1. Patients with perianal itching, burning, and sometimes weeping or spotting of blood on tissues are likely to have pruritis ani. This is caused by excessive rubbing, scratching and abrasion of the perianal skin.

2. Typical physical findings are tiny, punctuate, shallow ulcerations; inflammation; and thickening or corrugation of perianal skin.

3. Treatment is directed at reducing inflammation and eliminating the rubbing and scratching that is the underlying cause.

- 1% hydrocortisone cream or ointment BID
- use moist wipes to cleanse; pat dry
- avoid rubbing or excessive cleaning attempts

Differential diagnosis includes dermatitis, yeast infection, psoriasis, anal intra-epithelial neoplasia (HPV related).

Referral is indicated if condition does not clear up within 1-2 months or if there is concern about neoplasia (particularly in immune compromised patients and patients with history of HPV).