What is the initial treatment for pruritus ani in children?

Initial Treatment for Pruritus Ani in Children

For pruritus ani in children, the initial treatment should include proper hygiene, topical hydrocortisone cream, and screening for pinworm infection which is the most common cause in the pediatric population. 1, 2, 3

Etiology Assessment

First, determine the likely cause of pruritus ani:

1. Primary causes:

   • Pinworm infection (Enterobius vermicularis) - most common cause in children 3
   • Poor hygiene or excessive cleaning
   • Fecal soiling
   • Dietary irritants

2. Secondary causes:

   • Skin disorders (eczema, psoriasis)
   • Anorectal conditions
   • Fungal infections
   • Systemic diseases (rare in children)

Treatment Algorithm

Step 1: Rule Out Pinworm Infection

• Perform "sellotape test" by placing adhesive tape on perianal skin in the morning before bathing and examine for ova under microscope 4
• If positive for pinworms, treat with:
  • Albendazole 400 mg as a single dose 4, 1 OR
  • Mebendazole 100 mg as a single dose 4
  • Repeat treatment after 2 weeks to prevent reinfection

Step 2: General Measures (for all cases)

• Proper hygiene:

  • Gentle cleaning with mild soap and warm water
  • Thorough but gentle drying by patting (not rubbing)
  • Avoid excessive washing which can worsen symptoms 1

• Eliminate irritants:

  • Avoid harsh soaps, scented wipes, or bubble baths
  • Use soft, white, unscented toilet paper
  • Avoid scratching (cotton gloves at night may help)

Step 3: Topical Treatment

• Apply hydrocortisone cream 1% to affected area up to 3-4 times daily for children 2 years and older 5

  • Limit use to 7-10 days to prevent skin atrophy
  • For children under 2 years, consult a physician before using 5

• Emollients such as sorbolene or petroleum jelly can provide barrier protection 1, 2

Special Considerations

• For persistent symptoms despite treatment, consider:

  • Referral to pediatric gastroenterologist or dermatologist
  • Evaluation for other skin conditions like atopic dermatitis
  • Assessment for fecal soiling or constipation

• Dietary modifications may help in some cases:

  • Consider eliminating potential trigger foods (citrus, tomatoes, spicy foods, chocolate)
  • Ensure adequate fiber and fluid intake to prevent constipation

Common Pitfalls to Avoid

1. Failure to diagnose and treat pinworm infection - the most common cause of pruritus ani in children 3

2. Overuse of topical corticosteroids - can lead to skin atrophy and other adverse effects 1

3. Excessive cleaning - can damage skin barrier and worsen symptoms 1, 2

4. Ignoring fecal soiling - incomplete evacuation can contribute to persistent symptoms 6

5. Missing underlying skin conditions - eczema or psoriasis may require specific treatment 2

By following this approach, most cases of pruritus ani in children can be effectively managed, improving quality of life and preventing chronic symptoms.