Itchin and Burnin and Scratchin: Perianal Skin Disorders

Everyone is susceptible to dermatologic conditions/skin diseases that affect the perianal area (butthole area), but IBD patients may be at increased chance of this due to their immune-mediated nature. All the more reason to maintain a relationship with a provider you trust with your health so you can take care of these things best

 If these issues start happening, it’s important to take a few notes or things into consideration and take note of.

  • Duration – How long has this been going on?

  •  Itch -Is it itchy?

  •    Pain – how much does it hurt, and how (burning, stabbing, throbbing, etc)?

  • Bleeding – are you having blood upon wiping, bloody underwear, etc?

  •    Personal care products – what wipes/lotions/products do you use for sexual health and enjoyment (it doesn’t matter if you have been using it forever!)

  •   Is it only on your butt/anus or are your mouth/nails/scalp involved?

Dos and Don'ts

  • DO: Use *** gentle*** skin care to the area! Toilet Paper or a Bidet only (personally a bidet fan)

  •  DON'T: Go wild scrubbing. It may seem logical to clean the area more, use more products, but trust me on this one! (seriously, the experts in butt health confirmed it)

  • DO: Use water and Dove Sensitive Skin Bar Soap is the best bet until you can  see a trusted healthcare professional.

in IBD, we may be more prone immune-mediated skin diseases where cytokines (part of our body’s immune system) drive the itch

There are many things that can contribute to burning and itchy rash of the perianal area, and if you and your provider have eliminated IBD as the cause – these may be culprit

Psoriasis

  •      Yes, that psoriasis!

  •   Symptoms include:

  • Redness (the fancy word is erythema)

  • Itchiness in perianal area and cleft (buttcrack)

  •   Many only think of psoriasis as occurring on the hands or arms, but it can occur exclusively in the genitals as well.

  • Can also occur exclusively in the perineum/perianal area

  • It’s important to let your care team know about these symptoms as some IBD medications can treat both psoriasis and your CD/UC together!

Lichen Sclerosis

  • Associated with severe itch in the perianal area
  •  A shiny, patchy, thin rash that has papules  (raised spots/bumps) of the surrounding skin
  • Usually in the genital area
  •   LS is a chronic inflammatory condition of genital region, similar to how IBD  is a chronic inflammatory condition
  • It is very important to treat LS so make sure to reach out to your healthcare team if these symptoms start bothering you!

Hidradenitis Suprartiva (HS)

  • Symptoms include painful lumps and intermittent boils in the genital area and areas where skin rubs together like the buttcheeks and armpit.
  • Like IBD, HS is a chronic  inflammatory condition and can be influenced by the same thing IBD flares are influenced by (stress, diet, etc)
  • HS mainly affects people with Crohn’s Disease not UC.
  •   Similar to above,  let your care team know about these symptoms as some IBD medications can treat both  HS and your CD/UC together!

    Irritant Contact Dermatitis

    •  This is a Type IV (4) Sensitivity Reaction, and anyone can develop it! 
    • Similarly to how we can become allergic to our biologics overtime (a type III sensitivity, so not the same!)
    • This means it occurs to things you use frequently or develops over time

    • Including:

    • ingredients like fragrances or additives in wipes

    • Things that you may apply to your skin or perianal area such as Neosporin, benzocaine, bacitracin (I know I am a culprit of applying benzocaine and using bacitracin cream!)

    • Ingredients of topical hemorrhoid preparations, such as local anaesthetics benzocaine and lignocaine can worsen irritant contact dermatitis or lead to its development over long term use

    • Contact allergy to incontinence pads and their fragrances

    • Fragrances and preservatives, especially in wet wipes

    • Lanolin

    • Ingredients of body washes

    Perianal Contact Dermatitis

    •  Anyone can develop this – it is NOT because you are LGBTQ+ or because you have IBD! Obviously none of these things are caused because you are LGBTQ+ and none are your fault, but don’t feel blame or shame for any skin condition or condition period.

    • This is caused by repeated exposure to an irritant or moisture, such as:

    • Fecal soiling resulting from an “incompetent”anal sphincter

    • Incontinence pads which allow fecal material to be occluded against the skin

    • Skin irritants in skin cleansers and alkaline soaps

    • Moisture from gastrointestinal contents after consumption of spicy food or cathartics

    • Sweating

    • Some irritant laxatives (eg, co-danthrusate): metabolised to dithranol, and if overflow incontinence develops, its presence in the stool will irritate the perianal skin.

What if my perianal area is itchy and I don’t have a rash?

  • If you and your healthcare team have 10000% ruled out IBD activity and IBS or other gut disorders, it may be time to get creative!
  •  Excluding other factors and until you can see a provider you trust to talk about this, there are a few things you can do at home to ease the discomfort!
  • Several OTC creams are extremely effective and recommended by dermatologists who specialize in anorectal and perianal health, including:

  • Lidocaine, menthol, camphor and pramoxine cream.

  • It is important to keep a trusted healthcare provider in the loop about your butt and perianal symptoms because you may need some tests, especially if you have IBD or another health condition.

  •   These may include:

  •     Metabolic panels and tests

  •   Kidney function tests: making sure your renal system is working well and your Cr/BUN ratio is good!

  • Hepatic Function: LFTs (AST/ALT) to rule out things like cholestatic liver disease.

  • Your provider may want you to check in with a trusted mental health professional to make sure anxiety and psychogenic pain aren’t contributing.

  • Neurologic: Things like neuropathy, back injury, and spinal impingement can cause these issues

  • This is why it’s SO IMPORTANT to check in with your care team when something out of the ordinary starts happening – they are there to help you be your  best!