Persistent anal itching

Persistent anal itching is a relatively serious symptom. It mainly refers to skin damage around the anus. This disease is more common in young and middle-aged people, especially in men. The incidence rate is relatively high, and there are many causes. Sometimes, eating spicy and irritating foods often will irritate the skin in the anus. It may also be due to allergies, such as protein, drug, etc.

Causes

1. Food factors: Excessive consumption of spicy foods and condiments, such as chili, alcohol, mustard, pepper, spices, coffee, etc., can cause irritation to the anal canal and anal skin, inducing itching. 2. Allergic reaction Certain proteins (fish, shrimp, crab, etc.), drugs, pollen, lacquer, etc. can cause allergies in some people, causing excessive histamine to be produced in the body, which acts on the peripheral nerves and causes itching. 3. Mental factors: excessive excitement, depression, neurasthenia, addiction, etc. 4. Common fungal and viral infections of the perianal skin include Epidermophyton infections.

Classification

Classification based on etiology: 1. The cause of primary anal pruritus is unknown, there is no primary damage, and the main symptoms are itching that is stubborn and unhealed. 45%-70% of cases are primary anal pruritus. 2. Secondary anal pruritus is secondary to primary diseases and various skin diseases, accompanied by obvious specific skin damage. Itching is a symptom of the primary lesion, such as itching caused by anal fistula, perianal eczema, condyloma acuminatum, neurodermatitis, pinworms, etc.

TCM Syndrome Differentiation and Treatment

(1) Internal treatment: Use Chinese medicine according to TCM syndrome differentiation: ① If wind-heat attacks the lungs and moves to the large intestine and anus, the treatment should be to clear away heat, purge fire, and promote bowel movements. The prescription used is Liangge San. ② For those with wind evil accompanied by dampness or damp-heat in the liver and gallbladder, which blocks the anus, the treatment should be to dispel wind, clear heat and remove dampness. The prescription can be Xiaofengsan or Longdanxiegan Decoction. ③ Danggui Yinzi is used for those who suffer from blood deficiency, wind-induced dryness, and skin malnutrition. ④ For those with blood stasis causing wind and those with stagnation that cannot be dispersed, the treatment should be to remove blood stasis and wind, and the prescription should be Shufeng Jiedu Decoction. ⑤ If insect poisons invade the anal area, or if dampness or drug poisons block the posterior genitals, the treatment should be to kill insects, detoxify and relieve itching. The prescription is Wumei Pills. (2) External treatment: ① For those with moist skin, sprinkle alum powder on the affected area 3 times a day. ② Those with dry skin can apply Coptis chinensis ointment or Indigo ointment externally 3 times a day. (3) Chinese medicine external washing and sitting bathing should mainly use drugs that clear away heat and detoxify, remove dampness and relieve itching, and sit bathing in warm water.

Western medicine treatment

(1) Etiological treatment: Carefully identify the primary causes of pruritus and try to eliminate them. First, anorectal diseases should undergo surgery, followed by gynecological and skin diseases. (2) Drug treatment: The drug treatment of localized anal pruritus should be based on local topical treatment: ① Antihistamines such as diphenhydramine, chlorpheniramine, and astemizole can be used for treatment. ② Hormone therapy is available for women and elderly patients with severe illnesses. ③ For patients receiving antibiotic treatment combined with bacterial infection, antibiotics may be selected as appropriate based on the condition. ④ External drug treatment can have local cooling, anti-inflammatory, drying and antipruritic effects, such as calamine lotion (water-based powder). ⑤ For external drug treatment, antipruritic, antibacterial and hormonal ointments can be used as appropriate. (3) Physical therapy can use ultraviolet light or infrared light to irradiate the affected area around the anus. (4) Injection therapy is currently the most commonly used method, which is characterized by simple operation and definite efficacy. The method is to use drugs to inject subcutaneously or intradermally to destroy sensory nerves, reduce local sensation, and eliminate symptoms. ① Methylene blue injection has a reversible nerve blocking effect, which makes the patient feel no itching within 1 to 2 weeks. ② Hormone injection uses long-acting glucocorticoids injected subcutaneously, which has long-lasting anti-inflammatory, anti-allergic and antipruritic effects. (5) Surgical treatment ① Pruritus skin excision is suitable for primary anal pruritus of a smaller area. ② Itchy skin excision and suture is suitable for primary anal pruritus with a smaller range and bilateral symmetry. ③Perianal subcutaneous nerve terminal axotomy is suitable for patients with persistent anal pruritus without obvious skin lesions who have not responded to conservative treatment.