Hofer - Liebl - Specialists in Visceral Surgery and Proctology

Anal skin diseases

Itching, burning, rash

(Contribution in progress...)

Symptoms in the area of the outer skin around the anus (anus) are among the most common reasons why patients consult a proctologist. Although usually harmless, these complaints can significantly affect the quality of life.

The most important point for successful treatment is whether a cause can be found in the rectum. The examination therefore always includes a reflection of the rectum (proctoscopy, rectoscopy if necessary).

In doing so, one looks for inflammation of the mucous membrane(proctitis), a possible fistula opening as well as an internal or external prolapse of haemorrhoids or intestinal wall. These diseases cause chronic irritation of the surrounding skin due to moisture leakage.

If the rectal examination is unremarkable, one must assume a primary disease of the skin. A possible history of neurodermatitis, allergies or psoriasis supports this assumption. In this case, referral to a specialist in skin diseases (dermatology) is recommended.

Itching, scratching, burning at the anus
When the toilet paper feels like barbed wire....

When it itches and burns

Anal eczema: forms and causes

Irritative-toxic anal eczema

This complicated term refers to irritation of the skin caused by external influences such as moisture or irritating substances. However, these can also have an internal cause, such as anal dampness in haemorrhoidal disease or digestive enzymes in LARS (syndrome after deep rectal resection for rectal cancer). Therefore, the examination of the skin around the anus (perianal) always includes an examination of the rectum. Treatment depends on the cause, for example, haemorrhoid sclerotherapy can remove the dampness and the skin can recover.

Allergic Anal eczema

Allergic anal eczema belongs to the group of contact dermatitis, which is triggered by local exposure to an allergic substance (allergen). It is a reaction mediated by immune cells (T-lymphocytes). It is therefore understandable that this process of cells migrating into the affected area takes some time (late-type allergy) and leads to an initial thickening or swelling of the affected skin area, accompanied by redness.

In the area of the anus, common contact allergens are found in the preservatives and fragrances of moist toilet paper, personal care products (wool wax and wool wax alcohols in creams) and washing lotions.

Among the drugs or active substances used on the anus, it is often the local anaesthetic components in ointments for pain.

Therefore, the first immediate measure is to leave out everything that is not absolutely necessary. An allergy test at the dermatologist is recommended to further narrow down the trigger. In severe cases, treatment with a cortisone cream is also necessary.

Atopic Anal eczema

Atopic anal eczema is also the result of an excessive immune reaction. A history of neurodermatitis in childhood or multiple allergies, a so-called atopic disposition, is often found. Typically, the clinical picture is varied, with redness, sores (erosions) and traces of nocturnal scratching. In the acute situation, usually only a cream containing cortisone helps. However, cortisone preparations are only "allowed" on the anus for intervals of up to about 7 days, as longer-term use can cause permanent damage to the skin. This "thinning" of the skin is called atrophy. Alternative substances are therefore used as long-term treatment, such as the immunomodulators Protopic® and Elidel®.