Differential Diagnose

of Pruritus Ani
Diana Pramono

Pruritus Ani
persistent itch around the anus
is a symptom, not a final diagnosis

What Causes Pruritus

Ani ??

Anal

Disease
Skin Condition/Disease
Threadworm Infection
Sistemic Disease
Foods
Medicine
Idiopathic

Anal Disease
Haemorrhoids
Constipation
Skin tags
Tumour
Anal fissure

Skin Condition/ Disease

Skin Condition:

Sweating The skin around the back passage is

often moist with sweat. If long periods pass
without ventilation to the area, for instance if you
sit down for a long timeskin irritation itch
Adults with a lot of hair round itch
Excess cleaning of the anal area

Skin Disease:
may affect the skin around the anus itch
Eczema, psoriasis, lichen sclerosus
&seborrhoeicdermatitis
Allergic or Irritan contact dermatitis
toilet paper, moist wipes, soaps, perfumes,
antiseptics
Fungal Infection
Scabies
Bacterial infection
STI: herpes infection,anal warts, others

Threadworms Infection
common cause in children (> 4 in 10 children in
UK)
itching around the back passage, usually worse at
night
live in the gut and lay eggs around the anus
which cause itch
children may pass them on to adults in the same
home Consider this cause if there is more than
one person in the home with an itchy bottom

Sistemic Disease
Some diseasescan cause generalised itch,
which may seem more intense around the
anus at times : lymphoma, liver diseases,
iron deficiency anaemia, thyroid gland
problems
Other symptoms (+)

Foods
Some foodsare not fully digested and may
sensitise the skin around the anus after you
have gone to the toilet to pass faeces
These include: citrus fruits, grapes,
tomatoes, spices, and drinking large
amounts of beer, milk, tea, or coffee

Medicine
Local anaesthetics or preservatives in creams
used for piles
Some antibiotics can lead todiarrhoea irritate
the anal skin itch
Steroid medication or other medicines that can
weaken immune system increased risk of
developing skin infections may affect the skin
around the anus

Idiopathic
The cause is not clear
Depression ??

vicious circle
Anal Itch

Skin
Irritation

Cleans
with Soap

vicious circle
haemorrhoid
haemorrhoid
(pile)
(pile)

Cream/
ointment
for
treatment

Anal Itch

Allergy
Contact
Dermatitis

Treatment ??

If there is no obvious cause ?

(idiopathic pruritus ani)

Avoid any potential irritants:

Stop using scented soaps, talcum powder, bubble
bath, perfume, etc
Try avoiding for a while the foods and drinks listed
above (such as fruits and tomatoes)

Pay special attention to hygiene:

Wash with wather only after passing faeces. If using
soap, use bland non-scented soap rinse well
Have a bath or shower daily
Change underwear daily

Avoid excessive moisture

Keep it dry
Do not put on underwear until is fully dry

Wear loose cotton underwear (not nylon)

Avoid wearing tight-fitting trousers

Medication
Steroid cream
Capsaicin cream
Antihistamin

Thank You