A Review of the Therapeutic Interventions in the Management of Pruritus Ani

Abstract

Background: Pruritus Ani (PA) is the chronic itch of perianal skin and is poorly understood. There is a knowledge gap in understanding the pathophysiology and management of PA as there has been little research. The literature is sparse and of variable quality. There have been recent studies in understanding pruritic processing. We have performed a critical review of the literature concerning therapeutic inventions with the insights gained from this new understanding. In addition, an overview of PA is presented.
Method: A systematic review in accordance with Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) guidelines was undertaken. With the heterogeneity of the reviewed studies it was not possible to perform a true systematic review, but a critical appraisal has been performed using the same methodology.
Results: There are five randomised trials, one controlled study, one observational study, and eight case series critically appraised. The studies concerning topical and injectable intradermal steroid, topical tacrolimus and topical capsaicin have not provided evidence for their therapeutic benefit. Studies suggest methylene blue anal tattooing may beneficial in the treatment of PA.
Conclusions: The aim of this paper was a review of the best evidence available on the current treatment of PA. We set up to perform a systematic review, but were unable to due to the heterogeneity of evidence; hence a critical review was performed. There remains an evidence gap in the pathophysiology and treatment of PA. More research is needed, but there are so many unknowns about the nature of PA, this will be currently difficult to perform. The understanding of pruritus and pruritic processing is in its infancy. Newer therapies such as tacrolimus and capsaicin have failed to live up to initial promise, although they can be effective in a few. Anal tattooing shows the greatest promise.