Perianal neurodermatitis is a chronic and limited form of neurodermatitis, which is a neurological dermatosis with itchy sensation and skin damage. In ancestral medicine, it belongs to the category of urchin. It is discussed in some detail in works such as “Treatise on the Origin of Diseases” and “Surgical Zhengzong”. In addition, there are different names such as wind ringworm and psoriasis. The disease is characterized by a slow course, recurrent attacks, and often does not heal for several years.
I. Etiology and pathology
This disease is caused by the seven emotions, mostly due to internal fire in the heart, combined with the feeling of wind-dampness and heat, which block the skin, blood deficiency and wind dryness, and loss of skin glory. The etiology of the disease can be broadly divided into the following three categories.
(a) neuropsychiatric factors: due to emotional fluctuations, excessive mental excitement, depression, tension, anxiety, terror or neurasthenia, causing disorders of the plant nervous system, and thus the occurrence of perianal neurodermatitis. When the nerve function is abnormal, the activity function of the cerebral cortex is also disturbed and cannot regulate the relationship between the cerebral cortex and the skin. In this state, regardless of any stimulation, its skin is prone to react with tinea-like changes.
(B) Stimulating xenin: change of living environment, underwear friction, scratching and other local stimulation are all triggering causes.
(C) Disease factors: digestive system diseases, endocrine disorders, etc., are also prone to induce this disease.
II. Symptoms
At the beginning of the disease, there is only local paroxysmal severe itching, especially at night, often causing insomnia. Later, due to scratching, the skin damage is flat round or polygonal papules, dense clusters, normal skin color or light brown, the surface is smooth or covered with a very thin layer of furfur-like scales. As the disease progresses, the papules gradually fuse, the lesions increase in size, dark brown in color, and the skin thickens, forming a tinea-like sclerosis. At this time, the skin lines deepen, rhombic or polygonal, become dry and thick, resembling leather, with elevated skin crests, rough appearance, and scratch marks, bleeding spots or crusts on the epidermis and surrounding areas.
The clinical diagnosis of this disease is often divided into three types.
(a) rheumatic heat type: the patient’s rash is accompanied by flushing, moist or crusted with blood after scratching, with a red tongue, thin yellow or yellow greasy coating, floating or moist pulse, and a short duration of illness. Some patients also have symptoms such as dizziness, insomnia, palpitation and constipation.
(2) Spleen deficiency and dampness type: the disease lasts longer, with tinea-like changes in the perianal skin, often with secretions in the anus, or exudate flowing out due to scratching, making the perianal area damp, tiredness, loss of appetite, loose stools, or diarrhea, with a light tongue, thin white fur, and a thin, moist pulse.
Diagnosis
The diagnosis of the disease can be made based on the duration of the disease, the site of onset, the significant itching and tinea-like sclerosis. However, attention should be paid to differentiate it from the following diseases.
(a) Chronic eczema: there is often a history of acute eczema episodes with significant infiltration and thickening of the damage, often covered with scales and crusts; lichenoid lesions, which are uncommon or not prominent.
(B) Lichen planus: damage is purple-brown, dark red, or skin-colored flat papules with a waxy sheen on the surface; biopsy for histopathological examination has diagnostic value.
IV. Treatment
(I) Internal treatment.
1, dredge wind and clear heat, accompanied by dispelling dampness: applicable to patients with rheumatic heat type. The selected formula is often used to eliminate wind and heat with addition and subtraction or I clear heat drink with addition and subtraction.
2, nourish blood to dispel wind: for blood deficiency wind dry type patients. The selected formula is often used to eliminate wind with four substances or angelica drink. If insomnia due to blood deficiency and hyperactivity of Yang, with tianma hook vine drink, or in the above add mother of pearl, dragon bones, oysters, Wuweizi, nightshade, etc.
3, strengthen the spleen and remove dampness: applicable to spleen deficiency and dampness type. The selected formula is often used to remove dampness and stomach Ling Tang plus or minus.
In addition, oral antihistamines, sedatives or 1-2% procaine hydrochloride solution, 5-10 ml each time, 3 times a day, within 1 hour before meals, can be taken as appropriate. If there are systemic diseases (digestive system, endocrine disorders, etc.), the triggering cause should be removed.
(II) External treatment method.
1, local external use of 20-40% coal tar tincture, neurodermatitis tincture, or 5-10 pine distillation oil ointment, 5-10% sulfur coal tar ointment; skin hypertrophy less severe, external use of 0.1-0.25% fludrocortisone acetate soft, 2 times a day. Also available five times the cream, dermatitis cream, wound damp pain cream, etc., external dressing.
2.Local closure: 1～2％ procaine hydrochloride solution or long-acting analgesic solution, 5～10ml each time, 1～2 times a week, infiltrate and inject in the affected area.
3.Acupuncture therapy: prick with seven-star needle, plum blossom needle, or moxibustion with moxa stick on the affected area.
4, physical therapy: local skin lesions, by a variety of drug treatment effect is not good, can use shallow X irradiation, or with isotope phosphorus, strontium dressing treatment.