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Itching in the perianal area, pruritus ani, is a frequently voiced complaint. The rich nerve supply to the perianal area is thought to be the primary reason for the sensitivity to potential irritants. 肛门瘙痒症，即肛周区域的瘙痒为常见主诉。肛周区域神经丰富可能是人体对刺激物较敏感的主要原因。
SYMPTOMS 症状
Itching is usually noted in the anal genital areas. The condition tends to be worse at night, awakening the patient from sleep. This leads to scratching, which exacerbates the complaint even further. Pruritus ani is more common in men.
通常为肛门周围瘙痒。瘙痒多于夜间加重，常使病人痒醒，导致搔抓，而搔抓又进一步加重瘙痒。肛门瘙痒症多见于男性。
Differential Diagnosis 鉴别诊断
The symptoms may be associated with a specific condition (e.g., hemorrhoids, anal fissure, scarring from prior anal surgery, or with constipation or diarrhea). Besides anorectal disease, allergic dermatitis, mycoses, seborrhea, diabetes, and oxyuriasis (pinworm) have all been implicated as causative factors. In addition, the possibility of harboring a systemic disease, such as diabetes, may necessitate further studies. Anal neurodermatitis may cause violent itching, which may lead to tearing of the perianal area. With chronicity, the skin can become atrophic or hypertrophic, with nodularity and scarring. 瘙痒可见于一些疾病如痔、肛裂、肛门部位手术疤痕形成，也可为便秘或腹泻的伴随症状。除肛门疾病外，还有过敏性（即接触性）皮炎、真菌病、皮脂溢出、糖尿病和蛲虫病均可引起瘙痒。此外也许考虑全身性疾病如糖尿病，需要进一步检查。肛门神经性皮炎可引起剧烈瘙痒，导致反复搔抓使局部皮肤抓破、皲裂。随病程迁移，局部皮肤可发生萎缩或肥厚，或发生结节和疤痕。
Special Studies 特殊检查
It is postulated that pruritus and soiling in some patients may occur as a result of a defect in anal sphincter function.
有人推测部分患者的瘙痒和局部脏污可能是肛门括约肌功能缺陷所致。
Evaluation 病情评估
Physical examination should include anoscopy and proctosigmoidoscopy
to look for a local cause of the symptoms. Those with complaints of long duration should undergo evaluation for proximal colon and anorectal neoplasms. 体检应包括肛门镜和直肠乙状结肠镜检查以了解本病的局部原因。长期肛门瘙痒应检查有无近端结肠或肛门直肠的肿瘤。
Treatment 治疗
Pruritus ani has traditionally been considered a condition that eludes all attempts at cure. Numerous potions, nostrums, and lotions have been employed with varying degrees of success, as well as more aggressive treatment, such as injection of local anesthetics, phenol, methylene blue, and alcohol. Excision and skin grafting have also been suggested.
肛门瘙痒症通常很难治愈。许多饮剂、秘方以及洗剂有程度不等的疗效，更激进的治疗如局部麻醉药物、石炭酸、亚甲蓝以及酒精注射也有一定疗效，也有建议局部皮肤切除和皮肤移植的。
In recent years, attention has been drawn to the role of diet in the cause of the condition; therefore, an accurately obtained history will often dictate the appropriate treatment. Items that have been implicated include the following: 近年来注意到饮食与肛门瘙痒的关系，因此精确采集病史将有助于治疗。应注意下列食物：
Coffee (caffeine) 咖啡（咖啡因） Tea (caffeine) 茶（咖啡因）
Carbonated beverages, especially caffeinated colas 碳酸饮料特别是含咖啡的可乐类
Milk products 奶制品
Alcohol, particularly wine and beer 酒类特别是葡萄酒和啤酒
Tomatoes and tomato products, such as ketchup 西红柿及西红柿制品如番茄酱
Cheese 奶酪
Chocolate 巧克力
Citrus fruits, grapes, prunes, figs 柑橘类水果，葡萄，西梅及无花果
Nuts 坚果
Smoking 吸烟
Removing or changing the dietary factor may cause the symptoms to disappear. 去除或改变这些不良饮食因素可使症状消失。
Additionally, promoting complete evacuation with increased fl uids and bulking
agents (e.g., bran, psyllium) may help avoid the irritation. 此外大量饮水和摄入一些膨胀性食品（如麸糠和车前子）可促进排泄完全，有利于避免刺激。
The most important advice that can be given is usually directed toward the management of anal hygiene. Many individuals perceive their problem to be one of lack of cleanliness; the opposite is more likely. Vigorous scrubbing of the area with soap and water will cause the skin to be defatted, and contact dermatitis may supervene. 对患者最重要的建议莫过于适当的肛门卫生习惯。许多人认为自己的疾病是由于局部太脏，但实际上可能正好相反。过度用肥皂和水进行搓洗可使局部脂膜消失和导致接触性皮炎。
Uses of medication, topical cream or ointment are not discussed in this article and one should consult his/her protologist. 药物以及软膏等的使用在本文不做讨论。应咨询肛肠专科医生。
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