Differential Diagnosis for Anal Pruritis
- Single Most Likely Diagnosis
- Hemorrhoids: This is often the most common cause of anal pruritis due to the irritation and inflammation of the hemorrhoidal tissue, leading to itching sensations.
- Other Likely Diagnoses
- Anal fissure: A tear in the lining of the anus can cause pain, bleeding, and itching due to the exposure of the underlying mucosa and muscle.
- Fecal incontinence or soiling: Incomplete evacuation of stool or leakage can irritate the anal skin, leading to pruritis.
- Dermatological conditions (e.g., psoriasis, eczema, lichen sclerosis): These conditions can affect the anal region, causing itching and discomfort.
- Infections (e.g., candidiasis, bacterial infections): Fungal or bacterial infections in the anal area can cause pruritis, redness, and discharge.
- Do Not Miss Diagnoses
- Anal cancer: Although rare, anal cancer can present with persistent pruritis, pain, or bleeding, making it crucial not to miss this diagnosis.
- Inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis): These conditions can cause anal symptoms, including pruritis, and have significant implications for patient management and prognosis.
- STDs (e.g., herpes, syphilis): Certain sexually transmitted diseases can cause anal pruritis, and missing these diagnoses can lead to further complications and transmission to others.
- Rare Diagnoses
- Lichen planus: A rare inflammatory condition that can affect the mucous membranes, including the anal region, causing pruritis and discomfort.
- Leukoplakia: A condition characterized by white patches on the mucous membranes, which can occur in the anal region and cause pruritis.
- Extramammary Paget's disease: A rare skin condition that can affect the anal region, causing pruritis, redness, and discharge.