Stubborn itching of the skin around the anus, which does not heal over time, is called anal pruritus, a more common limited pruritus. In Chinese medicine, it belongs to the category of itchy wind. It is mostly paroxysmal and usually limited to the perianal area, but sometimes it can spread to the perineum, vagina or scrotum.
I. Etiology
According to traditional Chinese medicine, itch is caused by wind, dampness, heat, worms and blood deficiency, and there is also the saying that “all itches are deficient and windy, and heat is painful when it is abundant, while heat is itchy when it is slight. Itchy anus is caused by blood deficiency, wind, dampness, damp-heat stagnation and insect harassment of anal skin.
Modern medicine believes that this disease has the following factors.
(a) allergic reactions: consumption of irritating foods, such as certain chili peppers, mustard, spices, tobacco, alcohol or idiosyncratic protein foods. In addition, the use of certain drugs, such as morphine, quinine, arsenic, sulfonamides, antibacterial agents, anesthetics, etc., can cause anal itching.
(ii) Disease factors: chronic dyspepsia, diabetes, blood diseases, rheumatism, menopausal syndrome, jaundice, uremia, endocrine disorders, urticaria, syphilis, vaginal fungal infections, trichomoniasis, etc., can cause anal itching.
(iii) mental factors: such as neurasthenia, hysteria, excessive mental tension, excitement, agitation, etc., can cause this disease to occur.
(iv) genetic factors: people who are abnormally sensitive to perception and have family heredity can have anal itching in about 60% of cases.
(E) irritating factors: anal dampness and secretion stimulation are common causative factors. Such as anal fistula, internal and external hemorrhoids, anal fissure, anal sinusitis, anal papillitis, anal relaxation to increase secretions, mucus overflow; women with excessive vaginal secretions, perianal skin sweat glands and sebaceous glands secretions stimulation; fecal residue, intra-fecal indole, fecal odorant, stimulation of chemical drugs, can cause anal itching. In addition, body fat buttock fissure deep, old skin atrophy degeneration, or due to dryness, cold climate, temperature changes, or soap and stool paper too hard and other stimuli, also prone to anal itching.
(F) parasites: pinworms, pubic lice, roundworms, scabies, can cause anal itching.
(vii) skin diseases: such as eczema, ringworm, warts, folliculitis, dermatitis, neurodermatitis, etc., can also cause anal itching.
II. Symptoms and diagnosis
The main symptom is persistent itching around the anus, which is sometimes light and sometimes heavy; intermittent or persistent itching, and after scratching with hands, the burning pain is more intense, sometimes stinging, sometimes like insect bites, insect crawling, sometimes burning, ant walking, etc., which is worse at night and affects sleep. Local scratches, often bleeding, erosion, fissures, oozing, crusting and other continued damage, thickening of the affected skin, hypertrophy of the folds, tinea-like changes in the skin after prolonged illness, hyperpigmentation or hypopigmentation. In addition to the changes in signs, a systemic examination should be performed to determine if it is related to diabetes, parasitic diseases, etc.
III. Treatment
(a) Internal treatment: First, the cause should be removed as much as possible, the relevant disease should be treated in time, and local stimulation should be avoided and reduced, and then the treatment should be discriminated.
1. Nourish blood and moisten dryness, dispel wind and relieve itching: applicable to patients with blood deficiency and wind. Commonly used formula: 20 grams of Radix Rehmanniae, 15 grams of Radix et Rhizoma Ginseng, 15 grams of Mai Men Dong, 9 grams of Radix Paeoniae Alba, 9 grams of Peony Peel, 9 grams of White Moss Peel, 5 grams of Cicadellus, 15 grams of Hedychium Peel, 15 grams of He Shou Wu, 9 grams of Zhi Mu, decocted in water, one dose per day; or use Four Things to dispel wind drink.
2.Clear heat and dampness: for patients with dampness and heat obstruction. The selected formula is often used in Dioscorea Infiltration Dampness Soup. In case of damp-heat infiltrating the liver meridian, use Gentian Diarrhea Liver Soup. For those with infection, add honeysuckle, forsythia, asteranthus, cypress, atractylodes, coix seeds, etc.
3.Expel wind and infiltrate dampness: applicable to patients with wind and dampness. The selected formula is often used in Dioscorea Infiltration Dampness Soup, with the addition of Thornbush, Fenghuang, Peppermint and Cicada.
4.Killing insects and relieving itching: for patients harassed by insects, the formula is often used in Peach Skin Soup with addition and subtraction.
5, antihistamine drug therapy: paracetamol, benadryl and other drugs can be used to sedate and relieve itching, also available 10% calcium gluconate or 5% calcium bromide intravenous injection, once a day or every other day.
6, hormone therapy: branch menopause and elderly patients with severe disease, available sex hormone therapy. Women with has enestradiol 0.5 ~ 1 mg, oral, once a night: men with testosterone propionate 25 mg, intramuscular injection, 1 to 2 times a week.
7, mycobacterial infection, oral mycobacterium, each time 500 to 1 million units, 3 times a day.
(B) External treatment methods.
1, topical antipruritic agents: 5% camphor powder, 2% carbolic acid ointment, 30% tincture of bacopa monniera, glyburide lotion, fludrocortisone acetate ointment, etc.. For those with eczema-like lesions, 2% camphor cream, 5% benzocaine cream, Bishou cream and 5% sulfur coal tar ointment can be used.
2, fumigant: 30 grams of bitter ginseng, 15 grams of Cang Er Zi, 30 grams of snake bed seeds, 30 grams of Wei Ling Xian, 1 gram of ice chips (after the next), water decoction, first smoked and then washed.
3, the anus for ultraviolet or infrared radiation.
4.Acupuncture therapy: take Changqiang, Lumbar Yu, Chengshan, Sanyinjiao, Yinlingquan and other points, strong stimulation, once a day.
5, topical insecticide: such as scabies, available 10-20% sulfur ointment, two two-three benzoate drops. If it is vaginal trichomonas, available methotrexate, put 500 mg of vaginal tablets daily, 10 to 20 days per course.
(iii) Surgical treatment.
1.Injection therapy: commonly used drugs include seventy-three one, long-acting on pain solution, Bran pain relief solution, Puvic injection, etc.
Specific operation methods are.
① perianal closure method: prepare the skin before surgery, disinfect routinely, lay a towel, and inject Bulan pain relief solution into the perianal skin or subcutaneously with a fine needle in a fan or point shape, the total amount does not exceed 20 ml, and pain medication is available when it is painful.
②Changqiang point injection method: the patient takes the side lying position, the perianal area and around the long strong point for routine disinfection, after laying towels, with a long thin needle No. 5 into the long strong point, to have a sore numbness and swelling, inject Pu Wei injection 5 ~ 10 ml; can also be made in the long strong point fan-shaped injection, closed after the anus and its subcutaneous. Note that the needle must not be too deep to avoid penetrating into the anal canal or rectum.
2.perianal nerve endings cutting: after the routine preparation of skin and enema, the patient is placed in a truncated position after lumbar anesthesia, and then disinfected and toweled routinely; then a curved incision is made in both anuses, and the anus is dissected subconsciously; finally the wound is sutured, and the stool is controlled for 2-3 days, and the sutures are removed after 7 days with a sitz bath, drug change, and local disinfection.
3, excision flap grafting: preoperative preparation as before, on the anal side, cut the skin along the anal margin and excise the pruritic skin. At the normal skin on the outside of the wound, cut a skin flap with a similar shape to the wound, with the bottom of the skin flap at the back, and suture the transplanted skin flap to the wound, and finally suture the skin flap wound, compress it with gauze externally, and after 2 to 3 weeks, treat the opposite side with the same method.
IV. Prevention.
(a) Remove the cause of the disease: pay special attention to whether the patient has internal organs and local diseases. If there are other diseases, early treatment should be given
(B) Avoid irritating and allergic foods and drugs: such as wine, strong tea, chili, salted fish, etc. In case of drug allergy, the drug should be stopped immediately.
(C) Avoid local irritation: avoid scratching, change clothes for allergy, and wash the affected area without alkaline drugs that are too strong.
(iv) Keep local cleanliness: wash the anus with warm water bath after stool, and also locally apply gentian violet liquid, sprinkle skin sticky san or zinc oxide powder.