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Der Hautarzt; Zeitschrift Fur... Jan 2015Genitoanal pruritus is usually characterized by intense pruritus in the genital area, possibly also extending to the anal and gluteal regions. Besides pruritus, other...
BACKGROUND
Genitoanal pruritus is usually characterized by intense pruritus in the genital area, possibly also extending to the anal and gluteal regions. Besides pruritus, other sensations such as burning, stinging, heat sensations and pain may occur. Genital pruritus may be associated with specific skin lesions of dermatoses such as eczema, lichen sclerosus or others. The skin is often without pathological findings, but one should be alert to transient erythemas, fetor and excretions in the genital area. Caused by intense scratching, secondary lesions such as papules, excoriations and crusts may appear. Maceration also frequently develops. In chronic dermatoses such as eczema and psoriasis, the anogenital area is commonly involved, but often not mentioned by patients due to feelings of shame or because skin changes in other body areas are more prominent.
DIAGNOSIS
In addition to a complete medical history and thorough physical examination, special attention must be paid to the anogenital area including the mucosa surfaces. Diagnostics should be performed according to the guidelines on chronic pruritus. Besides a gynecological and if necessary urological examination, allergy testing (patch test) and, in case of possible neuropathic causes, magnetic resonance tomography (MRT) should be performed.
THERAPY
Therapy depends on the underlying cause. Symptomatic-antipruritic measures are available. Interdisciplinary medical care is often necessary, usually leading to a clarification of the causes and satisfactory therapy. Somatoform disorders should also be taken into account.
CONCLUSION
In summary, genital pruritus forms a challenge that can, however, be met well by careful diagnostics, therapy and interdisciplinary care in the daily clinical practice.
Topics: Anus Diseases; Female; Genital Diseases, Female; Genital Diseases, Male; Humans; Male; Pruritus
PubMed: 25430921
DOI: 10.1007/s00105-014-3547-z -
Seminars in Pediatric Surgery Dec 2017Perianal Crohn's is a common manifestation of Crohn's disease. Primary manifestations of perianal disease mirror common anorectal conditions, however treatment is less... (Review)
Review
Perianal Crohn's is a common manifestation of Crohn's disease. Primary manifestations of perianal disease mirror common anorectal conditions, however treatment is less successful than in those patients without Crohn's related perianal disease. A multimodal approach to therapy including medical and surgical modalities is often necessary. The goal of treatment is to manage symptoms while maintaining continence.
Topics: Anti-Bacterial Agents; Anus Diseases; Combined Modality Therapy; Crohn Disease; Digestive System Surgical Procedures; Humans; Immunosuppressive Agents; Treatment Outcome
PubMed: 29126509
DOI: 10.1053/j.sempedsurg.2017.10.009 -
BMJ Case Reports Jun 2017
Topics: Adult; Anus Diseases; Diagnosis, Differential; Herpes Simplex; Humans; Male; Proctitis
PubMed: 28663248
DOI: 10.1136/bcr-2017-220856 -
Journal of Medical Imaging and... Oct 2019Magnetic resonance imaging provides detailed visualisation, identification and extent assessment of many anal disorders. While many studies are performed in the... (Review)
Review
Magnetic resonance imaging provides detailed visualisation, identification and extent assessment of many anal disorders. While many studies are performed in the evaluation of malignant processes such as anorectal carcinoma, the primary focus of this pictorial review is benign lesions, which involve the anal canal and perianal spaces. This pictorial review will illustrate the MRI appearances of a variety of benign conditions, which predominantly affect the anal canal, including abscess, fistulae, lipomas, developmental cysts and inflammatory conditions. MRI aids in the identification and characterisation of these abnormalities, of coexisting complications and differentiation from other perineal abnormalities. This pictorial review highlights the spectrum of non-malignant processes involving the perianal region.
Topics: Anus Diseases; Contrast Media; Humans; Magnetic Resonance Imaging
PubMed: 31368659
DOI: 10.1111/1754-9485.12934 -
Der Hautarzt; Zeitschrift Fur... Apr 2020Hemorrhoidal disease is one of the most common illnesses in industrialized nations. Up to 70% of adults suffer from the disease once in their lifetime. This underlines... (Review)
Review
Hemorrhoidal disease is one of the most common illnesses in industrialized nations. Up to 70% of adults suffer from the disease once in their lifetime. This underlines the necessity and importance of knowing about the differential diagnosis of hemorrhoids. One can differentiate between differential diagnoses of symptoms (bleeding, pain, itching, tumor) and differential diagnoses of the phenotype findings (anal prolapse, mucosal prolapse and rectal prolapse, skin tags, hypertrophied anal papillae, condylomata acuminata, anal fissure, perianal venous thrombosis, anal cancer).
Topics: Adult; Anus Diseases; Diagnosis, Differential; Hemorrhoids; Humans; Pain
PubMed: 32077979
DOI: 10.1007/s00105-020-04553-y -
Anais Brasileiros de Dermatologia 2017The approach to children with anogenital warts in the context of sexual abuse is a challenge in clinical practice. This study aims to review the current knowledge of... (Review)
Review
The approach to children with anogenital warts in the context of sexual abuse is a challenge in clinical practice. This study aims to review the current knowledge of anogenital warts in children, the forms of transmission, and the association with sexual abuse and to propose a cross-sectional approach involving all medical specialties. A systematic review of the literature was conducted in Portuguese and English from January 2000 to June 2016 using the ISI Web of Knowledge and PubMed databases. Children aged 12 years or younger were included. The ethical and legal aspects were consulted in the Declaration and Convention on the Rights of Children and in the World Health Organization. Non-sexual and sexual transmission events of human papillomavirus in children have been well documented. The possibility of sexual transmission appears to be greater in children older than 4 years. In the case of anogenital warts in children younger than 4 years of age, the possibility of non-sexual transmission should be strongly considered in the absence of another sexually transmitted infection, clinical indicators, or history of sexual abuse. The importance of human papillomavirus genotyping in the evaluation of sexual abuse is controversial. A detailed medical history and physical examination of both the child and caregivers are critical during the course of the investigation. The likelihood of an association between human papillomavirus infection and sexual abuse increases directly with age. A multidisciplinary clinical approach improves the ability to identify sexual abuse in children with anogenital warts.
Topics: Anus Diseases; Child; Child Abuse, Sexual; Child, Preschool; Condylomata Acuminata; Humans; Papillomavirus Infections; Prognosis
PubMed: 29166505
DOI: 10.1590/abd1806-4841.201756411 -
Archives de Pediatrie : Organe Officiel... Apr 2022Benign anorectal disease refers to a diverse group of frequent anorectal complaints that cause considerable discomfort, disability, and often constitute a significant... (Review)
Review
Benign anorectal disease refers to a diverse group of frequent anorectal complaints that cause considerable discomfort, disability, and often constitute a significant problem for the child and his or her family. Hemorrhoids, fissures, rectal prolapse, and perianal abscess and fistulas are the most common anorectal disorders in pediatric population and their appearance may be age-specific. Although they generally follow a benign course, a careful examination must be performed in order to exclude other serious and complicated underlying pathology. Their diagnosis is based on the patient's medical history, physical examination, endoscopy, and imaging. Moreover, the management of these disorders includes medical and surgical treatment options, and if they are treated promptly and properly may be limited and short lived. This review presents the currently available data in the literature on the diverse aspects of these disorders, including the definition, epidemiology, clinical presentation, pathogenesis, diagnosis, indications for surgery, and long-term outcomes.
Topics: Abscess; Anus Diseases; Child; Endoscopy; Female; Hemorrhoids; Humans; Male; Rectal Diseases; Rectal Fistula; Rectal Prolapse
PubMed: 35249800
DOI: 10.1016/j.arcped.2022.01.015 -
Minerva Chirurgica Feb 2018Condylomata acuminata are the most common sexually transmitted disease worldwide. They are not usually a serious problem, but it causes emotional distress to patient and... (Review)
Review
INTRODUCTION
Condylomata acuminata are the most common sexually transmitted disease worldwide. They are not usually a serious problem, but it causes emotional distress to patient and physician alike because of its marked tendency to recurrence. The presence of anogenital warts mandates treatment, also for potential degeneration of the lesions.
EVIDENCE ACQUISITION
A review of the literature has been performed to analyze proposed treatments for anogenital warts.
EVIDENCE SYNTHESIS
Many treatments have been employed. They include cytotoxic agents, immunomodulation and physical ablation. The choice of the appropriate treatment varies depending on the number, size, and location of warts. Complications of various treatments are rare but include permanent depigmentation, itching, pain, scarring, bleeding, anal stenosis or incontinence and sepsis. The therapy of these lesions can sometimes be very painful and expensive, and therapy should not be worse than the disease.
CONCLUSIONS
No specific antiviral treatment is currently available, and no consensus has been reached on the appropriate treatment for anogenital warts. No data are available to indicate whether treatment eliminates infectivity, the primary aim of treatment being to remove the lesions. There is a paucity of published randomized trials. Despite the introduction of antiviral treatments such as interferon, immunomodulating agents or imiquimod, surgical destruction or removal remains the treatment of choice.
Topics: Aminoquinolines; Antiviral Agents; Anus Diseases; Condylomata Acuminata; Cryotherapy; Cytotoxins; Electrosurgery; Female; Humans; Imiquimod; Immunologic Factors; Interferons; Laser Therapy; Male; Papillomaviridae; Papillomavirus Infections; Photochemotherapy; Podophyllotoxin
PubMed: 29154519
DOI: 10.23736/S0026-4733.17.07554-X -
American Journal of Clinical Dermatology Jun 2017Perianal lesions in children are common reasons for dermatology clinic visits and a well-defined approach to diagnosis and management is helpful to the practicing... (Review)
Review
Perianal lesions in children are common reasons for dermatology clinic visits and a well-defined approach to diagnosis and management is helpful to the practicing clinician. In this article, we review and update various etiologies of perianal lesions in the pediatric population, including infectious, papulosquamous, vascular, and neoplastic. We provide a standard initial approach to diagnosis and updates on current management. Infectious etiologies of perianal lesions discussed in this article include fungal, bacterial, parasitic, and viral. Perianal papulosquamous lesions often encountered in children, and discussed in this article, include acrodermatitis enteropathica, psoriasis, contact dermatitis, and many others. We also discuss the diagnosis and management of other entities including infantile hemangiomas, Langerhans cell histiocytosis, and fibrous hamartoma of infancy.
Topics: Anus Diseases; Child; Humans; Skin Diseases; Skin Diseases, Infectious; Skin Diseases, Papulosquamous; Skin Neoplasms
PubMed: 28289985
DOI: 10.1007/s40257-017-0259-z -
Journal of Crohn's & Colitis Aug 2023Perianal lesion is a refractory phenotype of Crohn's disease [CD] with significantly diminished quality of life. We evaluated the clinical characteristics of perianal...
Diagnosis and Clinical Features of Perianal Lesions in Newly Diagnosed Crohn's Disease: Subgroup Analysis from Inception Cohort Registry Study of Patients with Crohn's Disease (iCREST-CD).
BACKGROUND AND AIMS
Perianal lesion is a refractory phenotype of Crohn's disease [CD] with significantly diminished quality of life. We evaluated the clinical characteristics of perianal lesions in newly diagnosed CD patients and the impact of perianal lesions on the quality of life in Japanese patients with CD.
METHODS
Patients newly diagnosed with CD after June 2016 were included between December 2018 and June 2020 from the Inception Cohort Registry Study of Patients with CD [iCREST-CD].
RESULTS
Perianal lesions were present in 324 [48.2%] of 672 patients with newly diagnosed CD; 71.9% [233/324] were male. The prevalence of perianal lesions was higher in patients aged <40 years vs ≥40 years, and it decreased with age. Perianal fistula [59.9%] and abscess [30.6%] were the most common perianal lesions. In multivariate analyses, male sex, age <40 years and ileocolonic disease location were significantly associated with a high prevalence of perianal lesions, whereas stricturing behaviour and alcohol intake were associated with low prevalence. Fatigue was more frequent [33.3% vs 21.6%] while work productivity and activity impairment-work time missed [36.3% vs 29.5%] and activity impairment [51.9% vs 41.1%] were numerically higher in patients with than those without perianal lesions.
CONCLUSIONS
At the time of CD diagnosis, approximately half of the patients had perianal lesions; perianal abscesses and perianal fistulas were the most common. Young age, male sex, disease location and behaviour were significantly associated with the presence of perianal lesions. The presence of perianal lesion was associated with fatigue and impairment of daily activities.
CLINICAL TRIALS REGISTRY
University Hospital Medical Information Network Clinical Trials Registry System [UMIN-CTR, UMIN000032237].
Topics: Male; Female; Humans; Crohn Disease; Quality of Life; Constriction, Pathologic; Anus Diseases; Abscess; Rectal Fistula; Registries
PubMed: 36869815
DOI: 10.1093/ecco-jcc/jjad038