Diagnosis and Management of Anorectal Disorders in the Primary Care Setting.

Anorectal disorders are very common among a wide population of patients. Because patients may be embarrassed about the anatomic location of their symptoms, they may present to care late in the course of their illness. Care should be taken to validate patient concerns and normalize fears. This article discusses the diagnoses and management of common anorectal disorders among patients presenting to a primary care physician.

Perianal pruritus in dogs with skin disease.

BACKGROUND: Perianal pruritus has been reported in dogs with anal sac disease but not in healthy dogs. Some authors describe it as typical of allergy, but there is little evidence in support of this. HYPOTHESIS/OBJECTIVES: The aim was to investigate the association between perianal pruritus and canine atopic dermatitis (CAD), adverse food reaction (ARF) and other skin diseases in dogs. ANIMALS: Two hundred and fifty privately owned dogs with skin disease and without anal sac disease. METHODS: The presence or absence of perianal pruritus, macroscopic and cytological evaluation of the perianal skin surface and the macroscopic appearance of anal sac contents were assessed. Chi-square and Fisher's exact tests were performed to compare the frequency of perianal pruritus with the clinical diagnoses and with clinical and cytological parameters. RESULTS: Perianal pruritus was seen in 39 of 75 dogs with CAD, in 29 of 57 dogs with ARF and in only 24 of 118 dogs with other conditions. The frequency of perianal pruritus in dogs with CAD and/or ARF was significantly higher than that in dogs with other diagnoses (P < 0.0001). No other disease was significantly associated with perianal pruritus. Perianal pruritus was significantly associated with signs of perianal alopecia, erythema, excoriations, lichenification and hyperpigmentation; it was not associated with the presence of bacteria or yeasts or with anal sac impaction. CONCLUSIONS AND CLINICAL IMPORTANCE: Perianal pruritus was seen more frequently in dogs with AFR/CAD than with other dermatological diseases. This is the first study to evaluate perianal pruritus in dogs with skin disease and without anal sac disease.

Perianal Hailey-Hailey disease: an unusual differential diagnosis of condylomata acuminata.

We describe a 25-year-old woman with multiple papules in the perianal and perineal area, clinically resembling condylomata acuminata. The histology revealed an acantholytic epidermis and focal parakeratosis. The lesions were diagnosed as Hailey-Hailey disease localized in the perianal areal and need to be distinguished from human papillomavirus-associated genital lesions.

1% hydrocortisone ointment is an effective treatment of pruritus ani: a pilot randomized controlled crossover trial.

BACKGROUND: Pruritus ani (PA) is a common condition which is difficult to treat in the absence of obvious predisposing factors. There is paucity of evidence-based guidelines on the treatment of this condition. We examined whether 1% hydrocortisone ointment is an effective treatment for PA. MATERIALS AND METHODS: A pilot randomized, double-blind, placebo-controlled, crossover trial was carried out. Eleven patients consented to take part in the trial and ten completed the study. After a 2-week run-in period, patients with primary PA were randomly allocated to receive 1% hydrocortisone ointment or placebo for 2 weeks followed by the opposite treatment for a further 2-week period. There was a washout period of 2 weeks between treatments. The primary outcome measure was reduction in itch using a visual analogue score (VAS). The secondary outcome measures were improvement in quality of life measured using a validated questionnaire (Dermatology Life Quality Index, DLQI) and improvement in clinical appearance of the perianal skin using the Eczema Area and Severity Index (EASI) score. RESULTS: Treatment with 1% hydrocortisone ointment resulted in a 68% reduction in VAS compared with placebo (P=0.019), a 75% reduction in DLQI score (P=0.067), and 81% reduction in EASI score (P=0.01). CONCLUSION: A short course of mild steroid ointment is an effective treatment for PA.