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.

Causes and Management of Pruritus Ani.

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.

Prevalencia de enterobiasis y factores socioambientales en una zona rural de Ecuador / Prevalence of enterobiasis and socio-environmental factors in a rural area from Ecuador

La gestión de los residuos sanitarios requiere atención especial y todos los equipos sanitarios deben participar en la manipulación de los residuos. Se presta menos atención a la gestión de residuos sanitarios en países en vías de desarrollo y no hay evidencia sobre las prácticas de gestión de residuos sanitarios en algunas instituciones sanitarias. Este estudio se realizó para evaluar las prácticas de gestión de residuos sanitarios y los factores asociados en tres hospitales de Perú. Es un estudio descriptivo, cuantitativo y de corte transversal basado en tres establecimientos de salud. Los datos se recopilaron mediante cuestionarios y listas de verificación de observación. El (66,67%) de los trabajadores conocían sobre el manejo de los desechos biológicos. La mayoría conocía los riesgos asociados con el manejo de los mismos (95,91%). Los participantes tenían el conocimiento de que pueden evitarse las infecciones. Nueve de cada diez de los trabajadores realizaron por lo menos dos capacitaciones en la gestión del manejo de los desechos biológicos. El 95,91% conocía los códigos de colores correctos de los contenedores para diferentes flujos de desechos. En cuanto a las actitudes, 161 (94,15 %) indicó que la gestión de los desechos biológicos era importante y 162 (94,74%) estuvo de acuerdo en que era necesaria una implementación estricta para la gestión adecuada de los mismos en el establecimiento de salud. Elementos clave para mejorar las prácticas de gestión de residuos sanitarios en hospitales: promover prácticas que reduzcan el volumen de residuos generados y aseguren una adecuada segregación de residuos(AU)

Healthcare waste management requires special attention and every healthcare teams should be involved in handling of wastes. However, less attention is paid to health care waste management in developing countries and there is no evidence on health care waste management practices in some institutions providing health services. This study was conducted to assess healthcare waste management practices and associated factors in three hospitals in Peru. It is a descriptive, quantitative and cross-sectional study based on three health establishments. Data were collected using questionnaire and observational checklists. The (66.67%) of the workers knew about the management of biological waste. The majority knew the risks associated with handling them (95.91%). Participants were aware that infections can be prevented. Nine out of ten of the workers completed at least two trainings in the management of biological waste. 95.91% knew the correct container color codes for different waste streams. Regarding attitudes, 161 (94.15%) indicated that the management of biological waste was important and 162 (94.74%) agreed that strict implementation was necessary for proper management of biological waste in the environment health facility. Key elements to improve healthcare waste management practices in hospitals: promote practices that reduce the volume of waste generated and ensure proper waste segregation(AU)

Melanoma del canal anal: a propósito de un caso / Melanoma of the anal canal: a propos of a case

RESUMEN Los melanomas mucosos son tumores poco frecuentes y de mal pronóstico. Presentan un comportamiento agresivo, y pueden tener varias localizaciones en el aparato digestivo. Este tipo de tumores es más frecuente en la región anorectal. Se presentó un caso de una paciente femenina de 59 años, con un cuadro de varios meses de evolución; caracterizado por ardor, prurito anal y sensación de masa que prolapsaba a través del ano. Se constató al examen físico masa tumoral aspecto polipoideo. Se realizó polipectomía donde la biopsia arrojó como resultados el aspecto histológico de un melanoma mucoso de canal anal.

ABSTRACT Mucous melanomas are few frequent and have a bad prognosis. They present an aggressive behavior and might have several locations in the digestive system. This kind of tumors is more frequent at the anus-rectal region. The authors presented the case of a female patient, aged 59 years, with clinical conditions of several months of evolution, characterized by burning, anal pruritus and the sensation of a mass prolapsing through the anus. A tumor mass of polypoid aspect was found at physical examination. Polypectomy was carried out and the biopsy showed the histologic aspect of a mucous melanoma of the anal canal.

Melanoma del canal anal: a propósito de un caso / Melanoma of the anal canal: a propos of a case

RESUMEN Los melanomas mucosos son tumores poco frecuentes y de mal pronóstico. Presentan un comportamiento agresivo, y pueden tener varias localizaciones en el aparato digestivo. Este tipo de tumores es más frecuente en la región anorectal. Se presentó un caso de una paciente femenina de 59 años, con un cuadro de varios meses de evolución; caracterizado por ardor, prurito anal y sensación de masa que prolapsaba a través del ano. Se constató al examen físico masa tumoral aspecto polipoideo. Se realizó polipectomía donde la biopsia arrojó como resultados el aspecto histológico de un melanoma mucoso de canal anal (AU).

ABSTRACT Mucous melanomas are few frequent and have a bad prognosis. They present an aggressive behavior and might have several locations in the digestive system. This kind of tumors is more frequent at the anus-rectal region. The authors presented the case of a female patient, aged 59 years, with clinical conditions of several months of evolution, characterized by burning, anal pruritus and the sensation of a mass prolapsing through the anus. A tumor mass of polypoid aspect was found at physical examination. Polypectomy was carried out and the biopsy showed the histologic aspect of a mucous melanoma of the anal canal (AU).

Management of Common Benign Anorectal Disease: What All Physicians Need to Know.

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.

Características clínico-demográficas de la población del Sur de Gran Canaria con diagnóstico de enterobiasis: valoración de la toma de muestras / Demographic and clinical features of diagnosed individuals of enterobiasis in the southern Gran Canaria: sampling assessment

Introducción. La enterobiasis, causada por Enterobius vermicularis es una de las parasitosis más prevalentes en población infantil, cuyo diagnóstico implica la demostración de los huevos o gusanos mediante el método de Graham. El objetivo del estudio es describir las características clínico-demográficas y microbiológicas de pacientes con sospecha de Enterobiasis en el área Sur de Gran Canaria. Material y métodos. Estudio descriptivo y prospectivo de los resultados de muestras perianales evaluadas mediante el método de Graham por el Servicio de Microbiología del Hospital Universitario Insular de Gran Canaria entre Noviembre de 2014 y Noviembre de 2015. Se ha realizado un análisis descriptivo y de asociación de riesgo de las variables clínicas y demográficas y los resultados del Test de Graham. Resultados. Se obtuvieron 1.128 muestras válidas. En el 11,4% se observaron huevos de E. vermicularis; el 88,4% de las muestras positivas en menores de 14 años y el 53,5% en género masculino. Dolor abdominal (18,6%), prurito anal (11,6%), eosinofilia (8,5%) y parasitosis intestinal (7,8%) fueron los motivos de solicitud en las muestras positivas. Predomino elevado sin diagnóstico de sospecha o diagnósticos no relacionados con enterobiasis. Conclusiones. La enterobiasis es un motivo de consulta en atención primaria y una patología de interés en Gran Canaria. La calidad de recogida de muestras y el diagnóstico de sospecha es necesaria para realizar un buen análisis microbiológico (AU)

Introduction. Enterobius vermicularis, also known as pinworn, is the responsible agent for Human Enterobiasis. It is one of the most prevalent, but underrated, parasitic disease in children population. Diagnosis involves demonstration of either eggs or adult worms by Graham test. The aim of this study is to describe the clinical, demographic and microbiological features of patients with suspected diagnosis of Enterobiasis in southern Gran Canaria. Material and methods. Descriptive and prospective study of perianal samples evaluated by Graham test in the Microbiology Department of `Insular de Gran Canaria´ University Hospital between November 2014 and November 2015. Descriptive analysis to evaluate the correlation between clinical and demographic variables and the results of Graham test microbiological observation. Results. 1,128 samples were analyzed. E. vermicularis was found in 11.4% of the samples. Among the positives samples, 88.4% belonged to children under 14 years, and 53.5% were male. Abdominal pain (18.6%), anal itching (11.6%), eosinophilia (8.5%) and intestinal parasitosis suspicion (7.8%) were the reasons of parasitological investigation request in positive samples. Nevertheless, a high proportion of the requests was not founded in a suspicious diagnosis or was unrelated to Enterobiasis. Conclusions. Enterobiasis is a common disease in primary health care and is of great importance in Gran Canaria. Quality in sample collection as well as diagnosis suspicious information are necessary for a good microbiological analysis (AU)

Anal Health Care Basics.

Despite the fact that countless patients suffer from anal problems, there tends to be a lack of understanding of anal health care. Unfortunately, this leads to incorrect diagnoses and treatments. When treating a patient with an anal complaint, the primary goals are to first diagnose the etiology of the symptoms correctly, then to provide an effective and appropriate treatment strategy.The first step in this process is to take an accurate history and physical examination. Specific questions include details about bowel habits, anal hygiene, and fiber supplementation. Specific components of the physical examination include an external anal examination, a digital rectal examination, and anoscopy if appropriate.Common diagnoses include pruritus ani, anal fissures, hemorrhoids, anal abscess or fistula, fecal incontinence, and anal skin tags. However, each problem presents differently and requires a different approach for management. It is of paramount importance that the correct diagnosis is reached. Common errors include an inaccurate diagnosis of hemorrhoids when other pathology is present and subsequent treatment with a steroid product, which is harmful to the anal area.Most of these problems can be avoided by improving bowel habits. Adequate fiber intake with 30 g to 40 g daily is important for many reasons, including improving the quality of stool and preventing colorectal and anal diseases.In this Special Report, we provide an overview of commonly encountered anal problems, their presentation, initial treatment options, and recommendations for referral to specialists.

[Pruritus ani]. / Pruritus ani.

INTRODUCTION: Pruritus ani is defined as a dermatologic disease characterized by itching and/or burning in the perianal area. It occurs in 15% of the population. Men are affected more frequently than women, in the ratio 4:1. It is accompanied by an irresistible desire to scratch in the perianal area. Pruritus ani is divided into two subtypes: primary (idiopathic) and secondary. In idiopathic (primary) pruritus it is not possible to detect any other cause of itching. Secondary pruritus has an obvious causal origin.The aim of this paper is to offer a complex overview of possible causes, diagnostic procedures and treatment possibilities of this unpleasant and annoying disease. METHODS: We have researched available publications using PubMed and MEDLINE databases, focusing on articles on anal pruritus. At first the key word "Pruritus ani" was put in without any restrictions. Subsequently, we limited the selection by the time period of 5 years and 10 years; then we looked up articles in English, German and Czech languages, and finally review articles, clinical trials and others. RESULTS: 574 articles were found without entering any restrictions; 45 of them were review articles and 25 clinical trials. 437 articles were in the English language and 40 of them were review articles. 44 were in the German language and 1 of them was a review article. A total of 33 articles were found with a 5-year time limit. 6 of them were review articles and 4 were clinical trials. 66 articles from the last 10 years were found. 14 of them were review articles and 10 were clinical trials. In most of the other articles among the total number of articles found, pruritus ani was mentioned only marginally in articles focused on different topics. We have not found any summary articles on this topic in Czech publications. CONCLUSION: Pruritus ani is a common disease with a number of causes; therefore, effective treatment may be insufficient in the initial stages. The therapy is focused on the primary cause, if found. Broad differential diagnosis options need to be taken into consideration, and reevaluation of the therapy is a priority. When no obvious secondary cause is found, the empiric treatment is focused on an improvement of hygiene and change in the life style, removal of common irritators, and protection of perianal skin.

Taenia saginata: descripción de un caso importado / Taenia saginata: an imported case

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[Differential diagnosis of anal eczema]. / Differenzialdiagnose des Analekzems.

Dermatologic disorders often show involvement of the (peri)anal skin. However, diagnosis of (peri)anal dermatoses is often difficult even for experienced dermatologists due to delayed clinical presentation or prior treatment with over-the-counter medications. The distinct anatomical conditions of the (peri)anal region results in atypical clinical presentation of common dermatoses. Typical symptoms include pruritus, burning, bleeding and pain. Careful history of symptoms, stool, hygiene, sexual practice as well as thorough inspection of the entire body and proctological examination are crucial to make the correct diagnosis. In case of atypical presentation or uncertainty a biopsy needs to be obtained to ensure correct diagnosis and treatment.

[Pseudo-condylomatous neurodermatitis of the anal margin]. / Forme pseudo-condylomateuse d'une nevrodermite de la marge anale.

Cerebral venous thrombosis (CVT) is a rare origin of stroke, the clinical presentation and etiologies vary. The prognosis is shown to be better compared to arterial thrombosis. Magnetic Resonance Imaging (MRI) and MR Venograpgy (MRV) are currently important tools for the diagnostic. We studied 30 cases of CVT diagnosed in the department of neurology of the University Hospital of Fez (Morocco). Patients diagnosed with CVT signs between January 2003 and October 2007 were included in the study. Cerebral CT-scan was performed in 27 cases (90%) while the MRI examination was done in 18 patients (67%); and most patients (90%) received anticoagulant therapy. The mean age of our patients was of 29 years (age range between 18 days and 65 years). A female predominance was observed (70%). The clinical presentation of patients was dominated by: headache in 24 cases (80%), motor and sensory disability in 15 cases (50%), seizures in 10 cases (33%) , consciousness disorder in 10 cases (33%). CVT was associated to post-partum in 10 cases (33%), infectious origin in 8 cases (26%), Behcet disease in 2 cases (7%), pulmonary carcinoma in 1 case, thrombocytemia in 1 case and idiopathic in 7 cases (23%). The evolution was good in 20 cases (67%), minor squelaes were observed in 6 patients (20%), while major squelaes was observed in 2 cases. Two cases of death were registered. The CVT is a pathology of good prognosis once the diagnosis is promptly established and early heparin treatment initiated.

Common anorectal conditions: evaluation and treatment.

Anorectal conditions are frequently encountered clinical entities but are often misunderstood and misdiagnosed. Although the most common anorectal disorders are not considered life threatening, they can negatively impact patients' activities of daily living and quality of life. Comprehensive anorectal examination, including the use of anoscopy, has become a "lost art," and graduate medical education programs should utilize more formal training in this area. This review discusses the comprehensive anorectal exam and the diagnosis and management of three common anorectal disorders: hemorrhoids, anal fissure, and pruritus ani.

[Acute anal pain]. / Douleur anale aiguë.

Anal pain is a common reason for consultation, whose etiology is varied and should not be limited to the hemorrhoidal disease. The purpose of this article is to conduct a review of the literature on anorectal pathologies most frequently encountered and make recommendations regarding their management.

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.

Assessment and treatment of three common anorectal conditions.

This is the second of two articles about the kinds of anorectal problem with which people can present at emergency departments. The first article concerns common symptoms and anorectal examination, while this one discusses the diagnosis and treatment of three common anorectal problems that can be managed by nurse practitioners: haemorrhoids, anal fissure and pruritus ani. Unexpected diagnoses might be found on examination and nurse practitioners should refer these patients to appropriate specialists.