Symposium on colon and anorectal surgery. Pruritus ani: a practical approach.

Pruritus ani is a symptom of diverse cause and varied presentation which will respond in most cases to measures directed at keeping the anal area clean and dry. The role of the surgeon is to evaluate the patient to determine the status of the problem and to rule out threatening conditions, to educate the patient in his responsibility for continuing care and prevention, and to prescribe initial therapy to relieve symptoms. Follow-up evaluation is necessary to intensify treatment for the unresponsive patient, to diagnose further or identify the candidate for surgery, and to refer the patient with uncontrolled pruritus exhibiting a dermatosis for dermatological diagnosis and therapy. The crux of this practical management rests in the control of perianal moisure, the elimination of which gives an enfilading effect to therapy.