The role of topical steroids in the treatment of primary pruritus ani: a systematic review

Background: Steroids can alleviate symptoms long enough for the patient to stop the compulsive pruritus-scratch cycle and allow for healing excoriated perianal skin, owing to potent anti-inflammatory and anti-proliferative effects. This systematic review was designed to evaluate the use of topical steroids for the treatment of primary pruritus ani.Methods: Studies were retrieved after searching the electronic databases Medline, Google Scholar, and Co-chrane Central. The search terms, pruritus ani, anal itching, idiopathic pruritus ani, primary pruritus ani and topical steroids were used. Outcomes were efficacy in reduction of pruritus and side-effects.Results: A total of 7 studies met our inclusion criteria accounting for 181 total of cases of primary pruritus ani treated with topical steroids between 1982 and 2007. On regard of the 181 cases, mean age of patients ranged from 35.4 to 49.5 years old, and similar proportion of males (51.6%) and females (48.4%) was found. Mean duration of symptoms (pruritus ani) varies widely among the studies, with a minimum 5.2 weeks to a maximum 6.5 years. The majority of studies employed hydrocortisone ointment at different concentrations (0.25% and 1%) as the primary therapy. On regard of the overall effectiveness of topical steroid therapy in patients with primary pruritus ani, it ranges between 73.9% to 100%. Few or no side effects were reported in the studies.Conclusions: This systematic review found a lack of high-quality studies on the efficacy of topical steroids in the treatment of primary pruritus ani.