Atopic anal dermatitis L20.8

Author: Prof. Dr. med. Peter Altmeyer

Last updated on: 29.10.2020

Synonym(s)

Afterekezm; Anal eczema; Anal eczema atopic; atopic anal dermatitis; Atopic Anal Eczema; Atopic dermatitis of the anus; Atopic eczema of the anus; eczema of the anus; Irritative anal eczema

Definition
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Itchy dermatitis of the anal and perianal skin occurring in the course of an atopic diathesis, usually with chronic course, often aggravated by irritative-toxic mechanisms, e.g. in hemorrhoidal diseases, incorrect anal hygiene, parasitoses, in obesity and hyperhidrosis, by anatomical malformations, e.g. funnel anus.

The "symptom of the wet and itchy anus" induced by this leads to chronic macerative dermatitis associated with torturous pruritus (see also eczema, anal eczema).

Occurrence/Epidemiology
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Can be found in about 20-30% of all patients with chronic anal eczema.

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Clinical features
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Usually limited to the anal and perianal area, bulging thickening and lichenification of the skin and semi-mucosa with erythema and rhagades as well as punctiform and extensive erosions, linelike scratch marks as an expression of the usually severe itching. The clinical picture varies depending on the clinical stage (acute, sub-acute, chronic). No scaling.

Differential diagnosis
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S.u. Eczema Anal eczema.

Complication(s)
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Chronic dermatitis of the anal region is often complicated by a contact allergy.

Therapy
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As therapeutic bases as indifferent as possible fat ointments like Vaselinum alb. or Ungt. molle, also Linola fat and e.g. Excipial almond oil ointment. Some patients cannot tolerate fatty ointment bases (occlusive effect). In these cases a zinc shaking mixture (DAB) or zinc oil (NRF 11.20.) is recommended.
Temporary local measures with low-potency glucocorticoids such as hydrocortisone 0.5-1% (e.g. Hydro-Wolff, R120 ) are useful. Caution! Patients are often pre-treated with corticosteroids for a long time!
In the long term, a local therapy with low-sensitizing, anti-inflammatory topicals (e.g. 1-5% ichthyol, CSF carbonis detergens) in non-irritant bases should be aimed for. Supplementary: sitz baths with synthetic tanning agents (e.g. Tannosynt liquid, Tannolact), soap-free anal showers. Frequently, general anal cleaning and care measures as well as dietary measures already lead to success. Pungent spices, for example, can cause complaints in the anal area even without real sensitization.
Notice!
The following applies to the basis: As far as possible allergologically neutral!
An interesting therapy approach (strictest indication because of unclear long-term side effects! Off-Label-Use!) is the use of Tacrolimus or Pimecrolimus in an ointment base in case of persistent and therapy-resistant course.

Note(s)
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Atopic anal eczema is a typical, extremely chronic but little known predilection site of atopic eczema.

Literature
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Proske S et al (2004) Anal eczema and its benign simulators. dermatologist 55: 259-264
Rajalakshmi R et al (2011) Lichen simplex chronicus of anogenital region: a clinico-etiological study. Indian J Dermatol Venereol Leprol 77:28-36
White hair E (2015) Genitoanal pruritus. dermatologist 66:53-59