Practice Parameters for Evaluation and Management of Pruritus Ani on Behalf of the Italian Society of Colorectal Surgery (SICCR).

Pruritus ani (PA) is an unpleasant sensation that leads to scratching and which can seriously compromise patients' quality of life. PA can be secondary to anorectal diseases, systemic disorders, infectious diseases, dermatological conditions, irritative conditions, and psychogenic diseases. However, in many cases, PA appears to be idiopathic. Diagnostic work-up should include medical history collection, psychological evaluation, and clinical examination including anoscopy, laboratory findings, skin swabs, skin scraping, and patch test. Skin biopsy may be useful to clarify doubtful cases or if the presence of a pre-/neoplastic lesion is suspected. The treatment of secondary PA aims to eradicate pathogens or cure the triggering disease. In cases of idiopathic PA, a stepwise approach is adopted, starting with elimination of local irritants and changes in diet and behaviour, progressing through topical and systemic medical therapy to subcutaneous injection of methylene blue for refractory situations.