Mechanism of pruritus ani lotion combined with Huajiao-Gancao-Bingpian oil for pruritus ani treatment based on network pharmacology and molecular dynamics.

Introduction: Pruritus ani lotion combined with a Chinese medicine formula named Huajiao (Pericarpium Zanthoxyli Bungeani)-Gancao (Radix Glycyrrhizae)-Bingpian (Borneol) is effective in treating pruritus ani. Aim: To investigate the mechanism of traditional Chinese medicine (TCM) in pruritus ani via network pharmacology and molecular dynamics (MD). Material and methods: The Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP) was utilised to screen active ingredients and their corresponding targets. Genes associated with pruritus ani were collected through GeneCards. Protein-protein interaction (PPI) network between target genes of the active ingredients of this formula and genes associated with pruritus ani was established through the STRING database. A drug-active ingredient-gene interaction network was constructed using Cytoscape with the top 50 genes in affinity coefficients. Molecular docking and MD simulation analysis were performed. Results: Epidermal growth factor receptor (EGFR) and Signal Transducer and Activator of Transcription 3 (STAT3) were core genes. Direct targeting of EGFR by the active ingredients (quercetin and luteolin) and direct targeting of STAT3 by the active ingredient (licochalcone A) may be key molecular mechanisms for the treatment of pruritus ani. Simulated trajectories of structural nuclear motion by MD also revealed that the binding of two pairs of molecules was relatively stable. Conclusions: This study unravels potential targets, active ingredients, and mechanisms of pruritus ani lotion combined with Huajiao-Gancao-Bingpian oil in the treatment of pruritus ani, providing a reference for future treatment.

Efficacy and safety of methylene blue injection for intractable idiopathic pruritus ani: a single-arm metaanalysis and systematic review.

PURPOSE: To evaluate how effective methylene blue injection was at treating intractable idiopathic pruritus ani. METHODS: A comprehensive literature search of the PubMed, Embase, Cochrane library, and Web of Science databases was conducted. All clinical studies (prospective and retrospective) that evaluated the efficacy of methylene blue in treating intractable idiopathic pruritus ani were included. Studies that reported the resolution rate, after a single injection and after a second injection, the recurrence rate, symptom scores, and transient complications of methylene blue injections in treating intractable idiopathic pruritus ani were included. RESULTS: The seven selected studies included 225 patients with idiopathic pruritus ani. The resolution rates after a single injection and after a second injection was 0.761 (0.649-0.873, P < 0.01, I2 = 69.06%) and 0.854 (0.752-0.955, P < 0.01, I2 = 77.391%), respectively, the remission rates at 1, 3, and 5 years were 0.753 (0.612-0.893, P < 0.001), 0.773 (0.675-0.871, P < 0.001) and 0.240 (0.033-0.447, P < 0.001), respectively, the effect value of the merger was 0.569 (0.367-0.772, P < 0.001, I2 = 79.199%), and the recurrence rates at 1, 2, 3, and < 1 year were 0.202 (0.083-0.322, P < 0.001), 0.533 (0.285-0.781, P < 0.001), 0.437 (-0.044, 0.917, P < 0.001) and 0.067 (0.023-0.111, P < 0.001), respectively. The effect value of the merger was 0.223 (0.126-0.319, P < 0.001, I2 = 75.840). CONCLUSION: Using methylene blue injections to treat intractable idiopathic pruritus ani is relatively efficacious, resulting in a relatively low recurrence rate and no severe complications. However, the available literature was of poor quality. Therefore, higher quality studies are necessary to confirm that methylene blue injection is efficacious for pruritus ani, such as a randomized prospective multicenter studies.

Manejo Clínico ­ Quirúrgico de pacientes con Fisura Anal en la Unidad de Coloproctología del HECAM / Clinical-Surgical Management of patients with Anal Fissure in the Unit HECAM Coloproctology

La fisura anal es una de las enfermedades más antiguamente descritas, la misma que, ha tenido hasta el momento múltiples tratamientos tanto médicos como quirúrgicos, existiendo controversias en su algoritmo terapéutico. Constituye una de las patologías cuyo diagnóstico y tratamiento corresponde a la Especialidad de Coloproctología, afecta a ambos sexos y a cualquier edad y puede ser aguda o crónica. Proponemos el presente Protocolo para un adecuado manejo de la patología, de manera que sirva de guía en la toma correcta de decisiones basadas en la evidencia y el consenso de quienes integramos la Unidad Técnica de Coloproctología del Hospital de Especialidades Carlos Andrade Marín.

Anal fissure is one of the oldest described diseases, which has so far had multiple medical and surgical treatments, with controversies in its therapeutic algorithm. It is one of the pathologies whose diagnosis and treatment corresponds to the Coloproctology Specialty, it affects both sexes and any age and can be acute or chronic. We propose the present Protocol for an adequate management of the pathology, so that it serves as a guide in the correct decision making based on evidence and consensus of those who integrate the Technical Unit of Coloproctology of the Hospital de Especialidades Carlos Andrade Marín.

Evaluation, management and future perspectives of anal pruritus: a narrative review.

PURPOSE: The without a time limitation. Most recent search was performed on 1st June 2022. RESULTS: Thorough history and physical examination are very important in view of multiple possible causes of anal pruritus. Most of the focus during examination is drawn on to the perianal region. A digital rectal examination and an anoscopy are essential. It is necessary aim of this narrative review is to overview the classification, diagnostics, possible treatment options and future perspective of anal pruritus. METHODS: The search was performed by two authors (AD and MJ) independently in the following electronic databases: PubMed, EMBASE, Web of Science, Cochrane Library, CENTRAL and the Allied and Complementary Medicine Databases (AMED). Search was restricted to English language only to avoid moisture and the use of soaps in the perianal region. Furthermore, the patient should avoid certain foods and increase the intake of fiber. If the symptoms do not resolve, topical steroids, capsaicin (0.006%) and tacrolimus (0.1%) ointments may be used. For intractable cases, intradermal methylene blue injection might give a long-lasting symptom relief. CONCLUSION: Anal pruritus is a long-term deteriorating quality of life issue. Most of the time it is a symptom with a difficult diagnosis. Thorough history and examination should be performed for the best possible treatment.

SOOTHER TRIAL: Observational study of an over-the-counter ointment to heal anal itch.

Introduction: Pruritus ani, or rectal or anal itch, is a common perianal disorder that affects ~5% of the population of the developed world. Treatments for this disorder are somewhat limited and include conservative non-medical perianal hygiene care, and topical medical treatments including topical steroids, antibacterial and antifungal agents, and topical anesthetic/analgesics such as lidocaine or capsaicin; astringents and vasoconstrictors such as ephedrine can also be used. Methods: The study was IRB approved. We assessed the efficacy of a novel, composite, over-the-counter, topical lidocaine ointment that included an epidermal barrier and antimicrobial effect along with the typical lidocaine anesthetizing effect, in a single arm, observational, longitudinal, population of 20 ambulatory pruritus ani patients. Patients applied the ointment twice daily, and were studied for 2 weeks; primary outcomes included time to symptom resolution and clinical exam resolution as measured on a 5-point visual analog scale. Results: Twenty-nine consecutive patients were screened and 20 patients (12 males; 8 females) were enrolled in the study. Ninety percent of patients achieved 100% symptom resolution by 2 weeks, and most were improved within 72 h of initiating treatment; 95% of patients had a normal visual exam by the 2 week endpoint. There were no significant adverse events attributable to the therapy. Conclusion: Use of a novel composite topical lidocaine agent, demonstrated rapid and effective relief of pruritus ani in an ambulatory population. Additional studies are underway. Clinical trial registered: Clinicaltrials.gov, identifier NCT05288907.

Assessment of the anxiety and depression among patients with idiopathic pruritus ani.

INTRODUCTION: Pruritus ani is an unpleasant sensation that leads to scratching of the skin around the anus. It is a common symptom due to many systemic, dermatological, and proctological conditions. In the absence of evident organic origin of a disease, pruritus may be related to mental disorders as well as personality disorders. AIM: To assess the influence of pruritus on anxiety and depression in these patients. MATERIAL AND METHODS: The study involved 60 patients complaining of persistent pruritus ani. The study included people in which pruritus for organic reasons was ruled out. Tests were carried out to assess the level of depression and anxiety disorders. In addition, patients were asked to fill in the Questionnaire for the Descriptive Assessment of Pruritus and the 4-Item Itch Questionnaire by prof. Jacek Szepietowski. RESULTS: The cause of pruritus ani in the study groups has been shown to have a significant influence on the level of depressive symptoms. There was no such relationship for anxiety disorders. In the study group, there was no correlation of depressive-anxiety symptoms with the level of pruritus intensity and the frequency of pruritus. CONCLUSIONS: The presented data reveal the negative effect of pruritus ani on the psychological functioning of patients. Pruritus ani is characterized by moderate intensity of pruritus, but has a significant influence on the aggravation of depressive symptoms. It is important to look for the causes of this symptom, which can help to eliminate its intensity, improve the patients' mood, and thus improve their quality of life.

Idiopathic Pruritus Ani and Acute Perianal Dermatitis.

This article reviews the etiologies, pathophysiology, clinical evaluation, and treatment of idiopathic pruritus ani and perianal dermatitis. It underscores a practical approach to each of these common proctologic conditions.

Long-term follow-up of intradermal injection of methylene blue for intractable, idiopathic pruritus ani.

BACKGROUND: While various medical treatments such as topical steroid ointment, antihistamine agent, and sedatives have been used for treating idiopathic intractable pruritus ani, they are not long-term solutions, due to the high recurrence rate. The aim of this study was to determine the effect of methylene-blue intradermal-injection therapy for treating patients with idiopathic intractable pruritus ani. Symptom improvement and recurrence rates were determined with a long-term follow-up. METHODS: A retrospective study was conducted from January 2011 to October 2013 on consecutive patients with intractable pruritus ani treated with methylene-blue intradermal injection. The therapy included 5 ml of 1% methylene blue and 15 ml of 1% lidocaine. Follow-up included a physical exam and satisfaction-score survey (1 = much worse, 2 = worse, 3 = no improvement, 4 = much better, 5 = gone completely) before treatment, 6 weeks after treatment, and 3 years after treatment to check patient status and recurrence rate. RESULTS: Of 103 treated patients, 96 were able to attend the 6-week follow-up visit. There were 58 (60.4%) males and 38 (39.6%) females with a mean age of 48.34 ± 10.21 years. Their mean satisfaction score at 6 weeks was 4.23 ± 0.86. Of the total of 96 patients, 9 (9.4%) patients scored 3 or less in their satisfactions score at 6 weeks. 62 (64.6%) patients were evaluated 3-year post-treatment. The satisfaction score at 3 years after treatment was 4.74 ± 0.57. Besides the 9 patients who initially failed treatment, 4 of the remaining 53 patients scored 3 or less in their satisfaction score surveys. Thus, the recurrence rate at 3 years was 7.5% (4/53). CONCLUSIONS: Methylene-blue intradermal injection can result in a high symptom improvement rate with low recurrence rate for patients with idiopathic pruritus ani.

Recalcitrant anal and genital pruritus treated with dupilumab.

Chronic anogenital pruritus can significantly impair affected patients' quality of life by disrupting their sleep, mood, sexual function, and personal relationships. Although a significant portion of these patients can be managed with hygiene measures, topical therapy, oral anti-pruritics, and allergen avoidance after patch testing, guidelines to treat patients who do not respond to standard therapy have yet to be established. We describe the therapeutic response of a case of anogenital pruritus recalcitrant to multiple topical and systemic therapies. Treatment of this patient with dupilumab, an interleukin-4 receptor alpha blocker, resulted in clinical remission at 1 year from the initiation of the therapy, without significant adverse effects.

Anorectal Complaints in the Emergency Department.

Patients commonly present to the emergency department with anorectal complaints. Most of these complaints are benign and can be managed conservatively; however, there are a few anorectal emergencies that clinicians must be aware of in order to prevent further complications. The history and physical examination are especially important so that critical disorders can be recognized and specific treatment plans can be determined. It is important to maintain a broad differential diagnosis of anorectal disease and to distinguish benign from serious processes.

Pruritus Ani.

Pruritus ani is a common condition with many different potential causes. Because of this, it can be difficult to treat. It is important to identify and eliminate any inciting factors, which are often unintentional consequences of the patient's attempts to alleviate symptoms. If no reversible cause is found, simple measures with diet modification and perianal hygiene are tried before using topical medications or procedures.

Common anorectal disorders.

Anorectal disorders result in many visits to healthcare specialists. These disorders include benign conditions such as hemorrhoids to more serious conditions such as malignancy; thus, it is important for the clinician to be familiar with these disorders as well as know how to conduct an appropriate history and physical examination. This article reviews the most common anorectal disorders, including hemorrhoids, anal fissures, fecal incontinence, proctalgia fugax, excessive perineal descent, and pruritus ani, and provides guidelines on comprehensive evaluation and management.

Tratamento tópico das doenças anorretais / Topical treatment of anorectal diseases

O tratamento das doenças anorretais, como a doença hemorroidária e as fissuras anais, é essencialmente clínico para a maioria dos pacientes, estando as alternativas cirúrgicas reservadas para doença avançada. Modificações no estilo de vida são fundamentais na prevenção e no tratamento das doenças anorretais e incluem aumento do consumo de fibras e ingestão de líquidos para evitar a obstipação intestinal, associado a higienização adequada da região anal. Medicamentos tópicos promovem rápido alívio dos sintomas e são amplamente utilizados na prática clínica. A associação do anestésico cinchocaína com o policresuleno, um agente com propriedades pró-coagulantes e vasoconstritoras, promove alívio dos sintomas associados à doença hemorroidária, à fissura anal, ao prurido local e no pós-operatório de cirurgias proctológicas, sendo uma opção terapêutica efetiva e segura para o tratamento conservador das afecções anorretais.

Pruritus ani: diagnosis and treatment.

Pruritus ani is a common condition with multiple causes. Primary causes are thought to be fecal soiling or food irritants. Secondary causes include malignancy, infections including sexually transmitted diseases, benign anorectal diseases, systemic diseases, and inflammatory conditions. A broad differential diagnosis must be considered. A reassessment of the diagnosis is required if symptoms or findings are not responsive to therapy. The pathophysiology of itching, an overview of primary and secondary causes, and various treatment options are reviewed.

Pruritus ani.

Pruritus ani is an unpleasant cutaneous sensation that induces the desire to scratch the skin around the anal orifice. It may start insidiously and appears in 1% to 5% of the population. It is classified as primary (idiopathic) pruritus ani when no cause can be found. However, as 25% to 75% of cases have co-existing pathology, a detailed history and examination are necessary. The goal of treatment is asymptomatic, intact, dry, clean perianal skin with reversal of morphological changes. The management of pruritus ani is directed towards the underlying cause. If the diagnosis is idiopathic pruritus ani, the patients can still be managed with great success by eliminating of irritants and scratching, by giving general advice regarding hygiene and lifestyle modification and by using active treatment measures.

Hidradenitis suppurativa and pruritus ani.

Hidradenitis suppurativa (HS) is a chronic debilitating disorder that can affect any areas bearing apocrine glands. Perineal HS is associated with high morbidity compared with other anatomic regions. Early-stage disease may mimic various other forms of cutaneous disorders, but as HS progresses pathognomonic skin changes occur. Clinical stage can guide the therapeutic approach, but the lowest recurrence rate is obtained by removing all involved skin and subcutaneous fat. Pruritus ani is a complex disease with a multitude of etiologies. Its management can be frustrating and disappointing for the patient and doctor alike. The key is to start with simple treatment options focusing on perianal hygiene and avoidance of the most common offending foods and beverages. If these measures fail, topical medications should be attempted before graduating to perianal injections of methylene blue as a last resort.

Pruritus Ani

Pruritus ani is an unpleasant cutaneous sensation that induces the desire to scratch the skin around the anal orifice. It may start insidiously and appears in 1% to 5% of the population. It is classified as primary (idiopathic) pruritus ani when no cause can be found. However, as 25% to 75% of cases have co-existing pathology, a detailed history and examination are necessary. The goal of treatment is asymptomatic, intact, dry, clean perianal skin with reversal of morphological changes. The management of pruritus ani is directed towards the underlying cause. If the diagnosis is idiopathic pruritus ani, the patients can still be managed with great success by eliminating of irritants and scratching, by giving general advice regarding hygiene and lifestyle modification and by using active treatment measures.

Relationship between anal symptoms and anal findings.

BACKGROUND: The frequencies and types of anal symptoms were compared with the frequencies and types of benign anal diseases (BAD). METHODS: Patients transferred from GPs, physicians or gynaecologists for anal and/or abdominal complaints/signs were enrolled and asked to complete a questionnaire about their symptoms. Proctologic assessment was performed in the knee-chest position. Definitions of BAD were tested in a two year pilot study. Findings were entered into a PC immediately after the assessment of each individual. RESULTS: Eight hundred seven individuals, 539 (66.8%) with and 268 without BAD were analysed. Almost one third (31.2%) of patients with BAD had more than one BAD. Concomitant anal findings such as skin tags were more frequently seen in patients with than without BAD (<0.01). After haemorrhoids (401 patients), pruritus ani (317 patients) was the second most frequently found BAD. The distribution of stages in 317 pruritus ani patients was: mild (91), moderate (178), severe (29), and chronic (19). Anal symptoms in patients with BAD included: bleeding (58.6%), itch (53.7%), pain (33.7%), burning (32.9%), and soreness (26.6%). Anal lesions could be predicted according to patients' answers in the questionnaire: haemorrhoids by anal bleeding (p=0.032), weeping (p=0.017), and non-existence of anal pain (p=0.005); anal fissures by anal pain (p=0.001) and anal bleeding (p=0.006); pruritus ani by anal pain (p=0.001), itching (p=0.001), and soreness (p=0.006). CONCLUSIONS: The knee-chest position may allow for the accumulation of more detailed information about BAD than the left lateral Sims' position, thus enabling physicians to make more reliable anal diagnoses and provide better differentiated therapies.

Patients' views of medical positioning for proctologic examination.

BACKGROUND: It is unknown which proctological position is most embarrassing to patients. METHODS: Individuals consecutively referred to our outpatient clinic in order to determine the causes of anal and/or abdominal complaints were randomized to complete an unvalidated six-item questionnaire which asked for their preferred proctologic positioning either before or after a proctological examination in knee-chest position followed by inspection of the anal verge, digital examination of the anal canal, and anoscopy. A third group of patients referred for gastroscopy was asked to complete the questionnaire before being gastroscoped. RESULTS: One hundred seventy-eight individuals of both genders aged 16-80 years who consecutively entered our outpatient clinic were enrolled. One third in each group had never experienced any of the offered medical positionings. Most patients favored the Sims' position if they had the choice. Randomized patients favored the knee-chest position more after experiencing it compared to those without experience (P < 0.03). Patients favored the positions they had recently experienced irrespective of the other positions offered in the questionnaire (P < 0.05). Individual answers to the question 'which position do you find most embarrassing?' did not depend on sex or age at first examination or when their last examination was performed. The majority of patients (55.2%-71.4%) held that no type of proctological positioning was most embarrassing to them. CONCLUSIONS: The medical profession is authorized to use the proctological positioning that allows the most reliable anal diagnoses.