Il prurito anale è una sensazione piuttosto sgradevole e mal tollerata, che riconosce diverse cause d’origine.
Per definizione, il prurito anale è caratterizzato dal bisogno, più o meno impellente, di grattarsi; in molti casi, si accompagna ad altri sintomi, quali eritema, perdite sierose od ematiche e dolore. Quando si fa particolarmente intenso e fastidioso, rendendo irresistibile lo stimolo a grattarsi, sovente il prurito si associa a lesioni da grattamento, che a loro volta possono infettarsi, aumentare il fastidio e peggiorare ulteriormente la situazione.
Il prurito anale è un sintomo di frequente riscontro e può avere una origine scarsamente identificabile o essere causato da malattie dermatologiche e/o proctologiche. Tipico del maschio adulto, non è raro anche nell’anziano: inizialmente intermittente, col passare del tempo diventa continuo.
Il prurito anale non è una diagnosi ma un sintomo.
Le possibili cause ed i fattori predisponenti devono essere ben valutati: infatti il prurito è presente in molti pazienti ipocondriaci, affetti da stati ansiosi, depressivi, e spesso è il sintomo principale che identifica un certo tipo di profilo psicologico.
Tra i numerosi fattori predisponenti ricordiamo:
- Iperglicemia alimentare e diabetegravidanza;
- Eccessiva sudorazione;
- Terapie cortisoniche;
- Terapie antitumorali;
- Ipotiroidismo;
- Prolungate terapie antibiotiche;
- Scarsa igiene o, al contrario, eccesso di pulizia;
- Malattie neoplastiche.
Tra le cause dermatologiche determinanti il prurito anale ricordiamo:
- Miceti: il fungo di più frequente riscontro, per la contagiosità, è la Candida Albicans.;
- Batteri, quali Streptococchi e Stafilococchi;
- Virus, quali l’Herpes Simplex e Zoster;
- Parassiti, come gli acari della scabbia, gli ossiuri;
- Protozoi, come il Trichomonas vaginale;
- Dermatiti: come il pemfigo, seborroiche o la Psoriasi.
Tra le cause proctologiche determinanti, legate cioè direttamente alla regione anale, annoveriamo:
- Emorroidi;
- Ragadi;
- Ascessi e fistole anali e retto vaginali;
- Cisti sebacee;
- Sinus pilonidalis;
- Malattia di Crohn e Rettocolite ulcerosa;
- Condilomi anali;
- Incontinenza anale;
- Rettocele;
- Sindrome del perineo discendente.
- Prurito Idiopatico
Vi sono forme di prurito che non riconoscono alcuna causa, in cui il quadro si manifesta in modo intermittente, favorito da particolari condizioni psichiche. Un’altra teoria considera il prurito anale come una condizione di causalgia conseguente ad una lesione di un tronco nervoso o a disturbi del metabolismo, con edema, ischemia e lesioni delle terminazione nervose
Per quel che concerne la diagnosi è necessario ricercare la causa del prurito e, quindi, dopo una corretta raccolta della storia clinica, si può procedere ad accertamenti di carattere laboratoristico (tampone rettale, tampone vaginale, esame chimico-fisico delle feci, esame colturale e parassitologico delle feci, scotch test) e clinico (visita proctologica).
La terapia del prurito anale deve mirare innanzitutto a rimuovere le cause, siano esse dermatologiche che proctologiche: ciò, però, non sempre è possibile ed allora è necessario attenersi ad alcune importanti precauzioni da adottare: poiché certi cibi possono causare il prurito anale, deve essere accertato l’effetto della loro eliminazione dalla dieta. Gli indumenti devono essere larghi e non aderenti e le coperte del letto leggere. Dopo ciascuna defecazione, l’area perianale deve essere pulita con del cotone assorbente inumidito con acqua. L’aspersione libera e frequente di talco in polvere del tipo non medicato aiuta a combattere l’umidità. L’acetato di idrocortisone all’1% sotto forma di emulsione, applicato in modo parco, solitamente è molto efficace. Si possono usare fungicidi topici (p. es. l’amfotericina B, la ciclopiroxolamina in crema all’1%). Le cause sistemiche e le infestazioni parassitarie devono essere trattate in modo specifico. Le biopsie delle lesioni refrattarie possono evidenziare una neoplasia maligna. La radioterapia e l’intervento chirurgico o le iniezioni, per determinare una anestesia locale permanente, sono raramente indicati.
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