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1.
Tech Coloproctol ; 27(10): 813-825, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37306793

RESUMO

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.


Assuntos
Prurido Anal , Humanos , Prurido Anal/tratamento farmacológico , Azul de Metileno/uso terapêutico , Estudos Retrospectivos , Estudos Prospectivos , Injeções Intradérmicas
2.
Eur J Med Res ; 28(1): 57, 2023 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-36732860

RESUMO

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.


Assuntos
Prurido Anal , Qualidade de Vida , Humanos , Prurido Anal/diagnóstico , Prurido Anal/etiologia , Prurido Anal/terapia , Azul de Metileno , Capsaicina/uso terapêutico , Fatores de Tempo
3.
Dis Colon Rectum ; 66(1): 10-13, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36515511

RESUMO

CASE SUMMARY: A 48-year-old healthy man presented to the office reporting a long-standing history of anal pruritus. He had tried various over-the-counter creams without much success. Besides an anal fissure in the past, which responded to nitroglycerin ointment, his medical history was unremarkable. On physical examination, he was found to have grade I hemorrhoids and mild fecal smearing on perianal skin. Recent colonoscopy and laboratory work ordered by the primary care provider were normal. He was counseled on common inciting agents and local irritants and was advised on hygiene, diet modification, and stool-bulking agents. The colorectal surgeon recommended that the patient keep a journal about his symptoms, foods, and household chemicals used. He was seen twice more over the course of 6 months to pinpoint the cause of his pruritus. A short-course trial of topical steroid, barrier cream, and topical tacrolimus was not helpful. A biopsy of perianal skin was performed and was unrevealing. Eventually, given the persistence of symptoms, it was decided that he would undergo methylene blue injection to address his pruritus (Fig. 1). The procedure consisted of several intradermal and subcutaneous injections of 10 mL of 1% methylene blue combined with 7.5 mL of 0.25% bupivacaine with adrenaline (1/100,000) and 7.5 mL 0.5% lidocaine. After the methylene blue injection, the severity of his symptoms improved, but pruritus still persisted. A methylene blue injection of the same concentration was repeated in 3 months with complete resolution of symptoms.


Assuntos
Fissura Anal , Hemorroidas , Prurido Anal , Masculino , Humanos , Pessoa de Meia-Idade , Prurido Anal/etiologia , Prurido Anal/terapia , Prurido Anal/diagnóstico , Azul de Metileno , Nitroglicerina , Hemorroidas/complicações
6.
Hautarzt ; 73(1): 53-60, 2022 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-34812913

RESUMO

BACKGROUND: Limited timely, cost-effective, and regional availability of healthcare data is considered one of the limiting factors for timely analyses in the field of health services research and thus for healthcare delivery to the general population. Thus, Internet search engine analyses are coming into focus in this context. OBJECTIVES: What contribution can data on the volume of Internet searches for various diseases make to the health care of the German population? Where is the potential and where are the limitations? METHODS: A review of the current literature and a selective overview of Internet search engine analyses of dermatological, allergological, and infectious diseases published in the last 4 years in Germany were performed. RESULTS: By analyzing web search data, temporal developments such as seasonality, months with the highest interest, and geographical differences can be mapped at the national, state (Bundesländer), and city level and major points of interest (e.g., skin cancer of the eye or anal itching) regarding a certain health topic can be identified. In addition, some studies were able to show correlations between search volume and external factors (e.g., temperature, care structure) and to registered cases (e.g., skin cancer, Lyme disease). CONCLUSION: Web search data, given the limitations noted, are able to directly provide spatiotemporal mapping regarding the needs of the Internet-using population. They are particularly useful in situations where traditional health data are limited or unavailable.


Assuntos
Doença de Lyme , Prurido Anal , Alemanha , Humanos , Internet , Ferramenta de Busca
7.
Comput Math Methods Med ; 2021: 1016108, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34721653

RESUMO

OBJECTIVE: To unearth the clinical efficacy of tacrolimus ointment + 3% boric acid lotion joint Chinese angelica decoction in chronic perianal eczema. METHODS: Patients with chronic perianal eczema admitted to hospital from June 2018 and June 2019 were retrospectively analyzed. Patients in the control group (n = 38) underwent basic therapy with tacrolimus ointment + 3% boric acid lotion, whereas those in the observation group (n = 38) were given oral Chinese angelica decoction on the basis of the above therapy. Patient's baseline information before therapy and clinical symptoms after therapy were observed and compared, including pruritus ani score, anus drainage and damp score, skin lesion score, skin lesion area score, life quality index score, and IL-2, IL-4, and IgE levels in serum. Overall efficacy in the two groups was also evaluated. RESULTS: No significant differences were found in the baseline information between the observation group and control group before therapy. After therapy, pruritus ani score (P = 0.023), anus drainage and damp score (P = 0.041), skin lesion score (P = 0.025), and skin lesion area score (P = 0.035) of patients in the observation group were remarkably lower than those in the control group. Significantly higher release levels of clinical symptoms of patients in the observation group were indicated. With respect to the control group, the life quality score (P = 0.020) and IgE level in serum (P = 0.003) of patients in the observation group were significantly lower, while IL-4 level in serum was significantly higher (P = 0.129). The therapy in the observation group achieved better clinical efficacy. Overall efficacy in the observation group was markedly favorable with respect to the control group. CONCLUSION: With respect to tacrolimus ointment + 3% boric acid lotion, patients with chronic perianal eczema displayed better clinical efficacy after jointly being treated by Chinese angelica decoction.


Assuntos
Doenças do Ânus/tratamento farmacológico , Ácidos Bóricos/administração & dosagem , Medicamentos de Ervas Chinesas/administração & dosagem , Eczema/tratamento farmacológico , Tacrolimo/administração & dosagem , Adulto , Angelica/química , Animais , Estudos de Casos e Controles , Doença Crônica , Biologia Computacional , Quimioterapia Combinada , Feminino , Humanos , Imunossupressores/administração & dosagem , Masculino , Pessoa de Meia-Idade , Pomadas/administração & dosagem , Fitoterapia , Prurido Anal/tratamento farmacológico , Estudos Retrospectivos , Creme para a Pele/administração & dosagem , Resultado do Tratamento
8.
J Med Case Rep ; 15(1): 357, 2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34289900

RESUMO

BACKGROUND: Langerhans cells belong to the histiocytic system and give rise to two tumors: Langerhans cell histiocytosis and Langerhans cell sarcoma. Clinical aggressiveness and degree of atypia distinguish the two neoplasms. Langerhans cell histiocytosis can infiltrate a single or multiple organ systems and particularly affects bone, skin, and lymph nodes. Perianal cutaneous Langerhans cell histiocytosis is a rare condition in adults, with 15 cases reported in the literature. CASE: We present the case of a 50-year-old hispanic man who presented with a 9-month history of pruritus ani and a personal history of diabetes insipidus. Punch biopsy confirmed a lesion of Langerhans cells origin but could not exclude Langerhans cell sarcoma because of limited sample size. An additional biopsy was planned as well as a positron emission tomography scan to determine the extent of disease spread. While the patient failed to follow up for repeat biopsy, the positron emission tomography scan was performed and was negative for metastatic disease. A stable perianal lesion of Langerhans cell histiocytosis with benign clinical features in a 50-year-old male despite lack of treatment is extremely rare and has not been described in the literature so far. Here, we review the presentation and workup of patients with Langerhans cell histiocytosis, review the relevant literature, and discuss treatment planning. CONCLUSION: Perianal Langerhans cell histiocytosis is rare, and there should be a high index of suspicion with chronic or new perianal lesions, especially in a patient with a history of diabetes insipidus. It is also important to consider the patient's full clinical course when it is not possible to reach a definitive pathological diagnosis before management.


Assuntos
Histiocitose de Células de Langerhans , Prurido Anal , Adulto , Biópsia , Histiocitose de Células de Langerhans/complicações , Histiocitose de Células de Langerhans/diagnóstico , Histiocitose de Células de Langerhans/tratamento farmacológico , Humanos , Linfonodos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons
11.
Tech Coloproctol ; 23(2): 143-149, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30734161

RESUMO

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.


Assuntos
Inibidores Enzimáticos/administração & dosagem , Azul de Metileno/administração & dosagem , Prurido Anal/tratamento farmacológico , Adulto , Quimioterapia Combinada , Feminino , Seguimentos , Humanos , Injeções Intradérmicas , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
12.
J Eur Acad Dermatol Venereol ; 33(1): 151-156, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30067284

RESUMO

BACKGROUND: It is difficult to estimate the prevalence of acute and chronic pruritus in the population at large due to a lack of affected persons seeking medical assistance. OBJECTIVE: To discover the incidence of pruritus in Germany and determine what the most common related complaints are via an analysis of Google's search volume. METHODS: From June 2013 to April 2017, the Google AdWords Keyword Planner was utilized to select and critically assess relevant keywords for 'pruritus'. RESULTS: Among a total of 13 691 470 German language Google searches on the topic of pruritus, it was found that the most searched for terms included atopic eczema (24.3%) and the layman's term for psoriasis ('Schuppenflechte'; 17.8%), as well as just psoriasis (13.4%). 'Juckreiz', the German word for pruritus, was determined to be only the sixth most searched for term (2.9%). Anal pruritus and pruritus of the entire body comprised the most searched for localizations. The various factors that impact pruritus, particularly skin conditions and disorders, were established to be among the most searched for terms (72.6%). A decreased monthly search volume was associated with the changing seasons; the summertime had the lowest number of searches for pruritus. CONCLUSION: The Google search engine analysis provided insight for this study into the unexpectedly large number of unmet medical needs of those suffering from pruritus within Germany, especially that of specific localizations on the body.


Assuntos
Comportamento de Busca de Informação , Prurido/epidemiologia , Ferramenta de Busca/estatística & dados numéricos , Dermatite Atópica/epidemiologia , Eczema/epidemiologia , Alemanha/epidemiologia , Humanos , Incidência , Internet , Prurido/etiologia , Prurido/terapia , Prurido Anal/epidemiologia , Psoríase/epidemiologia , Estudos Retrospectivos , Ferramenta de Busca/tendências , Estações do Ano
13.
Hautarzt ; 70(1): 21-28, 2019 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-29876613

RESUMO

BACKGROUND: Because affected persons often do not visit a doctor, the prevalence of chronic and acute pruritus in the general population is difficult to determine. OBJECTIVES: The aim of this study is to estimate the frequency and the most common locations of pruritus in German internet users, who-with 62.4 million persons-represent a large majority of the German population, by analysing the Google search volume. MATERIALS AND METHODS: Relevant keywords for the subject "pruritus" were identified and analysed using the Google AdWords Keyword Planner. The assessment period was January 2015 to December 2016. RESULTS: In total the Google AdWords Keyword Planner identified 701 keywords for the topic "Juckreiz" (German lay word for pruritus), resulting in 7,531,890 pruritus-related Google searches during the assessment period. Most common search terms were the German lay term for atopic eczema ("Neurodermitis", 23.7%), the German lay term for psoriasis ("Schuppenflechte", 17.8%) and "psoriasis" (13%). The German lay term for pruritus ("Juckreiz") was only the sixth most searched term (3%). Most searches (72%) focused on influencing factors for pruritus, especially on skin diseases and skin conditions. The most commonly searched location was pruritus on the whole body, followed by anal pruritus. Analysis of the temporal course showed a higher monthly search volume during winter. CONCLUSION: With its unconventional methodology, a Google search engine analysis, this study allows a rough estimation of the medical need of pruritus in the German general population, which seems to be higher than expected. Especially pruritus in the anal area was identified as an unmet medical need.


Assuntos
Prurido Anal/epidemiologia , Prurido/epidemiologia , Ferramenta de Busca , Alemanha , Humanos , Internet
14.
Am J Med ; 131(7): 745-751, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29499172

RESUMO

Benign anorectal conditions produce anal pain, rectal bleeding, or discharge from the perianal region, which are highly prevalent symptoms in the general population. Hemorrhoidal disease, anal fissure, perianal abscess, proctalgia syndromes, and pruritus anii are the most common clinical disorders. Well-trained physicians, irrespective of their specialty, can treat most of these disorders and refer them to a specialist in proctology only when necessary. The aim of this review is to provide a practical guide to the management of benign anorectal disorders in terms of their initial management and the criteria for specialist referral.


Assuntos
Doenças Retais/terapia , Fissura Anal/diagnóstico , Fissura Anal/terapia , Hemorroidas/diagnóstico , Hemorroidas/terapia , Humanos , Prurido Anal/diagnóstico , Prurido Anal/terapia , Doenças Retais/diagnóstico , Fístula Retal/diagnóstico , Fístula Retal/terapia
15.
Zhongguo Zhen Jiu ; 37(6): 608-612, 2017 Jun 12.
Artigo em Chinês | MEDLINE | ID: mdl-29231502

RESUMO

OBJECTIVE: To observe the differences in the therapeutic effects on chronic perianal eczema between auricular point sticking therapy and auricular sticking pseudo-press therapy on the basis of the treatment with western medication. METHODS: Ninety patients were randomized into an auricular therapy group and an auricular pseudo-press therapy group (pseudo group), 45 cases in each one. The western medication was used in both of the groups. In the auricular therapy group, the auricular sticking method with semen vaccariae was added at Fengxi (SF1,zi), Shenshangxian (TG2p), Duipingjian (AT1,2,4i), Fei (CO14), Pi (CO13), Gangmen (HX5). The patients were advised to press each auricular point every day. In the pseudo group, the plaster was applied to the same auricular points without semen vaccariae used and pressing manipulation given. The auricular sticking therapy was used once every three days in the two groups. The treatment for 2 weeks was as one session and one or two sessions of treatment were given accordingly. The severity of perianal itching, the area of skin lesion, the form of skin lesion and the score of dermatology life quality index (DLQI) and the clinical therapeutic effects were compared before and after treatment in the two groups. The adverse reaction and recurrence rate in 1-year follow-up visit were observed during treatment. RESULTS: After treatment, the itching degree, the area of skin lesion, the form of skin lesion and DLQI score were all reduced apparently as compared with those before treatment in the patients of the two groups (all P<0.05). The results in the auricular sticking therapy group were better than those in the pseudo group (all P<0.05). The curative and markedly effective rate and the total effective rate in the auricular sticking therapy group were apparently better than those in the pseudo group[52.3% (23/44) vs 19.0% (8/42), 97.7% (43/44) vs 76.2% (32/42), both P<0.05]. The recurrence rate in the auricular sticking therapy group was lower apparently than that in the pseudo group[7.0% (3/43) vs 37.5% (12/32), P<0.05]. No severe adverse reactions were found during the treatment in the two groups. CONCLUSIONS: The auricular sticking therapy combined with western medication effectively release itching in chronic perianal eczema and local skin lesions, improve the living quality and reduce recurrence rate.


Assuntos
Pontos de Acupuntura , Acupuntura Auricular/métodos , Doenças do Ânus/terapia , Eczema/terapia , Terapia por Acupuntura , Doenças do Ânus/tratamento farmacológico , Doença Crônica , Eczema/tratamento farmacológico , Humanos , Prurido Anal/tratamento farmacológico , Prurido Anal/terapia , Recidiva , Resultado do Tratamento
16.
Prim Care ; 44(4): 709-720, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29132530

RESUMO

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.


Assuntos
Doenças Retais/patologia , Doenças Retais/terapia , Fissura Anal/patologia , Fissura Anal/terapia , Fármacos Gastrointestinais/uso terapêutico , Hemorroidas/patologia , Hemorroidas/terapia , Humanos , Atenção Primária à Saúde , Prurido Anal/patologia , Prurido Anal/terapia , Doenças Retais/diagnóstico , Prolapso Retal/patologia , Prolapso Retal/terapia , Fatores de Risco
18.
BMJ ; 355: i4931, 2016 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-27815254
19.
Environ Health Prev Med ; 21(6): 547-553, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27714679

RESUMO

OBJECTIVES: We conducted a survey to investigate the use of bidet toilets among community dwelling Japanese people and explored the correlates for an itch on the anus. METHODS: A questionnaire-based survey was conducted among a convenience sample of individuals, who were derived from outpatients and employees of Kameda Medical Center, and students and employees of two technical colleges. RESULTS: A total of 4,963 respondents were evaluated in this study, 55 % of whom used bidet toilets either before or after defecation, and at least 30 % of bidet users washed the anus before defecation, partly to aid defecation. Men rather than women, and older people (aged ≥50 years) rather than younger people used bidets more actively. Logistic regression analysis showed that the correlates for an itch on the anus included male sex, younger age, washing the anus before defecation, warmer water for washing the anus after defecation, and the frequency of fecal leakage. CONCLUSIONS: Nearly, one-third of bidet toilet users washed the anus before defecation. An itch on the anus may be associated with the active use of bidets.


Assuntos
Prurido Anal/epidemiologia , Toaletes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Vida Independente/estatística & dados numéricos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
20.
JAAPA ; 29(11): 23-29, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27749400

RESUMO

Benign anal disease encompasses common problems including hemorrhoids, anal fissures, pruritus ani, perianal abscesses, and fistulae. Although many people will suffer from at least one of these conditions in their lives, healthcare practitioners diagnose and treat them accurately about 50% to 83% of the time. This article reviews common anal problems and the importance of a thorough history and physical examination to proper patient management.


Assuntos
Doenças do Ânus , Canal Anal , Doenças do Ânus/diagnóstico , Doenças do Ânus/terapia , Fissura Anal , Hemorroidas , Humanos , Prurido Anal
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