From the Guidelines
Excessive anorectal itching (pruritus) is commonly treated with proper hygiene, dietary modifications, and targeted medications, with the primary goal of reducing morbidity, mortality, and improving quality of life. The causes of anorectal pruritus can be multifactorial, including poor hygiene, moisture retention, skin conditions (psoriasis, eczema), infections (fungal, bacterial, parasitic), hemorrhoids, anal fissures, or certain medications 1.
Treatment Options
To manage anorectal pruritus, it is essential to keep the area clean and dry by gently washing with mild, fragrance-free soap and water after bowel movements, then patting dry thoroughly. Avoid using harsh soaps, scented toilet paper, or wet wipes containing alcohol or fragrances. Dietary changes include reducing spicy foods, caffeine, alcohol, citrus fruits, tomatoes, and chocolate, which can irritate the area. For immediate relief, over-the-counter options include:
- Hydrocortisone cream (1%) applied sparingly twice daily for up to 1-2 weeks
- Zinc oxide cream as a barrier
- Witch hazel pads to soothe irritation
If symptoms persist, prescription treatments may include stronger corticosteroids, antihistamines like hydroxyzine (25-50mg) for nighttime itching, or antifungal creams like clotrimazole if a fungal infection is present 1.
Additional Recommendations
- Wear loose cotton underwear
- Avoid scratching
- Consider using plain petroleum jelly as a protective barrier
- Anorectal pruritus can result from various causes, and if symptoms persist beyond 2 weeks despite self-care, seek medical attention as persistent itching may indicate an underlying condition requiring specific treatment. Although the provided evidence primarily focuses on anorectal abscesses 1, the principles of maintaining hygiene, considering dietary adjustments, and the use of topical treatments can be applied to managing anorectal pruritus, prioritizing the reduction of morbidity, mortality, and improvement of quality of life.
From the FDA Drug Label
Uses temporarily relieves itching associated with minor skin irritations, inflammation, and rashes due to: eczema psoriasis poison ivy, oak, sumac insect bites detergents jewelry cosmetics soaps seborrheic dermatitis temporarily relieves external anal and genital itching Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily children under 2 years of age: ask a doctor for external anal and genital itching, adults: when practical, clean the affected area with mild soap and warm water and rinse thoroughly gently dry by patting or blotting with toilet tissue or a soft cloth before applying apply to affected area not more than 3 to 4 times daily children under 12 years of age: ask a doctor
The causes of excessive anal (anorectal) itching (pruritus) are not explicitly stated in the provided drug labels. The treatment options for excessive anal (anorectal) itching (pruritus) include applying hydrocortisone to the affected area, not more than 3 to 4 times daily, after cleaning the area with mild soap and warm water 2 2.
- For adults, apply hydrocortisone to the affected area as directed.
- For children under 12 years of age, consult a doctor before applying hydrocortisone.
- For children under 2 years of age, consult a doctor before applying hydrocortisone for skin irritation, inflammation, and rashes.
From the Research
Causes of Excessive Anal Itching (Pruritus)
- Anal pruritus can be associated with idiopathic and secondary causes, such as anorectal diseases, cancer (anal or colorectal), dermatological and sexually transmitted diseases, fungal infections, and systemic diseases 3
- Pruritus ani can be caused by anorectal pathology, and other factors such as excessive cleaning, application of local irritants, and skin disorders 4, 5
- In children, perianal itch may be caused by intestinal hermetic infection such as pinworm 5
Treatment Options for Excessive Anal Itching (Pruritus)
- The treatment normally consists of a triple approach: proper hygiene, elimination of irritants, and skin care and protection 3
- Topical therapies have been described as possible treatments, including steroids, capsaicin, tacrolimus, and methylene blue intradermal injections 3, 6
- Avoiding trauma from excess washing, toilet paper, and topical agents is important, and treatments likely to be effective are emollients such as sorbolene, a short course of topical hydrocortisone cream, and capsaicin cream 6, 5
- For intractable cases, intradermal methylene blue injection might give a long-lasting symptom relief 6
- A digital rectal examination and an anoscopy are essential for proper diagnosis and treatment 3, 6