Intra-dermal methylene blue, hydrocortisone and lignocaine for chronic, intractable pruritus ani.

OBJECTIVE

To assess the use of intradermal methylene blue, lignocaine and hydrocortisone in cases of chronic pruritus ani refractory to standard primary, dermatological and colorectal care. METHODS: Five ml 1% methylene blue, 100 mg hydrocortisone and 15 ml 1% lignocaine were injected into the peri-anal skin of 25 patients with chronic pruritus ani which had proved refractory to standard care. Clinical and telephone follow-up was undertaken. RESULTS: After one injection of the above solution, 16 (64%) of patients were rendered symptom free. Repeat injection in those initial nonresponders ultimately rendered 22 (88%) symptom free overall. Morbidity was 4%. Treatment failure occurred in three patients (12%). CONCLUSIONS: Methylene blue used in solution with hydrocortisone and lignocaine can achieve effective control of pruritus ani in 88% of patients who have failed to respond to standard dermatological, hygiene and surgical treatments.