Dermatology/anal irritation.


Hi. So I've been having this problem for over 4 years I'm 24 years old now. So I've gone to many doctors thinking I had a hemorrhoid, but ever doctor I went to including rectal doctors said everything looks fine and I had that whole check up where the check my everything up to my big intestine and I get the same answer every time. Everything looks normal for your age. The last doctor told I might want to see a dermatologist because it might be a skin issue. My symptoms include slight pain when sitting for any amount of time and blood on my stool or toilet paper when I wipe. Some times the amount is small and sometimes it's a large amount. My question is have you ever heard of an condition that could be causing my problem that's related to the skin. I'm pretty hairy and I do sweat a good amount could that be irritating the skin and causing my problem???

Pruritus ani is severe itching of the skin around the external genitals or anus or slight pain. The itching seems to be particularly noticeable at night while the person is trying to sleep.

Pruritus ani can be caused by many things including pinworms (parasites), bacterial infections, diet, reactions to oral antibiotics, and underlying (systemic) disease conditions of the body such as diabetes mellitus.

Skin conditions in the anal area that may contribute to pruritus ani include fungus, a condition causing an intensely itchy patch of bumps (lichen simplex chronicus), or inflammation between folds of skin caused by warmth mixed with moisture (intertrigo).

It may also be caused by irritating substances coming in contact with the skin (contact dermatitis) such as diarrhea, colon or vaginal secretions, or detergents that remain in underclothing.

Trauma or injury to the anal area, a defective anal muscle (incompetent anal sphincter), an abnormal opening (fistula), and hemorrhoids are often associated with pruritus ani.

Other contributing factors may be either poor hygiene or too vigorous cleaning of the area.
History: There may be no other symptoms than severe itching of the anal area.

Physical exam may reveal any of the following: red, irritated skin, bumps, an unusual thickening or softening of the skin, and scratches or breaks in the skin from scratching. Hemorrhoids, fistula, or evidence of an incompetent anal sphincter may also be present. Females should also undergo a gynecological exam to rule out any underlying disease process, such as vaginitis.

Tests should be done to determine whether pruritus ani is the result of a systemic disease or from local causes. Tests may include blood glucose levels, blood nitrogen levels, ERS, hemochrome, liver (hepatic) functions, analysis of feces, and a skin biopsy. An examination of the inside of the rectum and lower colon is done using a viewing tube inserted through the anus (proctocolonoscopy).

Because there are so many possible causes of pruritus ani, it is very important that it is diagnosed and treated accurately.
To be effective, treatment must match the cause. Parasites or bacterial infections can be treated with medication. Underlying disease processes (such as diabetes mellitus) need treatment. Injuries, fistulas, and hemorrhoids need to be medically addressed. Allergic reactions can be avoided by changing soaps or detergents, or by additional rinsing of clothes after washing to remove soap residue.

Diet changes include avoiding spices, coffee, tea, cola, beer, chocolate, tomatoes, and citrus fruits. Poor hygiene needs to be corrected. On the other hand, too vigorous cleansing needs to be modified by stopping the use of over-the-counter preparations, cleaning pads, and solutions. Use of a blow dryer on the perineum may be used. Water, alone, may be adequate hygiene for over-sensitive skin.

For cases where the cause is never determined (idiopathic), injection of a medication under the skin of the affected area may be curative.

Individual should be reexamined again in two to three weeks to evaluate effectiveness of treatment.
Brand   Generic   Label   Rating
Paroxetine online   Paxil   Paroxetine   Off-Label   
Generic Amitriptyline online   Elavil   Amitriptyline   Off-Label   
Zofran (Ondansetron), Periactin (Cyproheptadine), Phenergan (Promethazine), Clarinex (Desloratadine), Atarax (Hydroxyzine), Revia (Naltrexone)
Severe excoriation, ulceration and secondary infection of the perineum are complications. The presence of hemorrhoids, an anal fistula, incompetent anal sphincter, or an underlying disease process might complicate pruritus ani.
If the cause can be determined and effectively treated, pruritus ani can be eliminated. Symptoms can be lessened or eliminated in idiopathic cases through use of injected medication.
Hemorrhoids, fistula, fissures, tumors of the anorectum, infections, contact dermatitis, psoriasis, Bowen's disease or Paget's disease are other possibilities.


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Michael S. Fisher, <B>Ph.D., M.D.</B>


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