Anal / perianal eczema

Last Updated: 2021-07-26

Author(s): Navarini

Anal itch

Spongiotic dermatitis of the anus.

  • Atopy
  • Toxic-cumulative effects
  • Contact allergy (wet toilet wipes)

Erythematous, sometimes confluent, often highly pruritic and excoriated papules in the area of the anus.

  • Medical history (atopy, use of wet wipes, hygiene).
  • Clinic
  • Patch testing if necessary
  • Atopy testing if necessary
  • If necessary, biopsy in case of therapy resistance and suspicion of extramammary Paget's disease
  • Candida swab if necessary

Anal / perianal region. 

Secondary colonization with C. albicans.

Typically chronic. Have to break the vicious cycle in case manual irritation is involved. The secret sign for this is lichenification. 

  • Elimination of the cause, if possible. Always make sure that manual irritation is eliminated as much as possible. This can be often just forceful cleaning with toilet paper. Regardless, always have the patient trim the fingernails so that the white margo liber is not visible anymore. 
  • Short-term medium strength steroids, such as betamethasone or momethasone.
  • After inflammation is well-controlled, begin long-term application of calcineurin inhibitor bd (Tacrolimus). Can irritate in the first few days, inform the patient about this so that adherence does not drop. 
  • Tannosynt sitz bath
  • Liquor carbonis detergens (Helps some patients a lot, but local irritation may occur. The odor is distressing for many patients).