Anal dermatitis cumulative toxic L24.9

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 02.01.2023

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After Eczema; Chronic anal eczema; cumulative toxic anal eczema; Cumulative toxic anal eczema; eczema of the anus; irritant anal eczema; irritant toxic anal eczema; Toxic anal eczema; Toxic-degenerative anal eczema

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Polyätiological, acute, subacute or chronic dermatitis of the anoderma, anal and perianal skin. With prolonged exposure to the noxious agent, irritant toxic anal eczema gradually turns into cumulative toxic anal eczema.

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About 30% of anal eczema have a cumulative toxic etiology.

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The most frequent cause is a disturbance of the fine continence of the anorectal continence organ (sphincter insufficiency), caused by internal hemorrhoids, anal prolapse, or marisci.

Acute anal eczema is usually caused by exogenous irritation (poor hygiene, sweating, diarrhea, mechanical irritation, e.g., after marching or long-distance running; use of coarse, rough toilet paper).

Chronic (non-atopic, non-contact allergic) irritative-toxic anal eczema is usually the result of continuous secretion from the anal canal. Less commonly, it is caused by irritant substances such as disinfectants.

Irritative-toxic mechanisms include: chronic, inflammatory or tumorous intestinal diseases with secretion flow from the anus, chronic diarrhea, incontinence, fistula disease, prolapse, faulty anal hygiene, anatomical maldevelopment (funnel anus), parasitosis (oxyuria), laxative and antibiotic abuse. The resulting alteration of the anal and perianal environment (pH shift, constant moisture; maceration) leads to bacterial and mycotic overgrowth and chronic dermatitis.

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Preferred >50 years, no gender preference

Clinical features
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Acute anal dermatitis: sharply demarcated, erosive weeping, usually extensive, highly red, itchy or painful areas of skin.

Chronic anal dermatitis: "Symptom of moist and itchy anus". Usually indistinct, weeping plaques of the swollen anal and perianal region with crumbly scaling as well as punctate and extensive erosions, rhagades, line-shaped or extensive scratch marks as an expression of the usually excruciating itching.

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Chronic toxic anal dermatitis (anal eczema) is often complicated by a contact allergy. In this respect, it is always important to exclude a contact allergy.

External therapy
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It is important to clarify and treat any underlying hemorrhoidal disease.

In the long term, local therapy with low-sensitizing, antiphlogistic topical preparations (e.g. 1-5% zinc oxide) in non-irritating bases should be aimed for.

Reminder. The following applies to the base: Galenically simple, allergologically indifferent bases (no W/O emulsions!). No creams! No polyglycol-containing carriers! Frequent burning on weeping surfaces).

Supplementary sitz baths with synthetic tanning agents (e.g. Tannolact), soap-free "anal douches".

In acute weeping anal eczema: application of non-irritating topical glucocorticoids (e.g. 0.1% triamcinolone acetonide in petrolatum); cleansing with olive oil; soap-free anal douches, sitz baths with synthetic tanning agents (e.g. Tannosynt liquid, Tannolact).

In chronic anal eczema (irritative-toxic): Treatment and elimination of the underlying condition, e.g., hemorrhoidal disease, diarrhea, mariscus, worm disease (tesafilm tear).

Insertion of linen strips or gauze strips to prevent maceration.

In chronic anal eczema, externals that are as allergologically indifferent as possible, such as Vaselinum alb. or, in the case of wool wax tolerance, Ungt. molle, are suitable as a basis; also Linola fat and, for example, Excipial almond oil ointment. Temporary local measures with low-potency glucocorticoids such as hydrocortisone 0.5-1% (e.g., Hydrogalen, R120 ) are useful.

Caveat. Patients are often pre-treated with corticosteroids for a long time! From the physician's point of view, it is important to achieve control over the "cortisone requirement" in order to be able to establish a controllable therapy regime. In the medium term, a cortisone-free local therapy should be aimed for.

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  1. Proske S et al (2004) Anal eczema and its benign simulators. dermatologist 55: 259-264
  2. Rajalakshmi R et al (2011) Lichen simplex chronicus of anogenital region: a clinico-etiological study. Indian J Dermatol Venereol Leprol 77:28-36

  3. White hair E (2015) Genitoanal pruritus. dermatologist 66:53-59


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Last updated on: 02.01.2023