The anal pruritus is a reason for frequent consultation in the Coloproctology Unit

Its most acute symptom is the intense itching in the anus and perianal zone that becomes of such intensity that affects the daily activity of the patient, creating a very high dependence on washing and use of creams that often complicate the problem more than solve it.

The causes are multiple so a thorough exploration and a good medical history are essential for their correct diagnosis. We will list the most frequent:

The excess of washing helps to alter the pH of the perianal skin with the consequent colonization by fungi that originate an intense itching that leads to wash the area more creating a vicious circle with a false relief of the symptoms.

Patients with evolved hemorrhoids who are usually externalized, have mucous flow from the rectum and that permeate perianal skin with the consequent humid anus which causes intense itching throughout the area.

Likewise, patients suffering from anal incontinence, suffer an incomplete closure of the anus and therefore the escape of fecal matter as well as rectal mucus and generate an intense pruritus also by humid anus.

Dermatological diseases should be taken into account at the time of diagnosis since atopic dermatitis, psoriasis, plane lichen, etc. can affect perianal skin causing an intense itching.

The presence of stool parasites (worms) that are objectified in the initial exploration must also be ruled out.

As can be deduced, the multitude of causes of pruritus anal makes its treatment sometimes, complex and in a few cases, the improvement is not possible with the consequent frustration of patient and medical.

Next, we will give basic tips to handle it:

• Washing with hot water, only after deposition with soft (childish) sponge and neutral pH soap.
• Always dry with hair dryer, avoiding the use of paper or wet wipes.
• Use three times a day, nutracel -type protective creams, see Lipogel, Halibut, etc. that lack corticosteroids in their composition and exert a barrier effect on the skin.

Of course, if the patient has evolved hemorrhoids, surgical treatment is the recommended previous step for the improvement of the humid anus.

Likewise, if the condition is of dermatological origin, the exploration by its specialist is essential for its management.

Even so, some patients are refractory to all the treatments prescribed by what they enter into the incoercible pruritus group.

In these cases, the use of ointments with tacrolimus or pimecrolimus seems to be the definitive attempt for its resolution, together with a multidisciplinary evaluation by specialists in surgery, dermatology, internal medicine and eventually psychiatry since the use of anxiolytics is contemplated to reduce the State of anxiety that such pathology causes.