(Disclaimer: The contents of this article are for general use only, and the following information is handled to protect the privacy of the patient)
Abstract: This is a case of a 55-year-old male who was operated on in our department for “anal papilloma”. On the second day of postoperative checkup, the patient reported redness and itching around the anus, most severely in the postoperative tape. After briefly understanding the situation, we examined the patient and asked about the history of exposure to special substances in the perianal area and related examinations, and considered it to be perianal dermatitis. The patient was given medication, and after treatment, the patient’s perianal itching and lesions disappeared and he recovered well.
Basic information】Male, 55 years old
Disease Type】Perianal dermatitis
Hospital】Hegang City People’s Hospital
Date of consultation】July 2020
Treatment plan】Medication (loratadine tablets, vitamin C tablets, tretinoin econazole cream)
Treatment Period】10 days of hospitalization and 2 months of follow-up
Treatment effect】Perianal itching and lesions disappeared, good recovery
I. Initial consultation
Patient Mr. Li, 55 years old, underwent surgery for “anal papilloma” in our department. The surgery went smoothly, and the patient was given anti-inflammatory treatment and daily change of anal medication during hospitalization. On the second postoperative day, during a room visit, the patient reported that he was suffering from perianal itching, which had appeared in the afternoon of the previous day, but he did not care about it. I then performed a brief examination of the patient and found that the skin in the anal and perianal areas was red, with significant local breakage and congestion, most severely in the postoperative tape area. At this point, the initial consideration was perianal dermatitis.
II. Treatment history
The patient in this case showed symptoms of perianal itching and discomfort 2 days after anal surgery, and did not care at first, but the itching in the anus became unbearable and needed to be scratched to stop itching. The main treatment for perianal dermatitis was pharmacological, and the patient was given oral antihistamine loratadine tablets, as well as vitamin C tablets. The perianal lesions exuded little fluid and did not have blisters, vesicles or crusts, so no drug wet dressing was given, and topical trimethoprim econazole cream was applied. The application of antibacterial drugs was continued to prevent secondary infection and the use of tape was discontinued at the time of anal dressing change. On the day of medication, anal itching was greatly relieved, and after 10 days, the patient’s anal skin color had returned to normal and was discharged from the hospital.
III. Treatment effect
The patient’s acute onset was promptly controlled after drug treatment and did not convert to chronic perianal dermatitis, and no recurrence of the disease was seen in the follow-up period of 2 months, indicating that the patient got the curative effect by regular treatment. The patient was treated with rapid removal of allergy-inducing factors, i.e., tape. Together with active pharmacological intervention, the patient’s immunity gradually recovered, the pruritus symptoms were relieved, the lesions disappeared, and no pigmentation or other sequelae were left, and the recovery was good. If perianal pruritus discomfort or dermatitis recurs after cure, timely review at the hospital is required and allergen determination is performed if necessary.
IV. Precautions
We are glad that the patient’s symptoms are relieved and the disease is recovered. After discharge, patients are advised to strengthen local care, avoid perianal friction and scratching perianal area to reduce trauma; keep clothing and bed sheets clean, and intimate clothing should be loose, soft and comfortable to avoid frictional stimulation of perianal skin by clothing; in addition, pay attention to skin cleaning of perianal area. In terms of diet, it is recommended to have a light and nutritious diet, drink water appropriately, eat more vitamin-rich foods, such as green vegetables, fruits and melons, etc. Avoid eating spicy and stimulating foods, such as onion, ginger, garlic, chili and other foods, and seafood is also not recommended. In addition, you should keep the indoor air fresh, open the windows regularly, and the environment as comfortable and clean as possible. Develop good living habits, pay attention to the combination of work and rest, and maintain sufficient sleep.
V. Personal insight
Perianal dermatitis is mostly acute and self-limiting, and the skin around the anus can be completely recovered in 1-2 weeks with active regular treatment. If repeated contact with allergic substances or improper treatment, it can evolve into subacute or chronic dermatitis with mossy changes or eczema-like lesions, which is less effective. Patients with perianal dermatitis are advised to look for and remember allergic substances and avoid re-exposure to prevent recurrence; for allergens related to one’s occupation, it is recommended to strengthen protective measures or change the working environment. As perianal itching is unbearable during acute attacks of perianal dermatitis, patients may become anxious and restless, and need to be comforted and educated in science to make them understand the disease correctly and thus stabilize their emotions.