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Dermatology100 papers

Pruritus ani

Last edited: 4/14/2026

Overview

Pruritus ani, or anal itching, is a common dermatologic condition often challenging to treat due to various potential etiologies including dermatologic, infectious, and systemic causes 30.

Diagnosis

  • Detailed history focusing on hygiene practices, skin conditions, and potential irritants 30.
  • Physical examination to identify dermatologic lesions, infections, or anatomical abnormalities 30.
  • Laboratory tests may include skin scrapings for fungal elements, cultures for infections, and relevant blood tests for systemic causes 30.
  • No specific grading system universally accepted; diagnosis guided by clinical presentation and exclusion of other causes 30.

    • Management

  • First-line treatments:
    • - Topical corticosteroids (e.g., hydrocortisone cream) for inflammatory conditions 30. - Antifungal agents if fungal infection is suspected 30. - Hygiene modifications (e.g., gentle cleansing, avoiding harsh soaps) 30.
  • Adjunctive treatments:
    • - Topical capsaicin cream to reduce nerve sensitivity 30. - Oral antihistamines (e.g., hydroxyzine) for symptomatic relief 30. - Low-dose tricyclic antidepressants like doxepin (e.g., 3-6 mg at night) for refractory cases 10.

    Special Populations

  • Elderly: Pruritus is more prevalent and may be exacerbated by polypharmacy; careful review of medications is essential 22.
  • Pediatrics: Chronic pruritus in children often associated with dermatologic diseases; multidisciplinary approach recommended 21.
  • Comorbidities: Consider systemic causes like liver or kidney disease in patients with underlying conditions 7.

    • Key Recommendations

  • Conduct a thorough history and physical examination to identify potential etiologies of pruritus ani (Evidence: Moderate 30).
  • Implement hygiene modifications and topical treatments as first-line management (Evidence: Moderate 30).
  • Consider systemic causes, especially in elderly patients with polypharmacy, and review medications (Evidence: Moderate 22).
  • Use low-dose doxepin for refractory cases of pruritus ani (Evidence: Weak 10).
  • In pediatric patients, adopt a multidisciplinary approach addressing dermatologic and systemic factors (Evidence: Moderate 21).

    • References

    1 Weisshaar E, Müller S, Szepietowski JC, Dalgard F, Garcovich S, Kupfer J et al.. European S2k Guideline on Chronic Pruritus. Acta dermato-venereologica 2025. link 2 Encarnaçao Domingos-Ancement E, Brenaut E, Misery L. Current Management of Chronic Pruritus by French Dermatologists. Acta dermato-venereologica 2025. link 3 Satoh T, Murota H, Aoyama Y, Hashimoto T, Ishiuji Y, Hatano Y et al.. Prurigo chronica multiformis: Expert consensus of the Japanese Dermatological Association. The Journal of dermatology 2024. link 4 Pereira MP, Zeidler C, Szymczak H, Bischoff C, Tsianakas A, Ständer S et al.. Acceptability and perceived benefits of validated pruritus assessment instruments in the dermatological office and clinic: The perspectives of patients and physicians. Journal of the European Academy of Dermatology and Venereology : JEADV 2024. link 5 Schwarzenauer M, Rukwied RM, Lampert A, Rolke R, Namer B. Electrical matrix stimulation suppresses acute itch independently of activation of sleeping nociceptors. European journal of pain (London, England) 2024. link 6 Navarro-Triviño FJ. [Translated article] Pruritus in Dermatology: Part 1-General Concepts and Pruritogens. Actas dermo-sifiliograficas 2023. link 7 Navarro-Triviño FJ. [Translated article] Pruritus in Dermatology: Part 2-Diseases and Their Treatment. Actas dermo-sifiliograficas 2023. link 8 Topp J, Apfelbacher C, Ständer S, Augustin M, Blome C. Measurement Properties of Patient-Reported Outcome Measures for Pruritus: An Updated Systematic Review. The Journal of investigative dermatology 2022. link 9 Ständer S, Zeidler C, Augustin M, Darsow U, Kremer AE, Legat FJ et al.. S2k guideline: Diagnosis and treatment of chronic pruritus. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG 2022. link 10 Myers B, Reddy V, Chan S, Thibodeaux Q, Brownstone N, Koo J. Optimizing doxepin therapy in dermatology: introducing blood level monitoring and genotype testing. The Journal of dermatological treatment 2022. link 11 Gurnani P, Miloh T, Chandar J, Landau DA, Hajjar F, Yosipovitch G. Systemic causes of non-dermatologic chronic pruritus in the pediatric population and their management: An unexplored area. Pediatric dermatology 2021. link 12 Kogame T, Kamitani T, Yamazaki H, Ogawa Y, Fukuhara S, Kabashima K et al.. Longitudinal association between polypharmacy and development of pruritus: a Nationwide Cohort Study in a Japanese Population. Journal of the European Academy of Dermatology and Venereology : JEADV 2021. link 13 Pardo-Zamudio AC, Valbuena MC, Jiménez-Torres HD, Colmenares-Mejía CC. Actinic prurigo in a dermatological reference center in Colombia: 108 cases. Biomedica : revista del Instituto Nacional de Salud 2020. link 14 Weisshaar E, Szepietowski JC, Dalgard FJ, Garcovich S, Gieler U, Giménez-Arnau AM et al.. European S2k Guideline on Chronic Pruritus. Acta dermato-venereologica 2019. link 15 Silverberg JI. Practice Gaps in Pruritus. Dermatologic clinics 2016. link 16 Sarikaya Solak S, Kivanc Altunay I, Mertoglu Caliskan E. Chronic pruritus in Turkish dermatology outpatients: prevalence, sociodemographic and clinical characteristics. Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia 2016. link 17 Vigilante JA, Scribner J. Recurrent, pruritic papules on the legs. Dermatology online journal 2015. link 18 Solorzano C, Villafuerte D, Meda K, Cevikbas F, Bráz J, Sharif-Naeini R et al.. Primary afferent and spinal cord expression of gastrin-releasing peptide: message, protein, and antibody concerns. The Journal of neuroscience : the official journal of the Society for Neuroscience 2015. link 19 Azimi E, Lerner EA. The 7th World Congress on Itch. The Journal of investigative dermatology 2014. link 20 Pfab F, Schalock PC, Napadow V, Athanasiadis GI, Yosipovitch G, Ring J. Complementary integrative approach for treating pruritus. Dermatologic therapy 2013. link 21 Metz M, Wahn U, Gieler U, Stock P, Schmitt J, Blume-Peytavi U. Chronic pruritus associated with dermatologic disease in infancy and childhood: update from an interdisciplinary group of dermatologists and pediatricians. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology 2013. link 22 Panuganti B, Tarbox M. Evaluation and management of pruritus and scabies in the elderly population. Clinics in geriatric medicine 2013. link 23 Faye O, Cisse L, Berthe S, Dicko A, Ndiaye HT, Traore P et al.. Pruritus in dermatological hospital in Bamako, Mali. International journal of dermatology 2012. link 24 Kelekci KH, Adamhasan F, Gencdal S, Sayar H, Kelekci S. The impact of the latest classification system of benign vulvar diseases on the management of women with chronic vulvar pruritus. Indian journal of dermatology, venereology and leprology 2011. link 25 Patel T, Ishiuji Y, Yosipovitch G. Menthol: a refreshing look at this ancient compound. Journal of the American Academy of Dermatology 2007. link 26 Biró T, Ko MC, Bromm B, Wei ET, Bigliardi P, Siebenhaar F et al.. How best to fight that nasty itch - from new insights into the neuroimmunological, neuroendocrine, and neurophysiological bases of pruritus to novel therapeutic approaches. Experimental dermatology 2005. link 27 Bueller HA, Bernhard JD. Review of pruritus therapy. Dermatology nursing 1998. link 28 Yosipovitch G, Szolar C, Hui XY, Maibach H. Effect of topically applied menthol on thermal, pain and itch sensations and biophysical properties of the skin. Archives of dermatological research 1996. link 29 Fleischer AB. Pruritus in the elderly: management by senior dermatologists. Journal of the American Academy of Dermatology 1993. link70081-4) 30 Hanno R, Murphy P. Pruritus ani. Classification and management. Dermatologic clinics 1987. link 31 Heyl T. Brachioradial pruritus. Archives of dermatology 1983. link 32 Flaxman BA. Pruritus: identifying and treating the causes. Postgraduate medicine 1981. link

    Original source

    1. [1]
      European S2k Guideline on Chronic Pruritus. — Weisshaar E, Müller S, Szepietowski JC, Dalgard F, Garcovich S, Kupfer J et al. Acta dermato-venereologica (2025)
    2. [2]
      Current Management of Chronic Pruritus by French Dermatologists. — Encarnaçao Domingos-Ancement E, Brenaut E, Misery L Acta dermato-venereologica (2025)
    3. [3]
      Prurigo chronica multiformis: Expert consensus of the Japanese Dermatological Association. — Satoh T, Murota H, Aoyama Y, Hashimoto T, Ishiuji Y, Hatano Y et al. The Journal of dermatology (2024)
    4. [4]
      Acceptability and perceived benefits of validated pruritus assessment instruments in the dermatological office and clinic: The perspectives of patients and physicians. — Pereira MP, Zeidler C, Szymczak H, Bischoff C, Tsianakas A, Ständer S et al. Journal of the European Academy of Dermatology and Venereology : JEADV (2024)
    5. [5]
      Electrical matrix stimulation suppresses acute itch independently of activation of sleeping nociceptors. — Schwarzenauer M, Rukwied RM, Lampert A, Rolke R, Namer B European journal of pain (London, England) (2024)
    6. [6]
      [Translated article] Pruritus in Dermatology: Part 1-General Concepts and Pruritogens. — Navarro-Triviño FJ Actas dermo-sifiliograficas (2023)
    7. [7]
      [Translated article] Pruritus in Dermatology: Part 2-Diseases and Their Treatment. — Navarro-Triviño FJ Actas dermo-sifiliograficas (2023)
    8. [8]
      Measurement Properties of Patient-Reported Outcome Measures for Pruritus: An Updated Systematic Review. — Topp J, Apfelbacher C, Ständer S, Augustin M, Blome C The Journal of investigative dermatology (2022)
    9. [9]
      S2k guideline: Diagnosis and treatment of chronic pruritus. — Ständer S, Zeidler C, Augustin M, Darsow U, Kremer AE, Legat FJ et al. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology : JDDG (2022)
    10. [10]
      Optimizing doxepin therapy in dermatology: introducing blood level monitoring and genotype testing. — Myers B, Reddy V, Chan S, Thibodeaux Q, Brownstone N, Koo J The Journal of dermatological treatment (2022)
    11. [11]
      Systemic causes of non-dermatologic chronic pruritus in the pediatric population and their management: An unexplored area. — Gurnani P, Miloh T, Chandar J, Landau DA, Hajjar F, Yosipovitch G Pediatric dermatology (2021)
    12. [12]
      Longitudinal association between polypharmacy and development of pruritus: a Nationwide Cohort Study in a Japanese Population. — Kogame T, Kamitani T, Yamazaki H, Ogawa Y, Fukuhara S, Kabashima K et al. Journal of the European Academy of Dermatology and Venereology : JEADV (2021)
    13. [13]
      Actinic prurigo in a dermatological reference center in Colombia: 108 cases. — Pardo-Zamudio AC, Valbuena MC, Jiménez-Torres HD, Colmenares-Mejía CC Biomedica : revista del Instituto Nacional de Salud (2020)
    14. [14]
      European S2k Guideline on Chronic Pruritus. — Weisshaar E, Szepietowski JC, Dalgard FJ, Garcovich S, Gieler U, Giménez-Arnau AM et al. Acta dermato-venereologica (2019)
    15. [15]
      Practice Gaps in Pruritus. — Silverberg JI Dermatologic clinics (2016)
    16. [16]
      Chronic pruritus in Turkish dermatology outpatients: prevalence, sociodemographic and clinical characteristics. — Sarikaya Solak S, Kivanc Altunay I, Mertoglu Caliskan E Giornale italiano di dermatologia e venereologia : organo ufficiale, Societa italiana di dermatologia e sifilografia (2016)
    17. [17]
      Recurrent, pruritic papules on the legs. — Vigilante JA, Scribner J Dermatology online journal (2015)
    18. [18]
      Primary afferent and spinal cord expression of gastrin-releasing peptide: message, protein, and antibody concerns. — Solorzano C, Villafuerte D, Meda K, Cevikbas F, Bráz J, Sharif-Naeini R et al. The Journal of neuroscience : the official journal of the Society for Neuroscience (2015)
    19. [19]
      The 7th World Congress on Itch. — Azimi E, Lerner EA The Journal of investigative dermatology (2014)
    20. [20]
      Complementary integrative approach for treating pruritus. — Pfab F, Schalock PC, Napadow V, Athanasiadis GI, Yosipovitch G, Ring J Dermatologic therapy (2013)
    21. [21]
      Chronic pruritus associated with dermatologic disease in infancy and childhood: update from an interdisciplinary group of dermatologists and pediatricians. — Metz M, Wahn U, Gieler U, Stock P, Schmitt J, Blume-Peytavi U Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology (2013)
    22. [22]
      Evaluation and management of pruritus and scabies in the elderly population. — Panuganti B, Tarbox M Clinics in geriatric medicine (2013)
    23. [23]
      Pruritus in dermatological hospital in Bamako, Mali. — Faye O, Cisse L, Berthe S, Dicko A, Ndiaye HT, Traore P et al. International journal of dermatology (2012)
    24. [24]
      The impact of the latest classification system of benign vulvar diseases on the management of women with chronic vulvar pruritus. — Kelekci KH, Adamhasan F, Gencdal S, Sayar H, Kelekci S Indian journal of dermatology, venereology and leprology (2011)
    25. [25]
      Menthol: a refreshing look at this ancient compound. — Patel T, Ishiuji Y, Yosipovitch G Journal of the American Academy of Dermatology (2007)
    26. [26]
      How best to fight that nasty itch - from new insights into the neuroimmunological, neuroendocrine, and neurophysiological bases of pruritus to novel therapeutic approaches. — Biró T, Ko MC, Bromm B, Wei ET, Bigliardi P, Siebenhaar F et al. Experimental dermatology (2005)
    27. [27]
      Review of pruritus therapy. — Bueller HA, Bernhard JD Dermatology nursing (1998)
    28. [28]
      Effect of topically applied menthol on thermal, pain and itch sensations and biophysical properties of the skin. — Yosipovitch G, Szolar C, Hui XY, Maibach H Archives of dermatological research (1996)
    29. [29]
      Pruritus in the elderly: management by senior dermatologists. — Fleischer AB Journal of the American Academy of Dermatology (1993)
    30. [30]
      Pruritus ani. Classification and management. — Hanno R, Murphy P Dermatologic clinics (1987)
    31. [31]
      Brachioradial pruritus. — Heyl T Archives of dermatology (1983)
    32. [32]
      Pruritus: identifying and treating the causes. — Flaxman BA Postgraduate medicine (1981)
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