Itching of the perianal skin, or pruritus ani, is more common in males and has an extensive etiology (Table III) ⁽²⁵⁾.  Leakage of stool onto the perianal skin is a common factor.  Treatment is oriented toward the underlying etiology.  Generally any medications such as antibiotics and laxatives should be discontinued, and diet should be adjusted as necessary.  A bulk-forming agent can be administered to allow for complete and predictable bowel evacuation, followed by bathing appropriately with warm water and little soap (to reduce chemical irritation).

Moistened rectal wipes are a reasonable alternative, but wipes containing chemicals such as perfumes, alcohol, or witch hazel should be avoided to reduce any effect of chemical contact dermatitis.  Gentle drying should be followed by the application of a lubricating lotion; nonmedicated talcum powder can be applied on the skin with a small piece of cotton to absorb moisture, and a hydrocortisone cream can be applied to help break the cycle of scratching and itching.  Good anal hygiene should be stressed.

Deepak V. Gopal, MD, FRCP (C)

Assistant Professor of Medicine
Division of Gastroenterology
Oregon Health & Science University
Portland VA Medical Center
Portland, Oregon

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