Pruritus ani is the medical term for itching around the anus. It is a symptom, not a diagnosis, and can be due to a wide variety of causes — local, systemic, dermatological, or idiopathic. The chronic "itch–scratch cycle" often perpetuates symptoms even when the initial trigger has resolved.

📍 Local Causes

🚻 Poor perianal hygiene (or conversely, overzealous cleaning causing irritation).
💦 Excessive sweating and moisture retention (common in warm weather or obesity).
🔧 Anal fistula with persistent discharge.
🔴 Haemorrhoids causing mucous seepage.
🧬 Anal or perianal neoplasia (rare but important to exclude).
🦠 Viral warts (HPV-related).
🍄 Fungal infections such as Candida albicans.
🧴 Contact dermatitis (to soaps, deodorants, wipes).
🪱 Worm infestations (especially Enterobius vermicularis in children).
💊 Antibiotics → diarrhoea or candida overgrowth.

💡 Clinical Pearls: - Always exclude sinister causes (anal carcinoma, HIV-related lesions) in persistent or refractory pruritus ani. - Nocturnal itch in children → think of Enterobius (threadworms). - Many cases remain idiopathic, and managing the itch–scratch cycle with behaviour modification is key. - In resistant cases, dermatology or colorectal referral may be needed.

🌍 General/Systemic Causes

🍬 Diabetes mellitus (secondary infections, candidiasis).
💛 Obstructive jaundice (bile salt deposition in skin).
🧪 Hodgkin’s lymphoma (generalised pruritus).

🩺 Dermatological Causes

🕷️ Scabies.
🪳 Pediculosis (pubic lice).
🧴 Psoriasis (may involve perianal area).
🌿 Atopic eczema or lichen sclerosus.

🔍 Symptoms and Signs

🌙 Nocturnal worsening of itch (classic, esp. in worm infestation).
📝 History of triggers — antibiotics, diabetes, jaundice, skin disease.
👀 Perianal skin: may be normal, erythematous, moist, excoriated, or thickened.
🤲 PR exam and proctoscopy essential to rule out haemorrhoids, fissures, or fistulae.

🧪 Investigations

📊 FBC (Hb) — chronic blood loss/anaemia.
🧪 Urine dip and blood sugar — screen for diabetes.
🔬 Perianal scrapings for fungal microscopy.
🪱 Cellophane tape test in children (for pinworm ova).
📸 Consider biopsy if suspicious lesion.

💊 Treatment

Management is twofold: treat the underlying cause and provide symptomatic relief.

🧼 Maintain meticulous but gentle hygiene — avoid excessive scrubbing.
🥗 High-fibre diet & adequate hydration — prevent constipation and straining.
🩲 Loose, breathable cotton underwear — avoid sweating and chafing.
🚿 Wash with plain water or mild soap after defecation; pat dry (not rub).
🌿 Apply soothing agents (glycerine, witch hazel, zinc oxide barrier cream).
💊 Topical 1% hydrocortisone or mild steroid + local anaesthetic for short-term relief.
🪱 Anthelmintics (e.g., mebendazole) if pinworms suspected.
🍄 Topical antifungal if candida infection confirmed.

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Pruritis ani