Perianal dermatitis is an inflammation of the skin around the anus, manifested by redness, swelling, soreness and itching. Disease can have a contact, allergic, bacterial or fungal nature, occur against the background of enterobiosis, inflammatory bowel diseases, hemorrhoids, anal fissure. In the diagnosis of the disease, the main importance is to determine its etiology by microscopic examination and back-seeding of a smear or scraping of the perianal area. Treatment is carried out in accordance with the established cause of perianal dermatitis.
General information
Perianal dermatitis occurs in people of any age from newborns to the elderly. In infants, it, like diaper dermatitis, is often associated with violation of the rules of baby skin care. In adults, disease often occurs against the background of pathology of the large intestine and rectum, disorders of the intestinal microflora, and other diseases of the anal region. Thus, about 6.5% of patients with intestinal candidiasis dysbiosis suffer from perianal dermatitis of candidiasis etiology. In this regard, not only dermatology, but also proctology is engaged in the diagnosis and treatment of perianal dermatitis.
Causes
Perianal dermatitis can be caused by a violation of hygiene or irritating effects on the anal area. Prolonged diarrhea, a negative effect on the skin of synthetic underwear or detergent left on the laundry after washing can lead to the appearance of dermatitis. Fecal incontinence with rectal prolapse or its tumor lesion can also cause perianal dermatitis.
With inflammatory diseases such as ulcerative colitis, Crohn’s disease, colitis, proctitis, paraproctitis, the inflammatory process from the intestine can spread to the skin of the perianal area. The appearance of perianal dermatitis is possible with enterobiosis, dysbiosis, hemorrhoids. Skin damage in the anus (anal fissure, scratching with anal itching) contribute to its infection with the development of dermatitis of bacterial or fungal etiology.
There is an abscessing fistulous form of perianal dermatitis, which develops during long-term driving or riding due to the introduction of broken hair into the skin of the perianal area. This form is called “jeep disease”.
The state of the macroorganism plays an important role in the occurrence of perianal dermatitis. The tendency to allergic reactions contributes to the development of contact dermatitis of the anal area. A decrease in immunity and barrier function of the skin leads to easy penetration of infectious agents into it with the development of staphylococcal, streptococcal, candidiasis or other dermatitis. Newborns and elderly people, patients with various immunodeficiency conditions, after prolonged antibiotic therapy, corticosteroid treatment, and HIV-infected people are prone to such a mechanism of occurrence of perianal dermatitis.
Symptoms
The main manifestations common to all types are inflammatory changes in the skin of the anal area: redness, soreness, swelling. Itching is often pronounced, aggravating the course of the disease due to constant injury to the skin when combing.
Perianal dermatitis of bacterial origin is characterized by the appearance of pustules and vesicles with purulent contents against the background of hyperemia. Such dermatitis can be accompanied by wetness, erosion and the formation of crusts. For fungal dermatitis, scalloped edges of the inflammation area, whitish plaque, peeling, the location of pustules and vesicles along the periphery of the inflammatory focus are typical. Allergic dermatitis is accompanied by severe itching, the formation of papules with serous contents, upon opening of which erosions occur.
Abscessing fistulous form of perianal dermatitis (jeep’s disease), manifested by small recurrent abscesses with the formation of short fistulous passages in the folds of the anus. In intestinal diseases, manifestations of perianal dermatitis are combined with stool disorders (constipation, diarrhea), abdominal or rectal pain (proctalgia), mucosal, purulent or bloody discharge from the anus.
Diagnostics
Patients with inflammatory skin changes in the perianal area most often come to a consultation with a dermatologist or proctologist. The doctor conducts a survey aimed at identifying the symptoms and causes of the disease, as well as concomitant intestinal pathology. Examination of the anal area allows you to determine not only the condition of the skin, but also to detect the presence of cracks, hemorrhoids, rectal prolapse.
To determine the etiology of perianal dermatitis, a scraping for pathogenic fungi is taken from the skin of the anal area, a bacteriological examination of the skin elements and a smear from the anus is performed, a scraping for enterobiosis and a stool analysis for dysbiosis are examined. Diagnosis of concomitant intestinal diseases is carried out with the help of coprogram, rectoromanoscopy, ultrasound, irrigoscopy, radiography with barium, colonoscopy.
Treatment
Therapy of perianal dermatitis is effective only if it is carried out in accordance with its etiology. It is important to observe hygiene of the anal area, wearing cotton soft underwear that does not cause compression, friction or irritation of the affected area. To relieve itching, oral antihistamines are prescribed: loratadine, chloropyramine, clemastine, mebhydroline.
Local treatment is carried out with the use of dexpanthenol, ointments with zinc and antiseptics, baths with chamomile, string, oak bark. With bacterial lesions, purulent pustules are opened and treated with solutions of aniline dyes (blue, green, fucarcin), antibacterial ointments are prescribed. Therapy of fungal dermatitis is carried out with local antifungal ointments.
When enterobiosis is detected, anthelmintic drugs are treated: piperazine, pyrantel, mebendazole, albendazole, ornidazole. The presence of dysbiosis and other intestinal diseases is an indication for treatment by a gastroenterologist or proctologist.