Perianal eczema is an allergic inflammatory skin disease that occurs in the perianal area. In Chinese medicine, it is called “damp sore”, “blood wind sore”, “dipping sore” and so on. The disease is mostly confined to the anus and its surrounding skin, but in severe cases it can spread to the buttocks, perineum, scrotum and other places. The disease can develop in both men and women, young and old, with the majority being congenitally endowed with intolerance, without obvious seasonality, and often recurs in winter. According to the course of the disease, it is divided into three categories: acute, subacute and chronic.
Etiology and disease mechanism
Western medicine]
Eczema etiology is more complex, is now recognized as a metabolic inflammatory skin disease.
1, physical and genetic factors, seen in patients with allergies, can be complicated by asthma, rhinitis and other allergic diseases.
2, mental and neurological factors, common after high tension, fatigue, worry and panic, insomnia, etc..
3, digestive system dysfunction, resulting in the invasion of foreign proteins or allergens into the body.
4, endocrine disorders, women with menstrual disorders or diabetes induced eczema after the decline in muscle resistance.
5, exposure to certain foods, pollen, cosmetics, detergents, dyes, hot and cold light, etc.
6, secondary to the stimulation of perianal diseases such as prolapse, hemorrhoids and anal fistula.
【TCM】
Most factors are weakness, endowment intolerance, diet disorders, spleen loss of health, damp-heat endogenous; or feel the evil of wind, damp, heat, insect poison; or blood deficiency to produce wind, dryness and injury to yin, skin loss of nourishment. In acute cases, damp-heat is often the main cause; in subacute cases, it is mostly related to spleen deficiency and dampness; in chronic cases, it is mostly due to depletion of yin and blood due to prolonged illness, blood deficiency and wind dryness, often manifested as skin nail fault.
Clinical symptoms
Itching is the main symptom of eczema. Anal damp eczema can increase perianal exudate, often contaminating underwear. Pain is often seen in conjunction with itching, mostly after scratching and ulceration. Systemic symptoms often include stomach discomfort, bloating, diarrhea, constipation, irritability and insomnia.
Diagnostic points]
Acute eczema lesions are polymorphic, diffuse, and symmetrically distributed. Most of them appear as dense corn-sized papules, papules, and small blisters. The base is flushed, oozing, itchy, scratched and bleeding, and erosion. Combined infections can form pustules and folliculitis.
Subacute eczema is caused by acute eczema that is not treated and is prolonged. The lesions are lighter, mainly papules, crusts, scales, mild erosions, itching is intense, especially at night.
The chronic eczema is mostly transformed from acute and subacute eczema repeatedly, and often recurrent episodes do not heal over time.
Differential diagnosis]
Contact dermatitis has an obvious cause and is often limited to the site of contact. Neurodermatitis lesions are typically mossy, without exudation and polymorphic rash. Anal pruritus is dominated by hypertrophy of the anal folds, with mossy lesions and radiolucent ruptures, mostly without exudation, and dry scratches and blood scabs.
【Treatment measures
【Western medicine treatment
General treatment
Find the cause of the disease, detailed medical history, working and living environment, habits, etc.; allergen test can be done to find out the allergenic source.
Local treatment
1. Topical drugs.
(1) acute eczema at the beginning of the disease only flushing, papules or a few small blisters without exudate, treatment should be gentle and anti-inflammatory, avoid stimulation, can be used wet compresses or lotions with antipruritic effect, can be applied externally furnace glycerine lotion, 4-6 times a day. When itching is heavy, corticosteroid cream can be applied externally, such as: hydrocortisone cream, Youzhuoer ointment, Pirexone ointment, etc.; vesicular exudate with saline or 4% boric acid solution wet compress, each 30 minutes, 2-4 times a day, after the reduction of exudation, change to external application of zinc oxide cream.
(2) subacute eczema can be used anti-inflammatory astringent anti-itch agent, such as zinc oxide cream or corticosteroid cream.
(3) chronic eczema treatment is appropriate to stop itching, inhibit epidermal cell proliferation to promote dermal inflammation absorption, can be used corticosteroid cream, ointment or hard cream, zinc oxide ointment and tar-based ointment.
2, local closure: chronic eczema with intractable pruritus, available 0.5% lidocaine 20ml plus methylene chloride 2ml perianal intradermal dot injection.
3, physical and radiotherapy: for chronic eczema skin lesions more limited.
Systemic treatment]
1, antihistamines: such as paracetamol 4-8mg 3 times a day, orally. Xithmin 10mg once a day orally, etc. The second generation of antihistamines without sedative effect can also be used, the representative drugs are cetirizine 10mg or keratan 10mg or xylazine 10mg once a day orally.
2.Non-specific desensitization therapy: 10% calcium gluconate 10ml or sodium thiosulfate 0.64 diluted with 10ml of water for injection and injected slowly intravenously; or combined with 5% glucose 500ml plus vitamin C 2g. once a day for sedation.
3.Corticosteroid is suitable for those with extensive skin lesions and other therapies are not effective.
4.Other therapies.
Chinese medicine treatment
Internal treatment method
Damp-heat type of this type, equivalent to acute eczema, with flushed lesions, blisters, vesicles, fluid, intense itching, accompanied by chest tightness and dullness, dry stools, yellow urine, dark red tongue, thin yellow greasy coating, slippery pulse.
Treatment: Clearing heat and relieving dampness, cooling the blood and detoxifying the toxin.
Treatment: Gentian and liver diarrhea soup, Dioscorea and dampness soup combined with Ermiao Wan, plus or minus. Gentiana 10g, Scutellaria 10g, Dan Pi 15g, Yin Hua 30g, Forsythia 15g, Bitter Ginseng 10g, Atractylodes 10g, Dioscorea 10g, Phellodendron 10g, Yin Chen 10g, Radix et Rhizoma Glycyrrhiza 6g, with heat, Radix et Rhizoma Gastrodiae 30g, Radix et Rhizoma Bacopaeniae 30g; with constipation, Radix et Rhizoma 10g.
Blood deficiency and wind dryness type, mostly chronic eczema. The lesions are hypertrophic and keratinized and ruptured, or there are scratches and blood scabs, with recurrent attacks that do not heal for several years, often accompanied by human wasting, with a light tongue and white fur, and a sunken pulse.
Treatment: Nourish the blood and dredge the wind, remove dampness and moisten dryness.
Remedy: Dissipate wind or Siwu Dissipate wind with addition and reduction. Radix Rehmanniae Praeparata 30g, Radix Paeoniae Alba 15g, Radix Angelicae Sinensis 10g, Radix Salviae Miltiorrhizae 20g, Radix Rehmanniae Miltiorrhizae 15g, Radix Bupleuri 10g, Radix Dioscorea 10g, Poria Bark 30g, Rhizoma Serpentis 10g, Radix Glycyrrhiza Uralensis 6g. Decoction with water, one dose per day, divided into two doses.
Dampness trapped in the spleen and stomach type, mostly subacute eczema, lesions dark red, light red or not red, blisters are not much, but the liquid water immersion, dull stomach, impotent face, loose urine, white greasy moss, smooth pulse.
Treatment: Strengthening the spleen and removing dampness, nourishing the blood and moistening the skin.
Direction: Removing Dampness and Stomach Ling Tang with addition and subtraction. Atractylodes Macrocephala 15g, Atractylodes Macrocephala 15g, Poria 15g, Poria 20g, Rhizoma Yam 15g, Raw Job’s Tear 30g, Plantago 10g, Zeligia 15g, Xu Changqing 30g, Chen Pi 10g, Yin Chen 10g, Raw Licorice 6g. Add Patchouli and Perilla if the stomach is sluggish; add Dioscorea and Bitter Ginseng if there is much exudation.
Home care]
Keep the perianal skin clean, change underwear regularly, do not wear chemical fiber underwear and fur clothing. Do not touch allergy-prone substances. Prohibit scratching the lesion area with hands or washing with hot water to avoid aggravating the disease.
Prevention and rehabilitation]
Exercise regularly to increase the body’s resistance. Avoid fatigue and mental tension. Avoid external stimuli, such as hot water, strenuous scratching, etc.; avoid spicy, seafood, fish and shrimp and other stimulating foods. Pay attention to maintain local hygiene of the anus, do not sit for a long time, avoid overwork, and maintain optimism to actively treat perianal pathologies that may cause eczema, such as hemorrhoids, fistulas, fissures, intestinal parasites and other diseases.