ANO - GENITAL PRURITUS Treatment

This condition results when any potentially pruritic eruption affects the ano-genital region. It is aggravated and prolonged by the process of lichenification. Pruritus has a pleasurable component—especially when it has this distribution. In sexual frigidity ano-genital pruritus may serve to rationalize the psychological disability. In some patients these attitudes towards pruritus greatly increase the difficulty in finding effective treatment.

Diabetes and threadworms must first be excluded. Local abnormalities causing vaginal discharge and secondary dermatitis are fairly easily diagnosed from the history and a careful physical examination.

For the symptomatic relief of the irritation the corticosteroid ointments have proved invaluable, and they should be combined with appropriate anti-infective agents to deal with the mixed flora of micro-organisms found in this region. Thus a combination of triamcinolone, neomycin, gramicidin and nystatin is often useful. Radiotherapy which was formerly in common use is now recom­mended only as a last resort, and should then be confined to women past the child-bearing age. Yeast infections of the bowel resulting from oral tetracycline therapy can precipitate anal pruritus. The bowel flora usually reverts to normal spontaneously when antibiotic therapy is stopped and the pruritus subsides. If, however, the yeast infection persists and causes ano-genital dermatitis, nystatin should be given by mouth in doses of ^ million units thrice daily. Recurring yeast infections in the ano-genital region should serve as a reminder to exclude a diagnosis of diabetes mellitus.


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