Appearance of the perianal skin will depend on the severity and chronicity of the underlying conditions that are causing the pruritus. The skin will appear normal with early, mild cases. With acute, more severe exacerbations, the perianal skin will appear reddened, edematous, and moist; frequently, there are excoriations caused by scratching. In chronic cases, the perianal skin takes on a thickened, almost leathery, depigmented appearance. The normal radiating folds of skin thicken into rugae and may include superficial fissures factitiously induced.
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