Cohen Arnon D, Vander Tatiana, Medvendovsky Evgeny, Biton Amnon, Naimer Sody, Shalev Raquel, Vardy Daniel A
Dermatology Service, Clalit Health Services, Southern District, Israel.
J Am Acad Dermatol. 2005 Jan;52(1):61-6. doi: 10.1016/j.jaad.2004.04.039.
Anogenital pruritus is defined as an itch localized to the anus, perianal, and genital skin. Anogenital pruritus is usually a symptom of an underlying disorder of the skin or mucosa or a consequence of anorectal pathology. When no demonstrable cause is found, anogenital pruritus is often described as "idiopathic".
To investigate the role of lumbosacral radiculopathy in the pathogenesis of anogenital pruritus.
Included in the study were consecutive patients with anogenital pruritus. Radiographs and nerved conduction studies were performed in all patients. Needle electromyography studies and computerized tomography were performed when necessary. Nerve conduction studies included measurement of distal sensory and motor latency, conduction velocity, and F-responses of the peroneal and tibial nerves. Patients with confirmed radiculopathy were treated with paravertebral injection of a mixture of triamcinolne acetonide and lidocaine. Response to the injections was assessed using visual analogue scales by the patients. Mean scores before and after treatment were compared using paired t tests.
Included in the study were 20 patients with anogenital pruritus. There were 18 men (90%) and 2 (10%) women. The mean age was 52.7 years (standard deviation [SD] 11.7 years). In 16 patients (80%), radiographs demonstrated degenerative changes of the lower spine. In 16 patients (80%) the presence of lumbosacral radiculopathy was confirmed by nerve conduction studies. Fifteen patients (75%) were treated with paravertebral injections, with significant decrease in mean pruritus score as assessed by the patients (6.3 [+/-2.8]; 4.5 [+/-2.7], before and after treatment, respectively, P = .033).
"Idiopathic" anogenital pruritus may be attributable to lumbosacral radiculopathy. Paravertebral blockade may be used for alleviation of symptoms in patients with anogenital pruritus.
肛门生殖器瘙痒症定义为局限于肛门、肛周及生殖器皮肤的瘙痒。肛门生殖器瘙痒症通常是皮肤或黏膜潜在疾病的症状，或是肛肠病理改变的结果。当未发现明显病因时，肛门生殖器瘙痒症常被描述为“特发性”。
探讨腰骶神经根病在肛门生殖器瘙痒症发病机制中的作用。
纳入连续性的肛门生殖器瘙痒症患者。对所有患者进行X线检查和神经传导研究。必要时进行针极肌电图检查和计算机断层扫描。神经传导研究包括测量腓总神经和胫神经的远端感觉和运动潜伏期、传导速度以及F波反应。确诊为神经根病的患者接受曲安奈德和利多卡因混合液的椎旁注射治疗。患者使用视觉模拟量表评估注射后的反应。使用配对t检验比较治疗前后的平均评分。
纳入研究的20例肛门生殖器瘙痒症患者中，男性18例（90%），女性2例（10%）。平均年龄为52.7岁（标准差[SD]11.7岁）。16例患者（80%）X线检查显示下脊柱退变。16例患者（80%）经神经传导研究确诊为腰骶神经根病。15例患者（75%）接受了椎旁注射治疗，患者评估的瘙痒平均评分显著降低（治疗前为6.3[±2.8]，治疗后为4.5[±2.7]，P = 0.033）。
“特发性”肛门生殖器瘙痒症可能归因于腰骶神经根病。椎旁阻滞可用于缓解肛门生殖器瘙痒症患者的症状。
