305(6859):955.

    Article  CAS  PubMed  Google Scholar 

  26. Lochridge E Jr. Pruritis ani: perianal psoriasis. South Med J 1969;62(4):450–452.

    PubMed  Google Scholar 

  27. Meffert JJ, Davis BM, Grimwood RE. Lichen sclerosus. J Am Acad Dermatol 1995;32(3):393–416; quiz 7–8.

    Article  CAS  PubMed  Google Scholar 

  28. Neill SM, Tatnall FM, Cox NH. Guidelines for the management of lichen sclerosus. Br J Dermatol 2002;147(4):640–649.

    Article  CAS  PubMed  Google Scholar 

  29. Wong YW, Powell J, Oxon MA. Lichen sclerosus. A review. Minerva Med 2002;93(2):95–99.

    CAS  Google Scholar 

  30. Powell JJ, Wojnarowska F. Lichen sclerosus. Lancet 1999;353 (9166):1777–1783.

    Article  CAS  PubMed  Google Scholar 

  31. Carli P, De Magnis A, Mannone F, Botti E, Taddei G, Cattaneo A. Vulvar carcinoma associated with lichen sclerosus. Experience at the Florence, Italy, Vulvar Clinic. J Reprod Med 2003;48(5): 313–318.

    PubMed  Google Scholar 

  32. Carli P, Cattaneo A, De Magnis A, Biggeri A, Taddei G, Giannotti B. Squamous cell carcinoma arising in vulval lichen sclerosus: a longitudinal cohort study. Eur J Cancer Prev 1995;4(6):491–495.

    Article  CAS  PubMed  Google Scholar 

  33. Byren I, Venning V, Edwards A. Carcinoma of the vulva and asymptomatic lichen sclerosus. Genitourin Med 1993;69(4): 323–324.

    CAS  PubMed  Google Scholar 

  34. Assmann T, Becker‐Wegerich P, Grewe M, Megahed M, Ruzicka T. Tacrolimus ointment for the treatment of vulvar lichen sclerosus. J Am Acad Dermatol 2003;48(6):935–937.

    Article  PubMed  Google Scholar 

  35. Bohm M, Frieling U, Luger TA, Bonsmann G. Successful treatment of anogenital lichen sclerosus with topical tacrolimus. Arch Dermatol 2003;139(7):922–924.

    Article  PubMed  Google Scholar 

  36. Friend WG. The cause and treatment of idiopathic pruritus ani. Dis Colon Rectum 1977;20(1):40–42.

    Article  CAS  PubMed  Google Scholar 

  37. Akl K. Yogurt‐induced pruritus ani in a child. Eur J Pediatr 1992;151(11):867.

    Article  CAS  PubMed  Google Scholar 

  38. Murie JA, Sim AJ, Mackenzie I. The importance of pain, pruritus and soiling as symptoms of haemorrhoids and their response to haemorrhoidectomy or rubber band ligation. Br J Surg 1981;68(4):247–249.

    Article  CAS  PubMed  Google Scholar 

  39. Koblenzer CS. Psychologic and psychiatric aspects of itching. In: Bernhard JD, ed. Itch: Mechanisms and Management of Pruritus. New York: McGraw‐Hill; 1994:347–365.

    Google Scholar 

  40. Andrews D, Grunau VJ. An uncommon adverse effect following bolus administration of intravenous dexamethasone. J Can Dent Assoc 1986;52(4):309–311.

    CAS  PubMed  Google Scholar 

  41. Kligman AM, Frosch PJ. Steroid addiction. Int J Dermatol 1979;18(1):23–31.

    Article  CAS  PubMed  Google Scholar 

  42. Goldman L, Kitzmiller KW. Perianal atrophoderma from topical corticosteroids. Arch Dermatol 1973;107(4):611–612.

    Article  CAS  PubMed  Google Scholar 

  43. Alexander‐ Williams J. Pruritus ani. Br Med J (Clin Res Ed) 1983;287(6386):159–160.

    Article  Google Scholar 

  44. Rohde H. Routine anal cleansing, so‐called hemorrhoids, and perianal dermatitis: cause and effect? Dis Colon Rectum 2000;43(4):561–563.

    Article  CAS  PubMed  Google Scholar 

  45. Thorp MA, Oliver SP, Kruger J, Prescott CA. Determination of the lowest dilution of aluminium acetate solution able to inhibit in vitro growth of organisms commonly found in chronic suppurative otitis media. J Laryngol Otol 2000;114(11):830–831.

    CAS  PubMed  Google Scholar 

  46. Thorp MA, Kruger J, Oliver S, Nilssen EL, Prescott CA. The antibacterial activity of acetic acid and Burow's solution as topical otological preparations. J Laryngol Otol 1998;112(10): 925–928.

    Article  CAS  PubMed  Google Scholar 

  47. Thorp MA, Gardiner IB, Prescott CA. Burow's solution in the treatment of active mucosal chronic suppurative otitis media: determining an effective dilution. J Laryngol Otol 2000;114(6): 432–436.

    Article  CAS  PubMed  Google Scholar 

  48. Dibb WL. In vitro efficacy of Otic Domeboro against Pseudomonas aeruginosa. Undersea Biomed Res 1985;12(3): 307–313.

    CAS  PubMed  Google Scholar 

  49. Sarmiento JM, Wolff BG, Burgart LJ, Frizelle FA, Ilstrup DM. Paget's disease of the perianal region: an aggressive disease? Dis Colon Rectum 1997;40(10):1187–1194.

    CAS  PubMed  Google Scholar 

  50. Jensen SL, Sjolin KE, Shokouh‐Amiri MH, Hagen K, Harling H. Paget's disease of the anal margin. Br J Surg 1988;75(11):1089–1092.

    Article  CAS  PubMed  Google Scholar 

  51. Helwig EB, Graham JH. Anogenital (extramammary) Paget's disease. A clinicopathological study. Cancer 1963;16:387–403.

    Article  CAS  PubMed  Google Scholar 

  52. Marchesa P, Fazio VW, Oliart S, Goldblum JR, Lavery IC. Perianal Bowen's disease: a clinicopathologic study of 47 patients. Dis Colon Rectum 1997;40(11):1286–1293.

    Article  CAS  PubMed  Google Scholar 

  53. Chang GJ, Berry JM, Jay N, Palefsky JM, Welton ML. Surgical treatment of high‐grade anal squamous intraepithelial lesions: a prospective study. Dis Colon Rectum 2002;45(4):453–458.

    Article  PubMed  Google Scholar 

  54. Goldstone SE, Winkler B, Ufford LJ, Alt E, Palefsky JM. High prevalence of anal squamous intraepithelial lesions and squamous‐cell carcinoma in men who have sex with men as seen in a surgical practice. Dis Colon Rectum 2001;44(5):690–698.

    Article  CAS  PubMed  Google Scholar 

  55. Goldman S, Glimelius B, Pahlman L. Anorectal malignant melanoma in Sweden. Report of 49 patients. Dis Colon Rectum 1990;33(10):874–877.

    Article  CAS  PubMed  Google Scholar 

  56. Brady MS, Kavolius JP, Quan SH. Anorectal melanoma. A 64‐year experience at Memorial Sloan‐Kettering Cancer Center. Dis Colon Rectum 1995;38(2):146–151.

    Article  CAS  PubMed  Google Scholar 

  57. Enker WE, Heilwell M, JanovAJ, et al. Improved survival in epidermoid carcinoma of the anus in association with preoperative multidisciplinary therapy. Arch Surg 1986;121(12):1386–1390.

    CAS  PubMed  Google Scholar 

  58. McClatchey KD. Clinical Laboratory Medicine. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2002.

    Google Scholar 

  59. Kerscher MJ, Korting HC. Comparative atrophogenicity potential of medium and highly potent topical glucocorticoids in cream and ointment according to ultrasound analysis. Skin Pharmacol 1992;5(2):77–80.

    Article  CAS  PubMed  Google Scholar 

  60. Kerscher MJ, Hart H, Korting HC, Stalleicken D. In vivo assessment of the atrophogenic potency of mometasone furoate, a newly developed chlorinated potent topical glucocorticoid as compared to other topical glucocorticoids old and new. Int J Clin Pharmacol Ther 1995;33(4):187–189.

    CAS  PubMed  Google Scholar 

  61. Robinson N, Singri P, Gordon KB. Safety of the new macrolide immunomodulators. Semin Cutan Med Surg 2001;20(4):242–249.

    Article  CAS  PubMed  Google Scholar 

  62. Ling MR. Topical tacrolimus and pimecrolimus: future directions. Semin Cutan Med Surg 2001;20(4):268–274.

    Article  CAS  PubMed  Google Scholar 

  63. Wolloch Y, Dintsman M. A simple and effective method of treatment for intractable pruritus ani. Am J Proctol Gastroenterol Colon Rectal Surg 1979;30(1):34–36.

    CAS  PubMed  Google Scholar 

  64. Eusebio EB, Graham J, Mody N. Treatment of intractable pruritus ani. Dis Colon Rectum 1990;33(9):770–772.

    Article  CAS  PubMed  Google Scholar 

  65. Eusebio EB. New treatment of intractable pruritus ani. Dis Colon Rectum 1991;34(3):289.

    Article  CAS  PubMed  Google Scholar 

  66. Farouk R, Lee PW. Intradermal methylene blue injection for the treatment of intractable idiopathic pruritus ani. Br J Surg 1997;84(5):670.

    Article  CAS  PubMed  Google Scholar 

Download references

Authors
  1. Charles O. Finne
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Professor of Surgery, Mayo Clinic College of Medicine, Chairman, Division of Colon and Rectal Surgery, Mayo Clinic Foundation, Rochester, MN, USA

    Bruce G. Wolff MD, FASCRS (Senior Editors) (Senior Editors)

  2. Professor of Surgery, Chief, Section of Colorectal Surgery, Washington University School of Medicine, St. Louis, MO, USA

    James W. Fleshman MD, FASCRS (Senior Editors) (Senior Editors)

  3. Chairman, Department of Colon and Rectal Surgery, Ochsner Clinic Foundation, New Orleans, LA, USA

    David E. Beck MD, FASCRS (Senior Editors) (Senior Editors)

  4. Professor of Surgery, Mayo Clinic College of Medicine, Consultant, Colon and Rectal Surgery, Mayo Clinic and Mayo Foundation, Rochester, MN, USA

    John H. Pemberton MD, FASCRS (Senior Editors) (Senior Editors)

  5. Chief of Staff, Cleveland Clinic Florida, Weston, FL, USA

    Steven D. Wexner MD, FASCRS (Senior Editors) (Senior Editors)

  6. Victor W. Fazio Chair of Colorectal Surgery, Department of Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    James M. Church BSc, MBChB, MMed Sci, FASCRS (Associate Editors) (Associate Editors)

  7. Professor of Surgery, Chief, Section of Colon and Rectal Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA

    Julio Garcia-Aguilar MD, PhD, FASCRS (Associate Editors) (Associate Editors)

  8. Department of Colon and Rectal Surgery, Lahey Clinic, Burlington, MA, USA

    Patricia L. Roberts MD, FASCRS (Associate Editors) (Associate Editors)

  9. Professor of Surgery, Head, Section of Colon and Rectal Surgery, Rush University Medical Center, Chicago, IL, USA

    Theodore J. Saclarides MD, FASCRS (Associate Editors) (Associate Editors)

  10. Division of Colon and Rectal Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, CA, USA

    Michael J. Stamos MD, FASCRS (Associate Editors) (Associate Editors)

Rights and permissions

Reprints and permissions

Copyright information

© 2007 Springer Science+Business Media, LLC

About this entry

Cite this entry

Finne, C.O. (2007). Perianal Dermatology and Pruritus Ani. In: Wolff, B.G., et al. The ASCRS Textbook of Colon and Rectal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-0-387-36374-5_16

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-36374-5_16

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-24846-2

  • Online ISBN: 978-0-387-36374-5

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation