From the Guidelines
The most effective approach to treating anal itch (pruritus ani) involves a combination of good hygiene practices, symptomatic relief measures, and addressing underlying causes, with the consideration that pinworm infection, such as Enterobius vermicularis, may require specific antiparasitic treatment like albendazole 400 mg or mebendazole 100 mg as a single dose 1. When managing anal pruritus, it's crucial to keep the anal area clean and dry, washing gently with mild soap and water after bowel movements, and then drying thoroughly. Avoiding scratching is essential to prevent worsening the condition. For immediate relief, applying over-the-counter hydrocortisone cream (0.5-1%) sparingly to the affected area, up to twice daily for no more than 1-2 weeks, can be beneficial. Other soothing options include:
- Witch hazel pads
- Zinc oxide cream
- Sitz baths with warm water for 10-15 minutes Additionally, wearing loose-fitting, cotton underwear and avoiding irritating foods such as spicy foods, caffeine, alcohol, and citrus can help alleviate symptoms. If symptoms persist beyond two weeks, worsen, or are accompanied by bleeding or discharge, a medical evaluation is necessary to determine if prescription treatments are required, which might include stronger corticosteroids, antihistamines like diphenhydramine 25-50mg at bedtime for nighttime itching, or specific treatments for identified causes such as fungal infections with clotrimazole or miconazole cream. In cases where pinworm infection is suspected due to intense pruritis ani, sometimes accompanied by weight loss, irritability, diarrhea, abdominal pain, and occasionally colitis with eosinophilia 1, diagnosis can be made using the ‘sellotape test’, and treatment with albendazole or mebendazole as mentioned can be effective. Given the potential for a variety of underlying causes, a thorough medical evaluation is critical for persistent anal pruritus to ensure appropriate treatment and prevent unnecessary complications.
From the FDA Drug Label
Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: ... temporarily relieves external anal and genital itching Directions for itching of skin irritation, inflammation, and rashes: ... for external anal and genital itching, adults: ... apply to affected area not more than 3 to 4 times daily
The recommended treatment for anal pruritus (itching) is the application of hydrocortisone (TOP) to the affected area, with the following guidelines:
- Adults: Apply not more than 3 to 4 times daily.
- Children under 12 years of age: Ask a doctor. It is also recommended to clean the affected area with mild soap and warm water and rinse thoroughly before applying the treatment 2 2.
From the Research
Treatment Options for Anal Pruritus
The treatment for anal pruritus, also known as anal itch, can vary depending on the underlying cause. Some studies suggest the following treatment options:
- Topical steroids, such as 1% hydrocortisone ointment, which has been shown to be effective in reducing itch and improving quality of life 3
- Topical lidocaine ointment, which has been found to provide rapid and effective relief of pruritus ani 4
- Capsaicin (0.006%) and tacrolimus (0.1%) ointments, which may be used if symptoms do not resolve with topical steroids 5
- Intradermal methylene blue injection, which may provide long-lasting symptom relief for intractable cases 5
Lifestyle Changes
In addition to medical treatments, some lifestyle changes may help alleviate anal pruritus, including:
- Avoiding moisture and the use of soaps in the perianal region 5
- Avoiding certain foods that may irritate the perianal area 5
- Increasing the intake of fiber to help prevent constipation and reduce irritation 5
Diagnosis and Management
A thorough history and physical examination are essential in diagnosing and managing anal pruritus, including a digital rectal examination and an anoscopy 5, 6. A broad differential diagnosis must be considered, and a reassessment of the diagnosis is required if symptoms or findings are not responsive to therapy 7.