Albuquerque Andreia
Department of Gastroenterology, Fernando Pessoa Teaching Hospital, Gondomar, Porto 4420-096, Portugal.
Precancerous Lesions and Early Cancer Management Research Group RISE@CI-IPO (Health Research Network), Portuguese Oncology Institute of Porto, Porto 4200-072, Portugal.
World J Gastrointest Endosc. 2024 Mar 16;16(3):112-116. doi: 10.4253/wjge.v16.i3.112.
Anal pruritus is a common anorectal symptom that can significantly impair a patient's quality of life, including their mental health. It can be one of the most difficult proctological conditions to treat. Patients often delay seeking medical attention, since it is an embarrassing but non-life-threatening situation. Pruritus ani can be associated with idiopathic and secondary causes, such as anorectal diseases, cancer (anal or colorectal), dermatological and sexually transmitted diseases, fungal infections and systemic diseases. If patients are referred for a colonoscopy, this can sometimes provide the first opportunity to evaluate the perianal area. Classifications of anal pruritus are based on the abnormalities of the perianal skin, one of the most commonly used being the Washington classification. A proper digital anorectal examination is important, as well as an anoscopy to help to exclude anorectal diseases or suspicious masses. Endoscopists should be aware of the common etiologies, and classification of the perianal area abnormalities should be provided in the colonoscopy report. Information on treatment possibilities and follow-up can also be provided. The treatment normally consists of a triple approach: proper hygiene, elimination of irritants, and skin care and protection. Several topical therapies have been described as possible treatments, including steroids, capsaicin, tacrolimus and methylene blue intradermal injections.
肛门瘙痒是一种常见的肛肠症状，会严重影响患者的生活质量，包括心理健康。它可能是最难治疗的直肠疾病之一。患者常常延迟就医，因为这是一种尴尬但不危及生命的情况。肛门瘙痒可能与特发性和继发性病因有关，如肛肠疾病、癌症（肛门或结直肠癌）、皮肤病和性传播疾病、真菌感染及全身性疾病。如果患者被转诊进行结肠镜检查，这有时能提供首次评估肛周区域的机会。肛门瘙痒的分类基于肛周皮肤的异常情况，最常用的一种是华盛顿分类法。进行适当的直肠指检以及肛门镜检查很重要，有助于排除肛肠疾病或可疑肿物。内镜医师应了解常见病因，结肠镜检查报告中应提供肛周区域异常情况的分类。还可提供关于治疗可能性及随访的信息。治疗通常采用三联疗法：保持适当的卫生、消除刺激物以及皮肤护理和保护。已有多种局部治疗方法被描述为可能的治疗手段，包括类固醇、辣椒素、他克莫司及亚甲蓝皮内注射。
