Perianalny dermatitis — the skin inflammation around an anus which is shown redness, puffiness, morbidity and an itch. Perianalny dermatitis can have the contact, allergic, bacterial or fungal nature, arise against the background of an enterobioz, inflammatory diseases of intestines, hemorrhoids, an anal crack. In diagnosis of a disease major importance has definition of its etiology by a microscopic research and a bakposev of dab or scrape of perianalny area. Treatment is carried out according to the established reason of perianalny dermatitis.
Perianalny dermatitis occurs at people of any age from newborns to old men. At children of chest age it, like diaper dermatitis, is often connected with violation of the rules of care of skin of the baby. At adults perianalny dermatitis quite often arises against the background of pathology of a large intestine and a rectum, violation of intestinal microflora, other diseases of anal area. So about 6,5% of patients with a kandidozny intestinal dysbiosis have perianalny dermatitis of a kandidozny etiology. Due to these not only the dermatology, but also a proktologiya is engaged in diagnostics and treatment of perianalny dermatitis.
Reasons of development of perianalny dermatitis
Perianalny dermatitis can be caused by violation of hygiene or the irritating impact on anal area. Long diarrhea, negative action on skin of the synthetic underwear or detergent which remained on linen after washing can lead to emergence of dermatitis. The incontience a calla at loss of a rectum or its tumoral defeat can also become the reason of perianalny dermatitis.
At such inflammatory diseases as ulcer colitis, a disease the Krone, colitis, proktit, paraproktit, inflammatory process of intestines can extend to skin of perianalny area. Emergence of perianalny dermatitis is possible at an enterobioza, dysbacteriosis, hemorrhoids. Injuries of skin in the field of an anus (an anal crack, raschesa at an anal itch) promote its infection with development of dermatitis of a bacterial or fungal etiology.
There is an abstsediruyushchy fistulose form of perianalny dermatitis which develops at long-term driving or astride because of introduction of the broken-off hair in skin of perianalny area. This form received the name "jeep disease".
In developing of perianalny dermatitis not the last role is played by a condition of a macroorganism. Tendency to allergic reactions promotes development of contact dermatitis of anal area. Decrease in immunity and barrier function of skin leads to easy penetration into it of infectious agents with development of dermatitis stafilo-, streptococcal, kandidozny or other nature. Newborns and people of advanced age, patients with various immunodeficiency, after long antibiotic treatment, treatment by corticosteroids, HIV-positive people are inclined to such mechanism of developing of perianalny dermatitis.
Symptoms of perianalny dermatitis
The main manifestations, the general for all types of perianalny dermatitis, are inflammatory changes of skin of anal area: reddening, morbidity, puffiness. The itch aggravating the course of a disease because of continuous traumatizing skin when combing is often expressed.
Perianalny dermatitis of bacterial genesis is characterized by emergence against the background of hyperaemia and bubbles with purulent contents. Such dermatitis can be followed moknutiy, erozirovaniy and formation of crusts. Scalloped regions of the area of an inflammation, a whitish raid, a peeling, an arrangement and bubbles on the periphery of the inflammatory center are typical for fungal dermatitis. Allergic dermatitis is followed by a severe itch, formation of papules with serous contents when which opening there are erosion.
The Abstsediruyushchy fistulose form of perianalny dermatitis (jeep disease), is shown by small recurrent abscesses with formation pleated of an anus of the short svishchevy courses. At diseases of intestines of display of perianalny dermatitis are combined with violation of a chair (locks, ponosa), belly-aches or a rectum (proktalgiya), allocations from an anus of mucous, purulent or bloody character.
Diagnosis of perianalny dermatitis
Patients with inflammatory changes of skin of perianalny area most often come to consultation of the dermatologist or proctologist. The doctor conducts survey directed to identification of symptoms and causes of illness and also the accompanying intestines pathology. Survey of anal area allows to define not only a condition of skin, but also to find existence of cracks, gemorroidalny knots, losses of a rectum.
For definition of an etiology of perianalny dermatitis from skin of anal area scrape on pathogenic mushrooms undertakes, the bacteriological research of the separated skin elements and dab from an anus is made, scrape on and the analysis a calla on dysbacteriosis is investigated. Diagnosis of associated diseases of intestines is carried out by means of a koprogramma, a rektoromanoskopiya, ultrasonography, an irrigoskopiya, a X-ray analysis with barium, kolonoskopiya.
Treatment of perianalny dermatitis
Therapy of perianalny dermatitis is effective only in case it is performed according to its etiology. Respect for hygiene of anal area, wearing the cotton soft linen which is not causing a sdavleniye, friction or irritation of the struck area is important. For simplification of an itch appoint intake of antihistamines: loratadina, hloropiramina, klemastina, mebgidrolina.
Local treatment of perianalny dermatitis is carried out with application of a dekspantenol, ointments with zinc and antiseptics, trays with a camomile, a train, oak bark. At bacterial damage purulent pustula open and process solutions of aniline dyes (blue, brilliant green, ), appoint antibacterial ointments. Therapy of fungal dermatitis is carried out by local antifungal ointments.
At identification of an enterobioz carry out treatment by antigelmintny medicines: piperazin, pyranbody, mebendazoly, albendazoly, ornidazoly. Existence of dysbacteriosis and other diseases of intestines is the indication for treatment at the gastroenterologist or the proctologist.