Pruritus ani is often idiopathic. Causes include the following:
1. Lack of hygiene is the most common cause.
2. Skin conditions such as psoriasis or lichen planus. Contact eczema may occur due to cream/lotion application.
3. Infections include candida especially in diabetic and immunosuppressed, lice and anal warts. Thread worms in children.
4. Gastrointestinal disorders causing an anal discharge may result in pruritus.
5. Drugs such as quinidine and colchicine may cause pruritus if used long term.
Proctoscopy and sigmoidoscopy may be required to examine for rectal disease. Management where the primary cause cannot be identified or treated includes discontinuation of all local preparations and careful attention to local hygiene. Surgical denervation has been attempted with varying success.