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Dermatologic Proctology

Dermatologic Proctology

document Dermatology (Chapter 5, European Manual of Medicine: Coloproctology)

By In Dermatologic Proctology

Diagnostic and therapeutic management of pruritus can be a challenge for a proctologist. Anal itching is the most frequent accompanying symptom of different dermatological, proctological and microbiological disorders of the anal region – more often than bleeding, pain, redness and other. Comparably to other locations, the pruritus has been divided into acute and chronic as well as into the two subtypes: secondary to underlying diseases and ‘idiopathic’. The chapter gives an overview of differential diagnosis which must be considered to clarify pruritus ani. The spectrum ranges from harmless slightly pruritic dermatoses to life-threatening malignant tumours. The main diagnosis is the anal eczema which must be differentiated into more detail (atopic, irritant and allergic contact dermatitis), and the irritant anal eczema can be the consequence of a number of different proctological diseases. First therapeutical priority, therefore, is the identification and correction of any underlying dermatosis, or irritation. Occasionally pruritus ani may be a symptom secondary to benign or malignant colon and anorectal pathology. Its appropriate therapy management should lead to prompt resolution of pruritic symptoms. In cases with pruritus of unknown origin, pruritus can become severe and refractory of any therapy. A psychiatric doctor specialized can be necessary in individual cases. Key words: acute and chronic anogenital pruritus.

Hidradenitis suppurativa (HS) is a chronic relapsing cutaneous inflammation mainly of intertriginous areas rich in terminal hair follicles and apocrine sweat glands. But it occurs also on the scalp devoid of any apocrine glands.

Condylomata acuminata mainly are a problem of sexually active middle-aged persons, but can concern all ages. They are epidermal tumours that result from an infection by human papilloma virus (HPV), low risk genotypes being found in >90% of patients. Persistent infections with high-risk HPV types are associated with the development of intraepithelial neoplasia which may progress to invasive anogenital cancer. The chapter gives an overview of the etiology, the wide variety of clinical settings and therapeutic alternatives of condylomata acuminata. First-line-therapies include podophyllotoxin alcoholic solution or cream, imiquimod, water-supported electrocaustic surgery, trichloracid and laser therapy (CO2 or Nd yag laser), second-line-therapies are 5-fluoruracil, cryotherapy with liquid nitrogen and interferon. The treatment algorithm for the management and follow-up must be established for each individual case depending on wart distribution, clinical skills and the experience of the physician concerning surgical techniques.

The etiology of Pilonidal Sinus Disease (PSD) is still not fully clarified although the body of evidence seems to favour an aquired disease. A deep intergluteal groove, hirsute, joung individuals mostly between 20 and 30 years, overweight, long-standing pressure or friction and inadequate personal hygiene have been identified as risk factors for the development of symptomatic PSD. Not uncommonly, PSD occurs in patients together with acne conglobata or acne inversa, sharing the same pathological process, i.e. an occluding follicular hyperkeratosis followed by a dissecting cellulits and the formation of draining sinuses.

Asymptomatic PSD may be treated conservatively by mediculous hair control shaving the natal cleft and improved hygiene. There is no reasonable conservative therapy of symptomatic PSD and the main stay of treatment is surgical, which offers several alternatives. Radical wide excision with shallow resection margins and open granulation is still the preferred surgical treatment in the majority of patients, simple to learn, gives the lowest rate of complications and recurrences and the best cosmetic results. Leaving the wound open results in longer healing periods which are no obstacle to an early return to work and social activities in patients.

Wound closure methods offer significant advantages: Shorter hospital stay, or even day case operation, earlier healing and shorter time off work. The disadvantages are a higher rate of complications and recurrences, and inferior cosmetic results when wound closure is achieved by flaps.

video Proctology: Perineal skin disorders

By In Dermatologic Proctology

Symposium - Eva Csatar at ESCP Vienna 2012

video Pruritus ani

By In Dermatologic Proctology

Core Subject Update - Eva Csatar at ESCP Prague 2009

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