Pruritis ani, also known as pruritus of the anus, is irritation and itching of the skin around the anus. It affects 1-5% of people and is more common in men than women. Common causes include peri-anal infections, local skin conditions, systemic diseases, medications, allergic reactions, poor hygiene, and underlying gastrointestinal issues. Treatment involves identifying and treating the underlying cause, improving hygiene, using mild topical steroids or antihistamines, and managing bowel symptoms. Surgery may be required in cases involving other anal pathological conditions.
In this presentation I have shown the etiology, clinical features and treatment for both Phimosis & Paraphimosis. I have also showed various methods of circumcision for both infants and adults.
In this presentation I have shown the etiology, clinical features and treatment for both Phimosis & Paraphimosis. I have also showed various methods of circumcision for both infants and adults.
PARAPHIMOSIS
DEFINITION
Inability to place back (cover) the retracted prepucial skin over the glans is called as paraphimosis.
It causes ring like constriction proximal to the corona and prepuceal skin.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
Genital warts are an epidermal manifestation attributed to the epidermotropic human papillomavirus (HPV).
> than 100 types of double-stranded HPV papovaviruses have been isolated thus far, and, of these, about 35 types have affinity to genital sites
Cutaneous manifestations of hiv infectiontashagarwal
Dermatological problems occur in more than 90% of patients with human immunodeficiency virus (HIV) infection. In some patients, skin is the first organ affected. Skin diseases have proved to be sensitive and useful measures by which HIV progression can be monitored.
This presentation gives general overview about different aspects of PILONIDAL DISEASE including pathophysiology, etiology, clinical Presentation, different treatment options available etc
Testicular tumors are rare.
1 – 2 % of all malignant tumors.
Most common malignancy in men in the 15 to 35 year age group.
Benign lesions represent a greater percentage of cases in children than in adults.
Most curable solid neoplasm
PARAPHIMOSIS
DEFINITION
Inability to place back (cover) the retracted prepucial skin over the glans is called as paraphimosis.
It causes ring like constriction proximal to the corona and prepuceal skin.
Disclaimer: A lot from this slides were taken also from https://www.slideshare.net/babysurgeon/scrotal-swellings-1 (Dr Selvaraj Balasubramani)
This covers only :
ANATOMY
CAUSES
TORSION OF TESTIS
EPIDIDYMO-ORCHITIS
HYDROCELE
EPIDIDYMAL CYST
VARICOCELE
Genital warts are an epidermal manifestation attributed to the epidermotropic human papillomavirus (HPV).
> than 100 types of double-stranded HPV papovaviruses have been isolated thus far, and, of these, about 35 types have affinity to genital sites
Cutaneous manifestations of hiv infectiontashagarwal
Dermatological problems occur in more than 90% of patients with human immunodeficiency virus (HIV) infection. In some patients, skin is the first organ affected. Skin diseases have proved to be sensitive and useful measures by which HIV progression can be monitored.
This presentation gives general overview about different aspects of PILONIDAL DISEASE including pathophysiology, etiology, clinical Presentation, different treatment options available etc
Testicular tumors are rare.
1 – 2 % of all malignant tumors.
Most common malignancy in men in the 15 to 35 year age group.
Benign lesions represent a greater percentage of cases in children than in adults.
Most curable solid neoplasm
There are several dermatoses that occur during pregnancy or immediately postpartum, in particular polymorphic eruption of pregnancy, pemphigoid gestationis, and atopic eruption of pregnancy. Pruritus due to intrahepatic cholestasis of pregnancy leads to nonspecific skin lesions, including excoriations due to scratching.
Impetigo herpetiformis simply represents pustular psoriasis occurring during pregnancy, and this may be related to the relative hypocalcemia of pregnancy. Lastly, there are physiologic changes that occur during pregnancy.
Gonorrhoea is a sexually transmitted disease caused by N. gonorrhoeae. Hippocrates referred to acute gonorrhea as “strangury” obtained from the “pleasures of Venus” in the fourth and fifth centuries B.C. (229). It was not until A.D. 130 that Galen, who mistakenly confused the purulent discharge associated with gonococcal urethritis with semen, introduced the term gonorrhea, i. e., “flow of seed” . N gonorrhoeae is the second most commonly occurring reportable sexually transmitted infection after Chlamydia trachomatis.
2. Pruritis Ani
Pruritus ani
• is the irritation of the peri-anal skin
• causing the desire to scratch
• mild to severe
– can cause intolerable discomfort accompanied by
burning and soreness
– if severe and persistent - depression
6. Pruritis Ani
Cause?
idiopathic – a diagnosis of exclusion
Nearly 100 different ‘causes’ have been
described
• co-existing pathology
• identifiable ‘irritant’
7. Pruritis Ani - pathogenesis
perineal faecal contamination
– overt
– occult
• faeces; moist; prolonged
• Peri-anal skin reacts differently from
skin elsewhere
• [Caplan – skin patch testing]
• on perineum up to 50%
• on arm 4%
8. Pruritis Ani - pathogenesis
perineal faecal contamination
• 50% - loose stools
• 41% - weekly faecal soiling
• alteration in recto-anal inhibitory reflexes
so any condition whichso any condition which
increases occult or overtincreases occult or overt
soiling should besoiling should be
identified and treatedidentified and treated
22. Pruritis Ani
allergic contact dermatitis
– chemicals
– cleansing and therapeutic
– creams, soaps, wet wipes, deodorants or perfumes
– Alcohol-based anal wipes
– glyceryl trinitrate, local anaesthetic
– toilet paper dye
– Fabric softener intolerance
Ointments have fewer preservativesOintments have fewer preservatives
and constituents than creams.and constituents than creams.
They are less likely to sensitise or beThey are less likely to sensitise or be
washed off.washed off.
24. Pruritis Ani
food
– caffeinated drinks
– alcohol
– milk products
– peanuts,
– spices
– citrus
– grapes
– tomato (histamine)
– chocolate
reduction in anal sphincter pressures,reduction in anal sphincter pressures,
exaggerated anal reflexesexaggerated anal reflexes
looser stoolslooser stools
quicker transit timequicker transit time
greater stool frequencygreater stool frequency
increased faecal seepageincreased faecal seepage
undigested foods sensitising the peri-anal skinundigested foods sensitising the peri-anal skin
anal trauma from recurrent wipinganal trauma from recurrent wiping
25. Pruritis Ani
history
– other skin diseases or symptoms
– allergies
– general health
– bowel history
– local applications
– clothes
– detergents
– food
29. Pruritis Ani
treatment
refer to appropriate speciality
elimination of irritants and scratching
general control measures
active treatment measures
31. Pruritis Ani
treatment
general control measures
wash the perineum
bidet or shower head
no soap,
hair dryer.
wash in the squatting position
Aqueous cream or emollients (not soap and barrier
creams inc zinc oxide)
petroleum ointment
32. Pruritis Ani
treatment
general control measures
change daily
keep dry
cotton wool
ACUTE EXACERBATIONACUTE EXACERBATION
of pain burning itchingof pain burning itching
best treatmentbest treatment
immediate local hygineimmediate local hygine
gently clean and drygently clean and dry
