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Pruritus, like any other symptoms, suggests the presence of an underlying cause that should be diagnosed and treated appropriately. Thus, excision of malignancies or surgical correction of fistulas, prolapses, or hemorrhoids would be the definitive treatment for patients with those conditions.

In most cases, specific anorectal lesions are not apparent, and the patient must be referred to a proctologist or dermatologist for probable long-term management.

In the meantime, the patient should be advised to make certain dietary changes, if appropriate, and should be instructed about proper anal hygiene. Scratching of the area must be avoided; if necessary, the patient should be advised to wear gloves at bedtime, when most of the scratching is likely to occur. Patients with maceration of perianal skin should use moist cotton rather than toilet paper. Soaps should be avoided, and the patient should take sitz baths for at least 15 min two to three times a day. The skin should then be thoroughly dried by gently blotting with a soft cloth. Zinc oxide ointment can provide a protective covering for the perianal skin and may enhance the healing. Fungicidal creams should be prescribed for patients with secondary fungal infections. One percent hydrocortisone cream is effective for the allergic component of the inflammation. Finally, as an adjunct to providing symptomatic relief, consider prescribing hydroxyzine hydrochloride (Atarax) as an effective bedtime sedative.

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