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Pruritus Ani, Vulvae

Pruritus ani (or itching of the anal area) can cause great distress and has many causes. Some of the causes are diarrhoea, fungal infections (particularly after taking antibiotics for long periods), tight synthetic clothing, stress, haemorrhoids, diabetes, warts, eczema, seborrhoeic dermatitis, psoriasis, rough toilet paper, deodorants or soaps. Clinical features vary depending on the cause of the pruritus.

All cases are exacerbated by rubbing or secondary infection. Pruritus vulvae (or severe itching of the external female genitalia) can be caused by tight, synthetic underwear, pantyhose, rough jeans or other clothing, prolonged use of antibiotics or contraceptive pills, fungal infections, bodily secretions or diabetes. Again, clinical features vary with the cause. Candida albicans frequently causes a superimposed monilial or thrush infection in warm, moist areas where inflammation is already present, such as the groin, vulvovaginal or anal areas.

Treatment varies depending on the cause of the pruritus. Symptomatic relief is important both for the well being of the patient and to help prevent damage due to rubbing and scratching. Bacterial or fungal infections need to be identified in order to prescribe correct treatment.

Advice for the Patient

The patient should be advised not to scratch. Scratching sets up the itch-scratch cycle and may lead to damage to the skin. Loose, soft clothing should be worn which allows air to circulate and does not rub the skin. Cotton is preferable to synthetic clothing as it absorbs sweat and helps to keep the skin dry and cool.

Do not use deodorants on the affected area as they may increase the irritation. After a bowel movement, a blotting action is less abrasive than rubbing the skin and the area should be washed if possible, using wet tissue or cotton wool soaked in Pinetarsol Solution.

Products to Help
Anti-pruritics, Soap Alternatives

PINETARSOL BATH OIL
Pinetarsol Bath Oil is a non-greasy, water dispersable bath oil for the treatment of dry, itching, inflamed skin conditions. Containing pine tar, Pinetarsol Bath Oil reduces inflammation and relieves pruritus. Pinetarsol Bath Oil also contains emollient oils to hydrate the skin. Due to the cleansing properties of Pinetarsol Bath Oil it can be used as a soap alternative. Add 15-30mL to a warm to tepid bath (5mL to a baby’s bath or hand basin) and bathe for 10 minutes once daily, more often in severe cases. Pat skin dry.

PINETARSOL SOLUTION
An anti-itch, anti-inflammatory and cleansing solution with a pH of 6.5, Pinetarsol Solution relieves itching and reduces inflammation. Bathing also helps to keep the skin and fingernails clean to reduce the risk of secondary infection caused by scratching. Add 15 - 30 mL to a warm to tepid bath (5 mL to baby’s bath). Bathe for 5 – 10 minutes, once daily or more often in severe cases.

PINETARSOL GEL
Pinetarsol Gel is a gentle soap alternative which relieves red and itching skin. The soft gel formulation gently cleanses tender skin and has a pH of 6 to maintain the skin’s natural acid protection against infection. Use for dermatitis, anal or genital itching, jogger’s groin rash, inflamed, scaly skin and other minor skin irritations.

Topical Anti-inflammatories - Nonsteroidal

EGODERM OINTMENT
Egoderm Ointment is a mild anti-inflammatory product containing ichthammol as a anti-inflammatory, zinc oxide for added soothing and
dimethicone for protection. Egoderm Ointment is recommended for use when the skin requires protection such as dribble rash or ano-genital pruritus. Apply to affected skin 3 times daily. Anti-fungal, Anti-inflammatories

RESOLVE BALM
Contains 2% miconozole nitrate to provide effective treatment of tender, inflamed or itchy skin infections. It also contains bufexamac to reduce inflammation, and is cortisone free. Use for thrush of the vulval area, male groin area or under the breast, fungal infected eczema/dermatitis, pityriasis versicolor and pityrosporum folliculitis with pityrosporum organisms. It rapidly soothes inflamed skin. Apply to the affected and surrounding skin twice daily for two weeks after symptoms disappear to avoid recurrence.