Patient:
Doctor, I was previously diagnosed with perianal eczema, and it cleared up for a while. But now, the itching around my anus is back. I’ve been using medication for the past five days, which has helped somewhat with the itching. Today, after taking a shower, I wiped and noticed a little bit of blood. The itchiness is also now inside the anus. At night, I’ve been applying zinc oxide ointment on the outside and some Ma Yinglong hemorrhoid cream internally. My routine for the last five days has been applying Pifupingyan in the morning, erythromycin ointment at noon, and zinc oxide sulfur ointment at night. The issue keeps recurring this year, and it’s really painful and frustrating. I maintain good hygiene, change my underwear daily, and wash the area regularly. I’ve even seen suggestions online to try a combination of berberine water and haciendine solution as a wet compress. Do you think that would help my condition, or is there a better treatment for this?
Doctor:
Thank you for the detailed information; I understand your concerns. From what you’ve described, it sounds like perianal eczema, possibly with an internal hemorrhoid. I have a few follow-up questions that will help me make a more accurate diagnosis and provide appropriate treatment advice:
- How long have you been experiencing symptoms in total? Do you feel any pain during bowel movements, or do you notice any lumps or protrusions around the anus? Is the area consistently moist?
- How has your bowel routine been? Any signs of constipation, diarrhea, or hard stools?
- Could you describe your daily routine? Do you experience long periods of sitting, fatigue, late nights, colds, or chills?
- What is your diet like? Do you consume spicy or irritating foods, alcohol, or have a low intake of fruits and vegetables? How much water do you usually drink daily?
Patient:
- I’ve had symptoms for about a year now. I don’t feel any pain when I have a bowel movement, and nothing really protrudes, although there’s a small bump as shown in the picture.
- My bowel movements have been normal these past few days—no constipation or diarrhea.
- I usually stay up late and have trouble sleeping lately. I sit for long periods due to work.
- My diet has been fairly regular, but I don’t eat much fruit, mostly boxed lunches, and I only drink water when I’m really thirsty.
Doctor’s Response:
Thank you for the additional details. Based on your answers and symptoms, it sounds like perianal eczema. Here’s a breakdown of what might be causing this and how we can work toward relief:
Cause: Perianal eczema is a common skin condition with various causes. Prolonged sitting or standing, poor ventilation in the area, spicy or irritating foods, diarrhea, loose sphincter muscles, anal and rectal inflammation, and other conditions like hemorrhoids or fissures can all contribute to moisture buildup and skin irritation. This can also be exacerbated by soaps, certain synthetic fabrics, and even some skincare products. People with sensitive skin are more prone to this condition.
Symptoms: It typically affects the skin around the anus and can extend to the perineal area in some cases. Itching can be intense, and the skin often feels moist, with thickening or cracking. Acute eczema might appear as clusters of small red bumps or tiny blisters on a red base. Scratching can lead to oozing, erosion, or even small wounds, and the affected area can gradually spread. Over time, eczema can become chronic, with darkened, thickened skin and an itchy, rough texture. Recurrences are common.
Treatment Plan:
Diet: Try to stick to a bland diet, focusing on high-fiber foods like vegetables, fruits, and whole grains to keep your stools soft. Avoid spicy foods, alcohol, seafood, lamb, beef, garlic, and other foods that may trigger symptoms. Drink plenty of water throughout the day.
Post-Bowel Care: Avoid vigorous wiping and scented toilet paper. It’s best to rinse with water and pat dry with a tissue afterward. Soaking in warm water for 10 minutes before bed can also help; use warm—not hot—water, as high temperatures can make itching worse.
Hygiene: Continue changing underwear daily, but consider applying talcum powder if the area is moist or a gentle ointment if it’s dry. Avoid scratching the area directly, as it can worsen symptoms.
Medications: You can apply a mild steroid cream, such as Pruronic or Elosone, for itch relief for 1–2 weeks (no more than 2 weeks at a time). For antibacterial protection, consider adding chlorhexidine spray or cream.
Lifestyle: This condition is highly prone to recurrence, so effective treatment often depends on consistent maintenance. During flare-ups, medication can alleviate itching, but between episodes, it’s essential to keep the area ventilated, clean, and as dry as possible.
I hope these recommendations bring you some relief!