Pruritus ani: More than a decade of personal experience in Lebanon

ABSTRACT

Pruritus ani is a common medical condition that is difficult to treat in the absence of obvious predisposing factors. Hereby, we report more than a ten-year experience in the management of pruritus ani stressing the importance of early detection, identification of the etiology, and management. A total of 124 patients were managed in the surgical clinic. The follow-up was between 11 to 17 months. All patients had the symptoms for a period of time ranging between 6 and 40 months. Patients were treated according to their respective etiology. Medical cases like con- tact dermatitis and psoriasis were treated by applying proper topical ointments, while other cases like anal fissure and fistula were treated surgically. Idiopathic patients were treated by tattooing [injection to perianal skin with methylene blue]. The majority of patients with known medical etiology responded favorably to conservative treatment [= 92%]. In addition, surgical management for anorectal disorders like hemorrhoids and fistula showed a consistent improvement [94%]. However, patients who had their symptoms neglected for longtime or had used over the counter medication without a proper medical follow-up, experienced a lower success rate of cure [76%]. Patients who were diagnosed and treated at first hand, showed better results than those who sought late medical advice and management [i.e. > 18 months]. In light of the above, a multidisciplinary team approach consisting of a proctologist, a gastroenterologist and a dermatologist is recommended