Kohutav sügelus pärakus juba aastaid 10.06.17 / Perearst

Arst vastas:

dr Madis Veskimägi

Perearst

Tõstamaa Tervisekeskus

Tere !
Mõistan muret. Julgen arvata, et kõik orgaanilised haigused on välistatud. Julgen ka soovitada õhtuse annusena allergiatabletti, päraku piirkonda määrida nõrka hormoonsalvi ( prednisoloon v dexamethason) või tsinksalvi ( sudocrem v dermilon ).
Uurisin veidi googlest ja leidsin allika, kus on palju soovitusi. Mis toimib, tuleks koostöös oma arstidega leida.
Head tervist soovides,
Madis Veskimägi
http://www.medicinenet.com/anal_itching/article.htm
What is the treatment for anal itching?
Initial treatment of simple itching is directed toward relieving the burning and soreness. It is important to clean and dry the anus thoroughly and avoid leaving soap in the anal area.
Cleaning efforts should include gentle showering without direct rubbing or irritation of the skin with either the washcloth or towel.
After bowel movements, moist pads (such as baby wipes, flushable moist wipes, and flushable anal cleansing wipes) should be used for cleaning the anus instead of toilet paper.
If there is constant moisture present in the anus or stool incontinence, it may be necessary to clean the anus with moist pads between bowel movements.
Many over-the-counter (OTC) products are sold for the treatment of anal itching and are available as ointments, creams, gels, suppositories, foams and pads. These products often contain the same drugs used to treat hemorrhoids.
When used around the anus, ointments, creams, and gels should be applied as a thin covering.
When applied to the anal canal, these products should be inserted with a finger using finger cots (latex covers for the fingertips) or a "pile pipe." Pile pipes are most efficient when they have holes on the sides as well as at the end. Pile pipes should be lubricated with ointment prior to insertion.
Suppositories or foams do not have advantages over ointments, creams, and gels.
Most products contain more than one type of active ingredient. Almost all contain a protectant in addition to another ingredient. Only examples of brand-name products containing one ingredient in addition to the protectant are discussed in this article.
Local anesthetics
Local anesthetics temporarily relieve pain, burning, and itching by numbing the nerve endings. The use of these products should be limited to the perianal area and lower anal canal. Local anesthetics can cause allergic reactions with burning and itching. Therefore, the application of anesthetics should be discontinued if burning and itching increase.
Examples of local anesthetics include:
benzocaine 5% to 20% (Americaine Hemorrhoidal, Lanacane Maximum Strength, Medicone)
benzyl alcohol (Itch-X) 5% to 20%
dibucaine 0.25% to 1.0% (Nupercainal)
dyclonine 0.5% to 1.0%
lidocaine (Xylocaine) 2% to 5%
pramoxine 1.0% (Fleet Pain-Relief, Procto Foam Non-steroid, Tronothane Hydrochloride)
tetracaine 0.5% to 5.0%
Vasoconstrictors
Vasoconstrictors are chemicals such as epinephrine, a naturally occurring chemical. Applied to the anus, vasoconstrictors make the blood vessels become smaller, which may reduce swelling. They also may reduce pain and itching due to their mild anesthetic effect.
Vasoconstrictors applied to the perianal area - unlike vasoconstrictors given by injection - have a low likelihood of causing serious side effects, such as high blood pressure, nervousness, tremor, sleeplessness, and aggravation of diabetes or hyperthyroidism.
Examples of vasoconstrictors include:
ephedrine sulfate 0.1% to 1.25%
epinephrine 0.005% to 0.01%
henylephrine 0.25% (Medicone Suppository, Preparation H, Rectocaine)
Protectants
Protectants prevent irritation of the perianal area by forming a physical barrier on the skin that prevents contact of the irritated skin with aggravating liquid or stool from the rectum. This barrier reduces irritation, itching, pain, and burning. There are many products that are themselves protectants or that contain a protectant in addition to other medications.
Examples of protectants include:
aluminum hydroxide gel
cocoa butter
glycerin
kaolin
lanolin
mineral oil (Balneol)
white petrolatum
starch
zinc oxide (Desitin) or calamine (which contains zinc oxide) in concentrations of up to 25%
cod liver oil or shark liver oil if the amount of vitamin A is 10,000 USP units/day
Astringents
Astringents cause coagulation (clumping) of proteins in the cells of the perianal skin or the lining of the anal canal. This action promotes dryness of the skin, which in turn helps relieve burning, itching, and pain.
Examples of astringents include:
calamine 5% to 25%
zinc oxide 5% to 25% (Calmol 4, Nupercainal, Tronolane)
witch hazel 10% to 50% (Fleet Medicated, Tucks, Witch Hazel Hemorrhoidal Pads)
Antiseptics

Antiseptics inhibit the growth of bacteria and other organisms. However, it is unclear whether antiseptics are any more effective than soap and water.
Examples of antiseptics include:
boric acid
phenol
benzalkonium chloride
cetylpyridinium chloride
benzethonium chloride
resorcinol
Keratolytics
Keratolytics are chemicals that cause the outer layers of skin or other tissues to disintegrate. The rationale for their use is that the disintegration allows medications that are applied to the anus and perianal area to penetrate into the deeper tissues.
The two approved keratolytics used are:
aluminum chlorhydroxy allantoinate (alcloxa) 0.2% to 2.0%
resorcinol 1% to 3%
Analgesics
Analgesic products, like anesthetic products, relieve pain, itching, and burning by depressing receptors on pain nerves.
Examples of analgesics include:
menthol 0.1% to 1.0% (greater than 1.0% is not recommended) (Calmoseptine)
camphor 0.1% to 3% (greater than 3% is not recommended)
juniper tar 1% to 5%
Corticosteroids
Corticosteroids reduce inflammation and can relieve itching, but their chronic use can cause permanent damage to the skin. They should not be used for more than short periods of a few days to two weeks. Only products with weak corticosteroid effects are available over-the-counter. Stronger corticosteroid products that are available by prescription should not be used for treating anal itching.
What if anal itching persists?
For persistent anal itching, efforts are directed toward identifying an underlying cause. An examination by a doctor can rapidly identify most causes of anal itching. Adjustments in diet, treatment of infections, or surgical procedures to correct the underlying cause may be required. 

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