Materiały źródłowe

• #1 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2647235/

  Pruritus ani is defined as intense chronic itching affecting peri-anal skin. It affects 15% of the population, is four times more common in men and is most frequent between the fourth and sixth decades of life. The symptoms range from mild to intense and depression may result when these are severe and persistent. […] Pruritus ani is classified as idiopathic when no cause can be found. However, as 75% of cases have co-existing pathology, a detailed history and examination are necessary. Nearly 100 different causes for pruritus ani have been reported. The majority of co-existing conditions are anorectal, predominately haemorrhoids and fissures, hence the number of referrals to coloproctologists. […] The goal of treatment is asymptomatic, intact, dry, clean peri-anal skin with reversal of morphological changes. The aim of this review is to provide a systematic method of diagnosis and management of pruritus ani. This is presented after an overview of how individual aetiologies relate to anal pruritus, the indications and pitfalls of the therapies available.

• #2 Pruritus Ani

  https://coloproctol.org/journal/view.php?doi=10.3393/jksc.2011.27.2.54

  Pruritus ani may have various causes, and it has been divided into two subtypes: idiopathic and secondary. […] The pathophysiology of pruritus ani has not been elucidated yet. It has been hypothesized that when sensory nerves in the perianal area are stimulated, skin irritation and subsequent pruritis is induced; consequently, the skin is excessively scratched, which causes skin injury. […] Fecal contamination due to abnormal transient internal sphincter relaxation has also been reported to result in a subsequent perianal itching problem. Feces contain endopeptidases of bacterial origin, in addition to potential allergens and bacteria. These enzymes are capable of causing both itching and inflammation.

• #3 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755774/

  Pruritus ani is a common condition with many different potential causes. […] The pathophysiology of itching in general is thought to be related to the C-fibers in the skin. […] Histamine, bradykinin, and kallikrein, among other substances, have been implicated in itching. […] Scratching to relieve the itch can cause further excoriation and inflammation, which leads to additional stimuli of the nerve fibers. […] This itchscratchitch cycle is difficult for patients to break, complicating treatment efforts. […] Causes of pruritus ani can be roughly classified into secondary and idiopathic, with 25 to 75% attributed to an identifiable source. […] Secondary causes are subdivided into local irritation, infection, inflammation, systemic diseases, and neoplasms. […] Many of these conditions have a myriad of presentations, one of which might be pruritus.

• #4 Management and Treatment of Pruritus

  https://www.skintherapyletter.com/urticaria/management-treatment/

  Pruritus is a complex process that involves the stimulation of free nerve endings found superficially in the skin. The sensation of pruritus is transmitted through the C-fibers in the skin to the dorsal horn of the spinal cord, and then, via the spinothalamic tract to the cerebral cortex for processing. Many chemicals have been found to be pruritogenic, therefore causing the itch sensation, including histamine, serotonin, cytokines, and opioids. There are six categories of pruritus: dermatologic, systemic, neurogenic, psychogenic, mixed, and other. Various treatment and management options exist depending on the category or cause. […] Treatment of pruritus can be categorized in several ways. A common method of grouping the various options is causative vs. symptomatic treatment. Causative treatment involves finding the underlying disorder and then correcting it, thereby eliminating the itch sensation. Symptomatic treatment involves substituting another sensation for the itch, using methods such as cooling, heating, or counter irritation (e.g., scratching). Symptomatic treatment can be used in addition to treating the underlying disease process in order to provide earlier relief. Most of the available treatment options are categorized under symptomatic therapy and management.

• #5

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/pruritus-itch/

  Itch can be produced by mechanical (gentle touch, pressure, vibration, and wool), thermal and electrical stimuli such as transcutaneous or direct nerve stimulation. The sensation is received by free nerve endings in the skin and transmitted via unmyelinated C fibers and myelinated A fibers to the central spinothalamic tracts. Microneurography studies have demonstrated that itch and pain are transmitted by separate neural pathways. […] Histamine is one of the most important mediators of itch, although other chemical substances have also been implicated. Some, such as neuropeptides, act by releasing histamine from mast cells, and itching caused by them responds to antihistamines. Others act independently; therefore antihistamines are not effective in some forms of pruritus. Opioids have a central pruritic action and also act peripherally by augmenting histamine itch.

• #6

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/pruritus-itch/

  Itch can be produced by mechanical (gentle touch, pressure, vibration, and wool), thermal and electrical stimuli such as transcutaneous or direct nerve stimulation. The sensation is received by free nerve endings in the skin and transmitted via unmyelinated C fibers and myelinated A fibers to the central spinothalamic tracts. Microneurography studies have demonstrated that itch and pain are transmitted by separate neural pathways. […] Histamine is one of the most important mediators of itch, although other chemical substances have also been implicated. Some, such as neuropeptides, act by releasing histamine from mast cells, and itching caused by them responds to antihistamines. Others act independently; therefore antihistamines are not effective in some forms of pruritus. Opioids have a central pruritic action and also act peripherally by augmenting histamine itch.

• #7

  https://link.springer.com/article/10.1007/s40257-024-00898-5

  This sensitization can result in spontaneous firing and heightened response to stimuli, leading to the sensation of itch. Central sensitization, involving changes in the spinal cord and brain, can further amplify itch signals, making them as pronounced as or more pronounced than pain signals. […] BRP is largely believed to result from radiculopathies involving the cervical dorsal root, as in spinal stenosis, or compression of spinal nerves that leads to the localized sensation of pruritus in a dermatomal distribution. […] The primary symptom of itch, rather than pain, in these conditions is unclear. […] The exact pathophysiology underlying NP is not clear, and many theories regarding both peripheral and central mechanisms have been proposed with supporting evidence. […] Damage to nerves in the lower spine is the most common cause of neuropathic anogenital pruritus. […] The primary cause of neuropathic itch in the genital area often stems from compression of the lumbar and sacral spinal cord dorsal rami, involving nerve roots L1L5 and S1S5.

• #8

  https://link.springer.com/article/10.1007/s40257-024-00898-5

  This sensitization can result in spontaneous firing and heightened response to stimuli, leading to the sensation of itch. Central sensitization, involving changes in the spinal cord and brain, can further amplify itch signals, making them as pronounced as or more pronounced than pain signals. […] BRP is largely believed to result from radiculopathies involving the cervical dorsal root, as in spinal stenosis, or compression of spinal nerves that leads to the localized sensation of pruritus in a dermatomal distribution. […] The primary symptom of itch, rather than pain, in these conditions is unclear. […] The exact pathophysiology underlying NP is not clear, and many theories regarding both peripheral and central mechanisms have been proposed with supporting evidence. […] Damage to nerves in the lower spine is the most common cause of neuropathic anogenital pruritus. […] The primary cause of neuropathic itch in the genital area often stems from compression of the lumbar and sacral spinal cord dorsal rami, involving nerve roots L1L5 and S1S5.

• #9

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/pruritus-itch/

  Itch can be produced by mechanical (gentle touch, pressure, vibration, and wool), thermal and electrical stimuli such as transcutaneous or direct nerve stimulation. The sensation is received by free nerve endings in the skin and transmitted via unmyelinated C fibers and myelinated A fibers to the central spinothalamic tracts. Microneurography studies have demonstrated that itch and pain are transmitted by separate neural pathways. […] Histamine is one of the most important mediators of itch, although other chemical substances have also been implicated. Some, such as neuropeptides, act by releasing histamine from mast cells, and itching caused by them responds to antihistamines. Others act independently; therefore antihistamines are not effective in some forms of pruritus. Opioids have a central pruritic action and also act peripherally by augmenting histamine itch.

• #10 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755774/

  Pruritus ani is a common condition with many different potential causes. […] The pathophysiology of itching in general is thought to be related to the C-fibers in the skin. […] Histamine, bradykinin, and kallikrein, among other substances, have been implicated in itching. […] Scratching to relieve the itch can cause further excoriation and inflammation, which leads to additional stimuli of the nerve fibers. […] This itchscratchitch cycle is difficult for patients to break, complicating treatment efforts. […] Causes of pruritus ani can be roughly classified into secondary and idiopathic, with 25 to 75% attributed to an identifiable source. […] Secondary causes are subdivided into local irritation, infection, inflammation, systemic diseases, and neoplasms. […] Many of these conditions have a myriad of presentations, one of which might be pruritus.

• #11

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/pruritus-itch/

  Itch can be produced by mechanical (gentle touch, pressure, vibration, and wool), thermal and electrical stimuli such as transcutaneous or direct nerve stimulation. The sensation is received by free nerve endings in the skin and transmitted via unmyelinated C fibers and myelinated A fibers to the central spinothalamic tracts. Microneurography studies have demonstrated that itch and pain are transmitted by separate neural pathways. […] Histamine is one of the most important mediators of itch, although other chemical substances have also been implicated. Some, such as neuropeptides, act by releasing histamine from mast cells, and itching caused by them responds to antihistamines. Others act independently; therefore antihistamines are not effective in some forms of pruritus. Opioids have a central pruritic action and also act peripherally by augmenting histamine itch.

• #12

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/pruritus-itch/

  Itch can be produced by mechanical (gentle touch, pressure, vibration, and wool), thermal and electrical stimuli such as transcutaneous or direct nerve stimulation. The sensation is received by free nerve endings in the skin and transmitted via unmyelinated C fibers and myelinated A fibers to the central spinothalamic tracts. Microneurography studies have demonstrated that itch and pain are transmitted by separate neural pathways. […] Histamine is one of the most important mediators of itch, although other chemical substances have also been implicated. Some, such as neuropeptides, act by releasing histamine from mast cells, and itching caused by them responds to antihistamines. Others act independently; therefore antihistamines are not effective in some forms of pruritus. Opioids have a central pruritic action and also act peripherally by augmenting histamine itch.

• #13

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/pruritus-itch/

  Itch can be produced by mechanical (gentle touch, pressure, vibration, and wool), thermal and electrical stimuli such as transcutaneous or direct nerve stimulation. The sensation is received by free nerve endings in the skin and transmitted via unmyelinated C fibers and myelinated A fibers to the central spinothalamic tracts. Microneurography studies have demonstrated that itch and pain are transmitted by separate neural pathways. […] Histamine is one of the most important mediators of itch, although other chemical substances have also been implicated. Some, such as neuropeptides, act by releasing histamine from mast cells, and itching caused by them responds to antihistamines. Others act independently; therefore antihistamines are not effective in some forms of pruritus. Opioids have a central pruritic action and also act peripherally by augmenting histamine itch.

• #14 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755774/

  Pruritus ani is a common condition with many different potential causes. […] The pathophysiology of itching in general is thought to be related to the C-fibers in the skin. […] Histamine, bradykinin, and kallikrein, among other substances, have been implicated in itching. […] Scratching to relieve the itch can cause further excoriation and inflammation, which leads to additional stimuli of the nerve fibers. […] This itchscratchitch cycle is difficult for patients to break, complicating treatment efforts. […] Causes of pruritus ani can be roughly classified into secondary and idiopathic, with 25 to 75% attributed to an identifiable source. […] Secondary causes are subdivided into local irritation, infection, inflammation, systemic diseases, and neoplasms. […] Many of these conditions have a myriad of presentations, one of which might be pruritus.

• #15 Pruritus Ani (Anal Itching) – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/pruritus-ani-anal-itching

  Most anal itching is […] Once itching occurs, resulting from any cause, an itch-scratch-itch cycle can begin, in which scratching begets more itching. Often, skin becomes excoriated and secondarily infected, causing yet more itching. Also, topical treatments for itching and infection may be sensitizing, causing further itching. […] In adults with chronic itching and no apparent cause, overly aggressive anal hygiene may be involved. […] Foods and topical agents suspected of causing pruritus ani should be eliminated. […] Practicing appropriate, nonirritating hygiene (ie, not too little but not too vigorous, avoiding strong soaps and chemicals) and decreasing local moisture can help alleviate symptoms.

• #16 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755774/

  Pruritus ani is a common condition with many different potential causes. […] The pathophysiology of itching in general is thought to be related to the C-fibers in the skin. […] Histamine, bradykinin, and kallikrein, among other substances, have been implicated in itching. […] Scratching to relieve the itch can cause further excoriation and inflammation, which leads to additional stimuli of the nerve fibers. […] This itchscratchitch cycle is difficult for patients to break, complicating treatment efforts. […] Causes of pruritus ani can be roughly classified into secondary and idiopathic, with 25 to 75% attributed to an identifiable source. […] Secondary causes are subdivided into local irritation, infection, inflammation, systemic diseases, and neoplasms. […] Many of these conditions have a myriad of presentations, one of which might be pruritus.

• #17 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755774/

  Pruritus ani is a common condition with many different potential causes. […] The pathophysiology of itching in general is thought to be related to the C-fibers in the skin. […] Histamine, bradykinin, and kallikrein, among other substances, have been implicated in itching. […] Scratching to relieve the itch can cause further excoriation and inflammation, which leads to additional stimuli of the nerve fibers. […] This itchscratchitch cycle is difficult for patients to break, complicating treatment efforts. […] Causes of pruritus ani can be roughly classified into secondary and idiopathic, with 25 to 75% attributed to an identifiable source. […] Secondary causes are subdivided into local irritation, infection, inflammation, systemic diseases, and neoplasms. […] Many of these conditions have a myriad of presentations, one of which might be pruritus.

• #18 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755774/

  Once moisture and subsequent maceration begin, the patient often takes several steps to alleviate symptoms and eliminate the general feeling of being unclean. […] Patients often admit to overzealous cleaning of the area, which includes vigorous scrubbing in the shower and the use of medicated wipes after bowel movements. […] These steps often lead to worsening irritation secondary to local trauma. […] Unfortunately, patients often react to this worsening irritation by increasing the aggressiveness of their local hygiene, and a deleterious positive feedback loop is created. […] Pruritus is a symptom of many sexually transmitted diseases, including herpes and condyloma acuminata. […] Identification and avoidance of inciting factors are important in the treatment of this condition. […] Primary or idiopathic pruritus is invoked when no specific pathologic etiology can be blamed for the patient’s symptoms.

• #19 Anal Itching (Pruritus ani) | Section of Colon and Rectal Surgery | Washington University in St. Louis

  https://colorectalsurgery.wustl.edu/colon-rectal-anus-patient-faqs/anal-itching-pruritus-ani-questions/

  Anal itching can be caused by multiple factors, but most often itching is related to excessive moisture at the anal opening and excessive wiping after a bowel movement. […] Additionally, there are certain skin conditions and infections which may contribute to anal itching. […] Your surgeon will also evaluate for enlarged hemorrhoids, anal fistula or anal fissures, all of which may contribute to your anal itching or pruritus ani. […] Rarely, allergies may also contribute to pruritus ani. […] Both of these will dry the skin and cause microabrasions. These microabrasions and dry skin cause itching that leads to scratching, which further escalates the symptoms. […] In general, prolonged use of over-the-counter ointments should be avoided, particularly if they contain a steroid or other anti-inflammatory, as these agents may weaken the skin and actually worsen the pruritus ani or itching symptoms. […] On occasion, surgical intervention of the underlying condition may be indicated; this will be discussed with you by your treating surgeon.

• #20 Anal Pruritus | Colorectal Surgeons Sydney

  http://colorectalsurgeonssydney.com.au/conditions/anal-conditions/anal-pruritus

  Anal pruritus (also known as pruritus ani) is persistent itching of the skin around the anus. […] It is important not to trivialise the symptoms of this debilitating condition. […] Regardless of cause, the problem is exacerbated by a self-escalating itch-scratch-itch cycle. […] Over time chronic pruritus due to scratching leads to lichenifucation (thickening) of the skin with leathery induration. […] Pruritus ani can be divided into two types: secondary to another condition, and idiopathic, which cannot be attributed to a specific cause. […] Ideopathic pruritus accounts for more than 50% of patients with this condition. […] Anal itching can be caused by irritating chemicals in the foods consumed, such as those containing spices, hot sauces, and chilli. […] Moisture due to excessive perspiration, frequent liquid stools (diarrhoea), or a degree of faecal incontinence or anal seepage can exacerbate this condition.

• #21 Evaluation, management and future perspectives of anal pruritus: a narrative review | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-023-01018-5

  Anal pruritus is defined as a condition characterized by itching around the perianal region. It affects around 15% of the general adult population, and it is four times more common in men than women. Although, not life threatening, when long lasting this condition can greatly impair patients quality of life and even result in psychological issues. It is mainly categorized as either primary (idiopathic) or secondary, being a consequence of causal pathology. The main linking factor of the idiopathic pruritis is thought to be an increased fecal contamination of the anal region. Several studies showed abnormal sphincter relaxation leading to fecal soiling and perianal irritation initiating what is called an itchscratch cycle. […] A thorough history and examination should be performed for the best possible treatment. Treatment consists of a stepwise approach focusing mainly on patient education and the use of topical agents.

• #22 Evaluation, management and future perspectives of anal pruritus: a narrative review | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-023-01018-5

  Anal pruritus is defined as a condition characterized by itching around the perianal region. It affects around 15% of the general adult population, and it is four times more common in men than women. Although, not life threatening, when long lasting this condition can greatly impair patients quality of life and even result in psychological issues. It is mainly categorized as either primary (idiopathic) or secondary, being a consequence of causal pathology. The main linking factor of the idiopathic pruritis is thought to be an increased fecal contamination of the anal region. Several studies showed abnormal sphincter relaxation leading to fecal soiling and perianal irritation initiating what is called an itchscratch cycle. […] A thorough history and examination should be performed for the best possible treatment. Treatment consists of a stepwise approach focusing mainly on patient education and the use of topical agents.

• #23 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2647235/

  Any factor which increases occult or overt soiling augments exposure of the peri-anal skin to irritants and is a potential area of therapy. […] Prolonged faecal contact is irritant to peri-anal skin and, as a group, patients with pruritus ani are less able to maintain absolute continence when dealing with loose stools and an anorectum whose physiology and morphology has been altered primarily by food, surgery or, presumably, by medications. […] The concurrent rate of infection is significant; however, as microbiological investigations are frequently incorrectly performed, false negatives occur resulting in treatment failure. […] Dermatological conditions should be treated by an appropriate specialist. The patient should be informed about the chronic nature of the condition, not just to reduce the expectation of immediate cure, but also to improve compliance with advice given.

• #24 Pruritus Ani

  https://coloproctol.org/journal/view.php?doi=10.3393/jksc.2011.27.2.54

  Pruritus ani may have various causes, and it has been divided into two subtypes: idiopathic and secondary. […] The pathophysiology of pruritus ani has not been elucidated yet. It has been hypothesized that when sensory nerves in the perianal area are stimulated, skin irritation and subsequent pruritis is induced; consequently, the skin is excessively scratched, which causes skin injury. […] Fecal contamination due to abnormal transient internal sphincter relaxation has also been reported to result in a subsequent perianal itching problem. Feces contain endopeptidases of bacterial origin, in addition to potential allergens and bacteria. These enzymes are capable of causing both itching and inflammation.

• #25 Pruritus Ani

  https://coloproctol.org/journal/view.php?doi=10.3393/jksc.2011.27.2.54

  Pruritus ani may have various causes, and it has been divided into two subtypes: idiopathic and secondary. […] The pathophysiology of pruritus ani has not been elucidated yet. It has been hypothesized that when sensory nerves in the perianal area are stimulated, skin irritation and subsequent pruritis is induced; consequently, the skin is excessively scratched, which causes skin injury. […] Fecal contamination due to abnormal transient internal sphincter relaxation has also been reported to result in a subsequent perianal itching problem. Feces contain endopeptidases of bacterial origin, in addition to potential allergens and bacteria. These enzymes are capable of causing both itching and inflammation.

• #26

  https://fascrs.org/patients/diseases-and-conditions/a-z/pruritis-ani-expanded-version

  Pruritis ani is classified as primary or secondary. The primary form is the classic syndrome which may not have an identifiable cause (referred to as idiopathic) and the secondary form has an identifiable, and often specifically treatable, cause. […] It is believed that an irritating secretion from the anal canal may cause the itching. The local nerve fibers in the skin may become chronically active with repetitive trauma or scratching for prolonged periods of time. […] While this is a wide variety of potential causes, it is important to understand that in many cases the itching has no identifiable source.

• #27 Approach to the patient with anal pruritus – UpToDate

  https://www.uptodate.com/contents/approach-to-the-patient-with-anal-pruritus

  Itching of the anus or perianal skin is a common disorder usually arising from benign conditions. It may be transient or chronic and difficult to treat. This topic will review the etiology, diagnostic approach, and management of patients with anal pruritus. […] Approximately 75 percent of cases of anal pruritus are secondary to inflammatory, infectious, systemic, neoplastic, and anorectal disorders that contribute to or underlie the development of pruritus. […] Idiopathic anal pruritus likely results from perianal fecal contamination and resultant trauma from wiping and scratching. […] Anorectal diseases associated with anal pruritus include prolapsed internal hemorrhoids, abscesses, fissures, and fistulas. […] Anal pruritus can also result from a variety of inflammatory skin disorders.

• #28 Itchy Bottom (Pruritus Ani): Causes and Treatment

  https://patient.info/skin-conditions/itchy-bottom-pruritus-ani

  Skin conditions cause about half of all cases of secondary pruritus ani. […] In many cases, the cause is not clear. In some people, it may be that something is irritating your skin. This may be an ointment that you are using, or your sweat, or the toilet tissue that you use but you cannot pinpoint the cause exactly. […] A 'vicious circle’ (itch-scratch cycle) sometimes develops. The more you scratch, the more irritated the skin becomes and the more it itches. Various factors can keep this cycle going. […] If a cause for the itchy bottom (pruritus ani) can be identified, it is easier to treat and relieve your symptoms. Most people respond well to treatment for an itchy bottom. However, in some people it can become a persistent (chronic) problem. Also, if you have had an itchy bottom in the past, you are more likely to develop it again at some point in the future.

• #29 Pruritus ani

  https://www.pcds.org.uk/clinical-guidance/pruritus-ani

  Once this assessment has been made the differential can be broadly divided in to four categories (there may be overlap): Hygiene-related, Inflammatory skin conditions, Infection, Lower GI pathology. […] Significant perianal erythema may suggest an inflammatory dermatosis, or infection. Several inflammatory dermatoses such as eczema and psoriasis can cause itch, erythema and sometimes lichenification. If psoriasis is suspected do a thorough skin examination including the scalp and nails. […] Local gastrointestinal pathology such as haemorrhoids and anal skin tags can exacerbate matters – large external haemorrhoids or anal skin tags (some of which arise secondary to old external haemorrhoids) can make post-defecation cleansing difficult, and large internal haemorrhoids can cause mucous drainage or faecal soilage and consequent irritation.

• #30 Pruritus Ani | Abdominal Key

  https://abdominalkey.com/pruritus-ani-3/

  Scratching the affected skin provides inadequate feedback to inhibit itching and prolonged itching can cause damaging excoriations and infections, which provides additional itching stimuli. […] Thus, scratching results in a vicious cycle of itching and scratching that is difficult to break. […] Secondary pruritus ani, which is pruritus induced by an underlying cause, can be divided into the following categories: inflammatory, nonsexual infectious, systemic, premalignant and malignant, and anorectal causes. […] In all of these cases pruritus ani is exacerbated by the scratch-itch cycle, which can lead to infections and further increase the itching frequency. […] Numerous inflammatory diseases can manifest with perianal symptoms and puritus ani including psoriasis, atopic dermatitis, seborrheic dermatitis, lichen planus, and lichen sclerosis.

• #31 Pruritus Ani | Abdominal Key

  https://abdominalkey.com/pruritus-ani-3/

  Psoriasis has been shown in numerous studies to be a prevalent underlying cause of pruritus ani. […] Lichen planus is believed to be caused by an altered cell-mediated immune response to an unidentified source. […] Lichen sclerosis is a chronic disease of unknown cause. […] Uremic pruritus, or itching associated with end-stage renal disease, is a common complaint among patients on dialysis, affecting up to 90% of patients. […] Pruritus from cholestasis is a common condition in patients with liver disease. […] There are numerous premalignant and malignant conditions that can lead to pruritus ani including intraepithelial neoplasia (AIN), or Bowen disease, and Paget disease.

• #32 Pruritus Ani | Abdominal Key

  https://abdominalkey.com/pruritus-ani-3/

  Psoriasis has been shown in numerous studies to be a prevalent underlying cause of pruritus ani. […] Lichen planus is believed to be caused by an altered cell-mediated immune response to an unidentified source. […] Lichen sclerosis is a chronic disease of unknown cause. […] Uremic pruritus, or itching associated with end-stage renal disease, is a common complaint among patients on dialysis, affecting up to 90% of patients. […] Pruritus from cholestasis is a common condition in patients with liver disease. […] There are numerous premalignant and malignant conditions that can lead to pruritus ani including intraepithelial neoplasia (AIN), or Bowen disease, and Paget disease.

• #33 Pruritus Ani | Abdominal Key

  https://abdominalkey.com/pruritus-ani-3/

  Psoriasis has been shown in numerous studies to be a prevalent underlying cause of pruritus ani. […] Lichen planus is believed to be caused by an altered cell-mediated immune response to an unidentified source. […] Lichen sclerosis is a chronic disease of unknown cause. […] Uremic pruritus, or itching associated with end-stage renal disease, is a common complaint among patients on dialysis, affecting up to 90% of patients. […] Pruritus from cholestasis is a common condition in patients with liver disease. […] There are numerous premalignant and malignant conditions that can lead to pruritus ani including intraepithelial neoplasia (AIN), or Bowen disease, and Paget disease.

• #34 Pruritus ani (itchy anus)

  https://dermnetnz.org/topics/itchy-anus

  Itchy anus can be classified as being primary (idiopathic, no obvious cause) or secondary. […] Primary perianal itch is more common than secondary. […] Any common skin disease may involve the anogenital area resulting in secondary anal itching, and this may be the only site of involvement. […] Anal itch is unrelated to haemorrhoids or other anal conditions. […] Pruritus ani is diagnosed on a normal examination of perianal skin apart from possible secondary excoriations and lichenification. […] The cause of secondary itchy anus is usually established on history and examination. […] Investigations may be required to confirm the cause. […] Perianal itch usually improves with attention to the above.

• #35 Pruritus ani

  https://www.pcds.org.uk/clinical-guidance/pruritus-ani

  Once this assessment has been made the differential can be broadly divided in to four categories (there may be overlap): Hygiene-related, Inflammatory skin conditions, Infection, Lower GI pathology. […] Significant perianal erythema may suggest an inflammatory dermatosis, or infection. Several inflammatory dermatoses such as eczema and psoriasis can cause itch, erythema and sometimes lichenification. If psoriasis is suspected do a thorough skin examination including the scalp and nails. […] Local gastrointestinal pathology such as haemorrhoids and anal skin tags can exacerbate matters – large external haemorrhoids or anal skin tags (some of which arise secondary to old external haemorrhoids) can make post-defecation cleansing difficult, and large internal haemorrhoids can cause mucous drainage or faecal soilage and consequent irritation.

• #36 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2647235/

  Any factor which increases occult or overt soiling augments exposure of the peri-anal skin to irritants and is a potential area of therapy. […] Prolonged faecal contact is irritant to peri-anal skin and, as a group, patients with pruritus ani are less able to maintain absolute continence when dealing with loose stools and an anorectum whose physiology and morphology has been altered primarily by food, surgery or, presumably, by medications. […] The concurrent rate of infection is significant; however, as microbiological investigations are frequently incorrectly performed, false negatives occur resulting in treatment failure. […] Dermatological conditions should be treated by an appropriate specialist. The patient should be informed about the chronic nature of the condition, not just to reduce the expectation of immediate cure, but also to improve compliance with advice given.

• #37 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755774/

  Once moisture and subsequent maceration begin, the patient often takes several steps to alleviate symptoms and eliminate the general feeling of being unclean. […] Patients often admit to overzealous cleaning of the area, which includes vigorous scrubbing in the shower and the use of medicated wipes after bowel movements. […] These steps often lead to worsening irritation secondary to local trauma. […] Unfortunately, patients often react to this worsening irritation by increasing the aggressiveness of their local hygiene, and a deleterious positive feedback loop is created. […] Pruritus is a symptom of many sexually transmitted diseases, including herpes and condyloma acuminata. […] Identification and avoidance of inciting factors are important in the treatment of this condition. […] Primary or idiopathic pruritus is invoked when no specific pathologic etiology can be blamed for the patient’s symptoms.

• #38 Anal Itch (Pruritus Ani) – Harvard Health

  https://www.health.harvard.edu/a_to_z/anal-itch-pruritus-ani-a-to-z

  Less often, anal itch is a symptom of some illness or condition that either affects the anal area alone, or involves larger areas of the digestive tract or skin. […] These include hemorrhoids, skin tags, rectal fistulas, rectal fissures, and, rarely, anorectal cancer. […] These include pinworms (especially in children), scabies, pediculosis, condyloma acuminata, and skin infections due to Candida or tinea fungi. […] These include psoriasis, eczema, and seborrhea. […] If the itch is due to a simple skin irritation, the problem usually goes away quickly once you identify the source of irritation and avoid it. […] In most cases, simple treatment measures provide some relief within one week and cure the problem totally within one month. […] If treating anal itch yourself doesn’t relieve the itch after three to four weeks, call your doctor. […] The outlook is excellent, since most people who have itching in the anal area don’t have an illness involving the anus or rectum.

• #39 Anal Pruritus | endoscopy online

  https://www.endoscopyonline.com.au/anal-pruritus/

  Anal itching can be caused by irritating chemicals in the foods consumed, such as those containing spices, hot sauces, and chilli. […] Moisture due to excessive perspiration, frequent liquid stools (diarrhoea), or a degree of faecal incontinence or anal seepage can exacerbate this condition. […] Infection with pinworm is common in those with young children and household pets. […] Yeast or fungal infections may occur if there is moisture around the anus and give a characteristic white film appearance overlying the skin. […] Anal cancer is uncommon, as are precancerous lesions (Bowens and Pagets disease). […] Some colorectal surgeons take a nihilistic approach to the management of pruritus, considering it incurable. […] Treatment needs to be aimed at identifying treating reversible causes, and getting severe intractable cases out of the itch-scratch cycle.

• #40 Anal Itching (Pruritus Ani): Causes, Treatment, Home Remedies

  https://my.clevelandclinic.org/health/diseases/15574-anal-itching-pruritus-ani

  Anal itching (pruritus ani) is a skin (dermatological) condition that causes itching in your anal area. Itching may worsen at night or after pooping. […] Anal itching has many causes. The skin in your perianal area is sensitive. Scented soaps, powders, lotions, creams and ointments can cause an allergic reaction. You may also irritate your skin if you wipe with rough toilet paper or use a rough washcloth or hot water to clean the area. […] Other causes of anal itching include: Hemorrhoids are swollen, enlarged veins that form inside and outside your anus and rectum. […] Anal fissures are tears in the lining of your anus or anal canal (the opening through which poop passes out of your body). Trauma to the area is the leading cause of anal fissures. […] Pinworms (threadworms) are tiny white or light gray worms. Pinworms are parasites, which means they depend on other living things (hosts) to get nutrients so they can grow and multiply.

• #41 Anal Pruritus | endoscopy online

  https://www.endoscopyonline.com.au/anal-pruritus/

  Anal itching can be caused by irritating chemicals in the foods consumed, such as those containing spices, hot sauces, and chilli. […] Moisture due to excessive perspiration, frequent liquid stools (diarrhoea), or a degree of faecal incontinence or anal seepage can exacerbate this condition. […] Infection with pinworm is common in those with young children and household pets. […] Yeast or fungal infections may occur if there is moisture around the anus and give a characteristic white film appearance overlying the skin. […] Anal cancer is uncommon, as are precancerous lesions (Bowens and Pagets disease). […] Some colorectal surgeons take a nihilistic approach to the management of pruritus, considering it incurable. […] Treatment needs to be aimed at identifying treating reversible causes, and getting severe intractable cases out of the itch-scratch cycle.

• #42 Anal Itching: 8 Common Causes & What to Do – Tua Saúde

  https://www.tuasaude.com/en/anal-itching/

  Anal itching usually has a cure and treatment involves using adequate personal hygiene. […] If anal itching it very intense or if it does not resolve following thorough hygiene in the area, it may be due to other conditions, like intestinal worms or hemorrhoids. […] Inadequate hygiene in the anus, especially after a bowel movement, can result in feces remaining in contact with the skin and rectal lining. This can lead to anal itching and irritation, which can increase with the presence of sweat. […] Anal itching, especially in children, is a very common symptom of a pinworm infection. Itching caused by this parasite is usually very intense and occurs mostly at night, when female parasites move toward the external anus to deposit eggs. […] Actively taking an antibiotic or having used one recently can alter bacterial flora in the intestines and anus. It can promote the growth of Candida albicans fungus which can lead to a yeast infection and cause anal itching.

• #43 Approach to the patient with anal pruritus – UpToDate

  https://www.uptodate.com/contents/approach-to-the-patient-with-anal-pruritus

  Itching of the anus or perianal skin is a common disorder usually arising from benign conditions. It may be transient or chronic and difficult to treat. This topic will review the etiology, diagnostic approach, and management of patients with anal pruritus. […] Approximately 75 percent of cases of anal pruritus are secondary to inflammatory, infectious, systemic, neoplastic, and anorectal disorders that contribute to or underlie the development of pruritus. […] Idiopathic anal pruritus likely results from perianal fecal contamination and resultant trauma from wiping and scratching. […] Anorectal diseases associated with anal pruritus include prolapsed internal hemorrhoids, abscesses, fissures, and fistulas. […] Anal pruritus can also result from a variety of inflammatory skin disorders.

• #44 Anal Itching (Pruritus Ani): Causes, Treatment, Home Remedies

  https://my.clevelandclinic.org/health/diseases/15574-anal-itching-pruritus-ani

  Anal itching (pruritus ani) is a skin (dermatological) condition that causes itching in your anal area. Itching may worsen at night or after pooping. […] Anal itching has many causes. The skin in your perianal area is sensitive. Scented soaps, powders, lotions, creams and ointments can cause an allergic reaction. You may also irritate your skin if you wipe with rough toilet paper or use a rough washcloth or hot water to clean the area. […] Other causes of anal itching include: Hemorrhoids are swollen, enlarged veins that form inside and outside your anus and rectum. […] Anal fissures are tears in the lining of your anus or anal canal (the opening through which poop passes out of your body). Trauma to the area is the leading cause of anal fissures. […] Pinworms (threadworms) are tiny white or light gray worms. Pinworms are parasites, which means they depend on other living things (hosts) to get nutrients so they can grow and multiply.

• #45 Anal Itching (Pruritus Ani): Causes, Treatment, Home Remedies

  https://my.clevelandclinic.org/health/diseases/15574-anal-itching-pruritus-ani

  Anal itching (pruritus ani) is a skin (dermatological) condition that causes itching in your anal area. Itching may worsen at night or after pooping. […] Anal itching has many causes. The skin in your perianal area is sensitive. Scented soaps, powders, lotions, creams and ointments can cause an allergic reaction. You may also irritate your skin if you wipe with rough toilet paper or use a rough washcloth or hot water to clean the area. […] Other causes of anal itching include: Hemorrhoids are swollen, enlarged veins that form inside and outside your anus and rectum. […] Anal fissures are tears in the lining of your anus or anal canal (the opening through which poop passes out of your body). Trauma to the area is the leading cause of anal fissures. […] Pinworms (threadworms) are tiny white or light gray worms. Pinworms are parasites, which means they depend on other living things (hosts) to get nutrients so they can grow and multiply.

• #46 Pruritus ani

  https://www.pcds.org.uk/clinical-guidance/pruritus-ani

  Once this assessment has been made the differential can be broadly divided in to four categories (there may be overlap): Hygiene-related, Inflammatory skin conditions, Infection, Lower GI pathology. […] Significant perianal erythema may suggest an inflammatory dermatosis, or infection. Several inflammatory dermatoses such as eczema and psoriasis can cause itch, erythema and sometimes lichenification. If psoriasis is suspected do a thorough skin examination including the scalp and nails. […] Local gastrointestinal pathology such as haemorrhoids and anal skin tags can exacerbate matters – large external haemorrhoids or anal skin tags (some of which arise secondary to old external haemorrhoids) can make post-defecation cleansing difficult, and large internal haemorrhoids can cause mucous drainage or faecal soilage and consequent irritation.

• #47 Pruritus Ani Specialist – Los Angeles, CA & Glendale, CA: Robert G Yavrouian, MD, FACS, FASCRS: Colon and Rectal Surgery

  https://www.lacolorectalsurgery.com/services/pruritus-ani

  Pruritus ani, Latin for itchy anus, occurs when the skin around your anus itches frequently. This condition affects up to 5% of all Americans, with men being about four times more likely to experience it. […] Pruritus ani has more than 100 possible causes, with some of the most common including: […] Up to 52% of people with pruritus ani have colorectal conditions. External hemorrhoids (swollen rectal veins), anal fissures (small tears in the lining of the anus), and anal fistulas (abnormal infected tunnel between the anus and the skin) can all cause severe anal itching. […] Over cleansing, such as too-frequent washing, can destroy the skins natural protective barriers, leading to anal itching. […] Some of the many other cases of pruritus ani include pinworms, yeast infections, and human papillomavirus (HPV). Dr. Yavrouian skillfully evaluates your symptoms and determines the root cause of your pruritus ani so he can prescribe an effective treatment.

• #48 Anal Pruritus | Colorectal Surgeons Sydney

  http://colorectalsurgeonssydney.com.au/conditions/anal-conditions/anal-pruritus

  A fistula brings contaminated and irritating fluids to the anal area. […] This mucous is extremely irritant to the skin and causes intense itching. […] Anal cancer is uncommon, as are precancerous lesions (Bowens and Pagets disease). […] Some colorectal surgeons take a nihilistic approach to the management of pruritus, considering it incurable. […] Treatment needs to be aimed at identifying treating reversible causes, and getting severe intractable cases out of the itch-scratch cycle. […] It must be emphasised that scratching the affected area is to be resisted, no matter how tempting it may be, as it only aggravates the problem and can lead to bleeding from the anal area and a delay in the recovery process. […] Anal pruritus is often exacerbated by watery stools. […] Stronger 1% corticosteroid ointments or creams containing hydrocortisone may be obtained with a prescription, and have been shown to reduce inflammation and relieve itching. […] The mechanism of action is thought to be due to destruction of nerve endings in the peri-anal skin.

• #49 Anal Itching: Causes and Treatments

  https://www.webmd.com/skin-problems-and-treatments/what-to-know-anal-itching

  Other health conditions. Some conditions can cause itching, such as diabetes mellitus, leukemia, lymphoma, thyroid disease, renal disease, liver disorders, Crohns disease, and irritable bowel syndrome. […] Physical conditions. Physical issues involving your anus, such as hemorrhoids or anal fissures, can result in itching.

• #50 Pruritus Ani | Abdominal Key

  https://abdominalkey.com/pruritus-ani-3/

  Psoriasis has been shown in numerous studies to be a prevalent underlying cause of pruritus ani. […] Lichen planus is believed to be caused by an altered cell-mediated immune response to an unidentified source. […] Lichen sclerosis is a chronic disease of unknown cause. […] Uremic pruritus, or itching associated with end-stage renal disease, is a common complaint among patients on dialysis, affecting up to 90% of patients. […] Pruritus from cholestasis is a common condition in patients with liver disease. […] There are numerous premalignant and malignant conditions that can lead to pruritus ani including intraepithelial neoplasia (AIN), or Bowen disease, and Paget disease.

• #51 Pruritus Ani | Abdominal Key

  https://abdominalkey.com/pruritus-ani-3/

  Psoriasis has been shown in numerous studies to be a prevalent underlying cause of pruritus ani. […] Lichen planus is believed to be caused by an altered cell-mediated immune response to an unidentified source. […] Lichen sclerosis is a chronic disease of unknown cause. […] Uremic pruritus, or itching associated with end-stage renal disease, is a common complaint among patients on dialysis, affecting up to 90% of patients. […] Pruritus from cholestasis is a common condition in patients with liver disease. […] There are numerous premalignant and malignant conditions that can lead to pruritus ani including intraepithelial neoplasia (AIN), or Bowen disease, and Paget disease.

• #52 Is It Normal to Have an Itchy Anus? – NYC Gastroenterologist | Manhattan Gastroenterology

  https://www.manhattangastroenterology.com/is-it-normal-to-have-an-itchy-anus/

  Anal itching is a common condition. You may develop the itch inside or around the anus, which is often intense, and feel a strong urge to scratch. Anal itching can be uncomfortable and embarrassing if you do not address it promptly. […] Causes of the itchy anus can be primary, meaning there is no sign of another condition, or they could be secondary, meaning there is an identifiable underlying cause. […] Skin irritation often results from dermatological or hygiene conditions. Some of the factors are: Prolonged contact with feces, poor hygiene, fecal incontinence, and seepage. […] Some conditions that affect the entire body can cause itching in the anus. They include: Anemia, Inflammatory bowel disease (IBD), Jaundice, Leukemia, Liver disease, Autoimmune diseases, Anal or rectal disorders such as piles, fistulas, and anal fissures.

• #53 Pruritus Ani | Abdominal Key

  https://abdominalkey.com/pruritus-ani-3/

  Psoriasis has been shown in numerous studies to be a prevalent underlying cause of pruritus ani. […] Lichen planus is believed to be caused by an altered cell-mediated immune response to an unidentified source. […] Lichen sclerosis is a chronic disease of unknown cause. […] Uremic pruritus, or itching associated with end-stage renal disease, is a common complaint among patients on dialysis, affecting up to 90% of patients. […] Pruritus from cholestasis is a common condition in patients with liver disease. […] There are numerous premalignant and malignant conditions that can lead to pruritus ani including intraepithelial neoplasia (AIN), or Bowen disease, and Paget disease.

• #54

  https://fascrs.org/patients/diseases-and-conditions/a-z/pruritis-ani-expanded-version

  Pruritis ani is classified as primary or secondary. The primary form is the classic syndrome which may not have an identifiable cause (referred to as idiopathic) and the secondary form has an identifiable, and often specifically treatable, cause. […] It is believed that an irritating secretion from the anal canal may cause the itching. The local nerve fibers in the skin may become chronically active with repetitive trauma or scratching for prolonged periods of time. […] While this is a wide variety of potential causes, it is important to understand that in many cases the itching has no identifiable source.

• #55 Anal itching – Pruritus – Coloproctologie

  https://coloproctologie.com/en/pathologies/anal-itching-pruritus/

  Anal itching is characterized by an uncontrolled urge to scratch around the anus and anal rim. […] In about 50% of cases, no clear cause can be found for anal itching (idiopathic anal itching). Most likely, a chronic irritation is caused by contamination with fecal debris, combined with trauma due to excessive hygiene (rubbing) and scratching. […] Scratching the anus leads to scratch lesions that cause skin irritations. These lesions cause an inflammatory reaction which in turn stimulate the nerve endings. The stimulation of the nerve endings maintains the urge to scratch. This creates a vicious cycle where chronic itching is present even though the initial cause of itching has already disappeared. This also explains why the origin of anal itching can only be determined in half the cases.

• #56 Anal Pruritus | endoscopy online

  https://www.endoscopyonline.com.au/anal-pruritus/

  Anal pruritus (also known as pruritus ani) is persistent itching of the skin around the anus. […] It is important not to trivialise the symptoms of this debilitating condition. […] Regardless of cause, the problem is exacerbated by a self-escalating itch-scratch-itch cycle. […] Over time chronic pruritus due to scratching leads to lichenifucation (thickening) of the skin with leathery induration. […] Pruritus ani can be divided into two types: secondary to another condition, and idiopathic, which cannot be attributed to a specific cause. […] Ideopathic pruritus accounts for more than 50% of patients with this condition. […] Skin conditions such as dermatitis, psoriasis and lichen sclerosis have typical plaque appearance and also can irritate the anus and result in anal pruritus.

• #57 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755774/

  A variety of associations have been made with patients complaining of pruritus ani, including loose stools, fecal soilage, increased water intake, exaggerated rectoanal inhibitory reflex, earlier incontinence to saline infusion, certain foods, overzealous hygiene, inadequate hygiene, dyes, perfumes, and various cleansing regimens. […] This extensive and sometimes contradictory list makes it clear that our understanding of pruritus ani is severely lacking. […] Once underlying infectious, neoplastic, and anorectal pathology has been treated or ruled out, therapy must be directed toward proper anal hygiene, avoidance of irritants, and minimizing skin trauma.

• #58 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755774/

  A variety of associations have been made with patients complaining of pruritus ani, including loose stools, fecal soilage, increased water intake, exaggerated rectoanal inhibitory reflex, earlier incontinence to saline infusion, certain foods, overzealous hygiene, inadequate hygiene, dyes, perfumes, and various cleansing regimens. […] This extensive and sometimes contradictory list makes it clear that our understanding of pruritus ani is severely lacking. […] Once underlying infectious, neoplastic, and anorectal pathology has been treated or ruled out, therapy must be directed toward proper anal hygiene, avoidance of irritants, and minimizing skin trauma.

• #59 Anal itching – Pruritus – Coloproctologie

  https://coloproctologie.com/en/pathologies/anal-itching-pruritus/

  Anal itching is characterized by an uncontrolled urge to scratch around the anus and anal rim. […] In about 50% of cases, no clear cause can be found for anal itching (idiopathic anal itching). Most likely, a chronic irritation is caused by contamination with fecal debris, combined with trauma due to excessive hygiene (rubbing) and scratching. […] Scratching the anus leads to scratch lesions that cause skin irritations. These lesions cause an inflammatory reaction which in turn stimulate the nerve endings. The stimulation of the nerve endings maintains the urge to scratch. This creates a vicious cycle where chronic itching is present even though the initial cause of itching has already disappeared. This also explains why the origin of anal itching can only be determined in half the cases.

• #60 Approach to the patient with anal pruritus – UpToDate

  https://www.uptodate.com/contents/approach-to-the-patient-with-anal-pruritus

  Itching of the anus or perianal skin is a common disorder usually arising from benign conditions. It may be transient or chronic and difficult to treat. This topic will review the etiology, diagnostic approach, and management of patients with anal pruritus. […] Approximately 75 percent of cases of anal pruritus are secondary to inflammatory, infectious, systemic, neoplastic, and anorectal disorders that contribute to or underlie the development of pruritus. […] Idiopathic anal pruritus likely results from perianal fecal contamination and resultant trauma from wiping and scratching. […] Anorectal diseases associated with anal pruritus include prolapsed internal hemorrhoids, abscesses, fissures, and fistulas. […] Anal pruritus can also result from a variety of inflammatory skin disorders.

• #61 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755774/

  Once moisture and subsequent maceration begin, the patient often takes several steps to alleviate symptoms and eliminate the general feeling of being unclean. […] Patients often admit to overzealous cleaning of the area, which includes vigorous scrubbing in the shower and the use of medicated wipes after bowel movements. […] These steps often lead to worsening irritation secondary to local trauma. […] Unfortunately, patients often react to this worsening irritation by increasing the aggressiveness of their local hygiene, and a deleterious positive feedback loop is created. […] Pruritus is a symptom of many sexually transmitted diseases, including herpes and condyloma acuminata. […] Identification and avoidance of inciting factors are important in the treatment of this condition. […] Primary or idiopathic pruritus is invoked when no specific pathologic etiology can be blamed for the patient’s symptoms.

• #62 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755774/

  Once moisture and subsequent maceration begin, the patient often takes several steps to alleviate symptoms and eliminate the general feeling of being unclean. […] Patients often admit to overzealous cleaning of the area, which includes vigorous scrubbing in the shower and the use of medicated wipes after bowel movements. […] These steps often lead to worsening irritation secondary to local trauma. […] Unfortunately, patients often react to this worsening irritation by increasing the aggressiveness of their local hygiene, and a deleterious positive feedback loop is created. […] Pruritus is a symptom of many sexually transmitted diseases, including herpes and condyloma acuminata. […] Identification and avoidance of inciting factors are important in the treatment of this condition. […] Primary or idiopathic pruritus is invoked when no specific pathologic etiology can be blamed for the patient’s symptoms.

• #63 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755774/

  Once moisture and subsequent maceration begin, the patient often takes several steps to alleviate symptoms and eliminate the general feeling of being unclean. […] Patients often admit to overzealous cleaning of the area, which includes vigorous scrubbing in the shower and the use of medicated wipes after bowel movements. […] These steps often lead to worsening irritation secondary to local trauma. […] Unfortunately, patients often react to this worsening irritation by increasing the aggressiveness of their local hygiene, and a deleterious positive feedback loop is created. […] Pruritus is a symptom of many sexually transmitted diseases, including herpes and condyloma acuminata. […] Identification and avoidance of inciting factors are important in the treatment of this condition. […] Primary or idiopathic pruritus is invoked when no specific pathologic etiology can be blamed for the patient’s symptoms.

• #64 Pruritus Ani (Anal Itching) – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/pruritus-ani-anal-itching

  Most anal itching is […] Once itching occurs, resulting from any cause, an itch-scratch-itch cycle can begin, in which scratching begets more itching. Often, skin becomes excoriated and secondarily infected, causing yet more itching. Also, topical treatments for itching and infection may be sensitizing, causing further itching. […] In adults with chronic itching and no apparent cause, overly aggressive anal hygiene may be involved. […] Foods and topical agents suspected of causing pruritus ani should be eliminated. […] Practicing appropriate, nonirritating hygiene (ie, not too little but not too vigorous, avoiding strong soaps and chemicals) and decreasing local moisture can help alleviate symptoms.

• #65 Anal Itching: Causes, Prevention and Treatment Tips – Scripps Health

  https://www.scripps.org/news_items/7231-what-are-the-causes-of-anal-itching

  Personal habits, such as what we eat and wear, how we clean ourselves and products we use, can irritate the skin around the anus. Excessive washing, prolonged exposure to moisture from loose stools, perspiration or wearing tight clothes can exacerbate the condition. […] Specific health conditions that can aggravate your anus area include: Type 2 diabetes, leukemia and lymphoma, kidney failure or liver disease, hyperthyroidism, anemia, anxiety and stress.

• #66 Pruritus Ani (Itchy Bottom) – Causes & treatment | Glasgow Colorectal Centre

  https://www.colorectalcentre.co.uk/pruritus-ani-itchy-bottom.html

  Pruritus ani means a chronic (persistent) itchy feeling around the anus. It is commonly know as itchy bottom or itchy bum. The main symptom is an irresistible urge to scratch the anus or bottom. The urge to scratch may occur at any time, but most often happens after a bowel movement or at night (particularly just before falling asleep). The itch may be made worse by heat, wool, moisture, leaking, soiling, stress and anxiety. […] Several factors may be at fault although frequently, no specific cause can be found. Common factors that may lead to pruritus ani include the following […] Cleanliness is occasionally a factor. However, the natural tendency once a person develops the itching is to wash the area vigorously and frequently with soap and a wash cloth. This almost always makes the problem worse by damaging the skin and washing away protective natural oils, leading to a vicious circle.

• #67 Pruritus Ani (Anal Itching) – Gastrointestinal Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/pruritus-ani-anal-itching

  Most anal itching is […] Once itching occurs, resulting from any cause, an itch-scratch-itch cycle can begin, in which scratching begets more itching. Often, skin becomes excoriated and secondarily infected, causing yet more itching. Also, topical treatments for itching and infection may be sensitizing, causing further itching. […] In adults with chronic itching and no apparent cause, overly aggressive anal hygiene may be involved. […] Foods and topical agents suspected of causing pruritus ani should be eliminated. […] Practicing appropriate, nonirritating hygiene (ie, not too little but not too vigorous, avoiding strong soaps and chemicals) and decreasing local moisture can help alleviate symptoms.

• #68 Anal Pruritus | Colorectal Surgeons Sydney

  http://colorectalsurgeonssydney.com.au/conditions/anal-conditions/anal-pruritus

  Anal pruritus (also known as pruritus ani) is persistent itching of the skin around the anus. […] It is important not to trivialise the symptoms of this debilitating condition. […] Regardless of cause, the problem is exacerbated by a self-escalating itch-scratch-itch cycle. […] Over time chronic pruritus due to scratching leads to lichenifucation (thickening) of the skin with leathery induration. […] Pruritus ani can be divided into two types: secondary to another condition, and idiopathic, which cannot be attributed to a specific cause. […] Ideopathic pruritus accounts for more than 50% of patients with this condition. […] Anal itching can be caused by irritating chemicals in the foods consumed, such as those containing spices, hot sauces, and chilli. […] Moisture due to excessive perspiration, frequent liquid stools (diarrhoea), or a degree of faecal incontinence or anal seepage can exacerbate this condition.

• #69 Pruritus Ani | Houston Colon

  https://houstoncolon.com/service/pruritus-ani

  Foods that are acidic and spicy, as well as carbonated or caffeinated beverages, may worsen the condition by irritating the anal area. Alcohol, especially beer and wine, and smoking are also well known to result in irritation. […] Try to follow the above measures as strictly as possible during the period of treatment recommended by the surgeons at Houston Colon (usually 4 to 8 weeks). Eventually, one can usually resume regular activities and eating habits with only slight modifications, depending on the cause of the symptoms. […] Keep the area clean and dry. The best way to clean the area is to gently apply water pressure from a showerhead or in the bath. Use warm water only and avoid any soaps or scrubs. Pat the area dry and apply a soft absorbent directly to the itchy area (such as cotton, a 4 x 4 gauze or cornstarch powder) to keep the area dry. Avoid all medicated, perfumed, and deodorant powders.

• #70 Anal Itching: 8 Common Causes & What to Do – Tua Saúde

  https://www.tuasaude.com/en/anal-itching/

  Some allergies caused by hygiene products, like scented toilet paper, deodorant, talc powder or scented soaps can irritate the skin and cause wounds, which can lead to anal itching. […] Hemorrhoids can also cause anal itching. […] Infections that can cause anal itching include fungal infections, scabies infection, crabs, and sexually-transmitted infections (STIs).

• #71 Aetiology, pathogenesis and management of neuropathic itch: A narrative review with recent updates – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/aetiology-pathogenesis-and-management-of-neuropathic-itch-a-narrative-review-with-recent-updates/

  The pathogenesis is still unclear, but the impingement of nerves when they exit the spinal column or traverse through dorsal back muscles is the possible cause. […] The pathophysiology is poorly elucidated, and therapy is often based on clinical experience and anecdotal reports. […] Chronic itch, including psychogenic itch, pruritus ani or vulvar pruritus, may occur due to central sensitization and loss of descending control. […] Recent researchers have suggested that neural and synaptic plasticity may be responsible for the close association between chronic pain and chronic itch.

• #72 Aetiology, pathogenesis and management of neuropathic itch: A narrative review with recent updates – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/aetiology-pathogenesis-and-management-of-neuropathic-itch-a-narrative-review-with-recent-updates/

  The pathogenesis is still unclear, but the impingement of nerves when they exit the spinal column or traverse through dorsal back muscles is the possible cause. […] The pathophysiology is poorly elucidated, and therapy is often based on clinical experience and anecdotal reports. […] Chronic itch, including psychogenic itch, pruritus ani or vulvar pruritus, may occur due to central sensitization and loss of descending control. […] Recent researchers have suggested that neural and synaptic plasticity may be responsible for the close association between chronic pain and chronic itch.

• #73

  https://link.springer.com/article/10.1007/s40257-024-00898-5

  This sensitization can result in spontaneous firing and heightened response to stimuli, leading to the sensation of itch. Central sensitization, involving changes in the spinal cord and brain, can further amplify itch signals, making them as pronounced as or more pronounced than pain signals. […] BRP is largely believed to result from radiculopathies involving the cervical dorsal root, as in spinal stenosis, or compression of spinal nerves that leads to the localized sensation of pruritus in a dermatomal distribution. […] The primary symptom of itch, rather than pain, in these conditions is unclear. […] The exact pathophysiology underlying NP is not clear, and many theories regarding both peripheral and central mechanisms have been proposed with supporting evidence. […] Damage to nerves in the lower spine is the most common cause of neuropathic anogenital pruritus. […] The primary cause of neuropathic itch in the genital area often stems from compression of the lumbar and sacral spinal cord dorsal rami, involving nerve roots L1L5 and S1S5.

• #74 Anal Itching Treatment in Santa Ana, CA | Albert Chung, MD

  https://crsurgeryoc.com/services/pruritus-ani/

  Pruritus ani is when the skin at the exit of the rectum (anus) becomes irritated, causing an uncomfortable amount of itchiness. […] Aside from diseases relative to the condition, a common view suggests that the initial cause of the itch may have passed and that the illness is in fact prolonged by what is known as an itch-scratch-itch cycle. It states that scratching the itch encourages the release of inflammatory chemicals, which worsen redness, intensifies itchiness, and increases the area covered by dry skin, thereby causing a snowball effect. […] Psychological factors may also contribute to the awareness of itching.

• #75 Anal itching: Causes, treatments, and home remedies

  https://www.medicalnewstoday.com/articles/168728

  Psychological causes can sometimes trigger anal itching. In turn, this symptom can lead to anxiety, stress, and depression. […] Some practical tips can help treat and prevent anal itching. […] The following treatments may be available from pharmacies with or without a prescription. […] Some conditions that affect the whole body can involve anal itching. […] Treating an underlying condition can help stop the itching, and it may prevent further complications.

• #76 Anal Itching – The Waiting Room

  https://thewaitingroom.karger.com/embarrassing-problems/anal-itching/

  Anal conditions (particularly piles) can have itching as one of their symptoms, partly because of the slimy discharge they produce. […] Sensitivities and allergies to other chemicals, such as bubble baths and perfumed soaps, may be responsible. […] Ointments and creams are notorious causes of anal itching. […] Skin conditions, such as psoriasis or eczema, or a condition called lichen sclerosis, can affect the skin around the anus and cause itching. […] Fungal infections, similar to thrush or athletes foot, are another common cause. […] Genital warts (on the vulva or penis), caused by papillomavirus, thrive in warm, moist conditions such as the skin near the anus, and can be very itchy. […] Threadworms (pinworms) are tiny worms, 213 mm long, which live in the lower part of the bowel.

• #77

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/pruritus-itch/

  Patients with tumors and lesions of the central nervous system have been reported to have intractable pruritus. Administration of opioids in epidural anesthesia can also lead to pruritus. […] Itching is associated with dermatologic and systemic causes, and it is important to determine whether there is an associated skin eruption. A characteristic rash usually establishes the diagnosis of a primary dermatologic disorder. […] Severe itching leads to scratching that causes secondary skin changes of excoriation, lichenification, dryness, eczematization, and infection. Excessive bathing and contact allergy to topical therapies can lead to dermatitis. These findings should not be interpreted as the primary skin disorder. […] Select systemic conditions associated with itching are listed in Box 2. Several are potentially serious, and it can be dangerous to label a case of generalized pruritus nonspecific eczema until these conditions are excluded. Pruritus of systemic disease is usually generalized, it may be the only manifesting symptom, and a specific rash is not present. […] Identifying and treating the underlying cause is the most effective therapy for pruritus. Symptomatic treatment should be prescribed while the primary condition is being treated.

• #78 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4755774/

  Pruritus ani is a common condition with many different potential causes. […] The pathophysiology of itching in general is thought to be related to the C-fibers in the skin. […] Histamine, bradykinin, and kallikrein, among other substances, have been implicated in itching. […] Scratching to relieve the itch can cause further excoriation and inflammation, which leads to additional stimuli of the nerve fibers. […] This itchscratchitch cycle is difficult for patients to break, complicating treatment efforts. […] Causes of pruritus ani can be roughly classified into secondary and idiopathic, with 25 to 75% attributed to an identifiable source. […] Secondary causes are subdivided into local irritation, infection, inflammation, systemic diseases, and neoplasms. […] Many of these conditions have a myriad of presentations, one of which might be pruritus.

• #79

  https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/pruritus-itch/

  Itch can be produced by mechanical (gentle touch, pressure, vibration, and wool), thermal and electrical stimuli such as transcutaneous or direct nerve stimulation. The sensation is received by free nerve endings in the skin and transmitted via unmyelinated C fibers and myelinated A fibers to the central spinothalamic tracts. Microneurography studies have demonstrated that itch and pain are transmitted by separate neural pathways. […] Histamine is one of the most important mediators of itch, although other chemical substances have also been implicated. Some, such as neuropeptides, act by releasing histamine from mast cells, and itching caused by them responds to antihistamines. Others act independently; therefore antihistamines are not effective in some forms of pruritus. Opioids have a central pruritic action and also act peripherally by augmenting histamine itch.

• #80 Pruritus Ani

  https://coloproctol.org/journal/view.php?doi=10.3393/jksc.2011.27.2.54

  Pruritus ani may have various causes, and it has been divided into two subtypes: idiopathic and secondary. […] The pathophysiology of pruritus ani has not been elucidated yet. It has been hypothesized that when sensory nerves in the perianal area are stimulated, skin irritation and subsequent pruritis is induced; consequently, the skin is excessively scratched, which causes skin injury. […] Fecal contamination due to abnormal transient internal sphincter relaxation has also been reported to result in a subsequent perianal itching problem. Feces contain endopeptidases of bacterial origin, in addition to potential allergens and bacteria. These enzymes are capable of causing both itching and inflammation.

• #81 Pruritus Ani

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2647235/

  Any factor which increases occult or overt soiling augments exposure of the peri-anal skin to irritants and is a potential area of therapy. […] Prolonged faecal contact is irritant to peri-anal skin and, as a group, patients with pruritus ani are less able to maintain absolute continence when dealing with loose stools and an anorectum whose physiology and morphology has been altered primarily by food, surgery or, presumably, by medications. […] The concurrent rate of infection is significant; however, as microbiological investigations are frequently incorrectly performed, false negatives occur resulting in treatment failure. […] Dermatological conditions should be treated by an appropriate specialist. The patient should be informed about the chronic nature of the condition, not just to reduce the expectation of immediate cure, but also to improve compliance with advice given.

• #82 Anal itching – Pruritus – Coloproctologie

  https://coloproctologie.com/en/pathologies/anal-itching-pruritus/

  Anal itching is characterized by an uncontrolled urge to scratch around the anus and anal rim. […] In about 50% of cases, no clear cause can be found for anal itching (idiopathic anal itching). Most likely, a chronic irritation is caused by contamination with fecal debris, combined with trauma due to excessive hygiene (rubbing) and scratching. […] Scratching the anus leads to scratch lesions that cause skin irritations. These lesions cause an inflammatory reaction which in turn stimulate the nerve endings. The stimulation of the nerve endings maintains the urge to scratch. This creates a vicious cycle where chronic itching is present even though the initial cause of itching has already disappeared. This also explains why the origin of anal itching can only be determined in half the cases.

• #83 Evaluation, management and future perspectives of anal pruritus: a narrative review | European Journal of Medical Research | Full Text

  https://eurjmedres.biomedcentral.com/articles/10.1186/s40001-023-01018-5

  Anal pruritus is defined as a condition characterized by itching around the perianal region. It affects around 15% of the general adult population, and it is four times more common in men than women. Although, not life threatening, when long lasting this condition can greatly impair patients quality of life and even result in psychological issues. It is mainly categorized as either primary (idiopathic) or secondary, being a consequence of causal pathology. The main linking factor of the idiopathic pruritis is thought to be an increased fecal contamination of the anal region. Several studies showed abnormal sphincter relaxation leading to fecal soiling and perianal irritation initiating what is called an itchscratch cycle. […] A thorough history and examination should be performed for the best possible treatment. Treatment consists of a stepwise approach focusing mainly on patient education and the use of topical agents.

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