ABSTRACT
Patients with primary perianal dermatologic conditions and secondary perianal involvement in systemic diseases are initially seen with a variety of symptoms and macroscopic appearances. Even though patients may have painful, friable, indurated, ulcerated, or raised skin lesions, their most frequent symptom is pruritus (1). For practical purposes the perianal skin conditions may be classified as pruritic and nonpruritic. When no underlying cause for pruritus can be identified, the condition is termed ‘‘idiopathic pruritus ani,’’ the most common type. Consequently, it serves as the basis for much of this discussion. In treating this group of conditions, the dermatologist and the surgeon frequently work in concert. The dermatologist, because of his or her visual training, is equipped to diagnose, scrape, culture, and prepare microscopic preparations and perform a biopsy in the office, and the surgeon is able to examine and culture and to perform a biopsy on anorectal pathology through anoscopes and proctoscopes. This chapter reviews the dermatologic conditions with emphasis on diagnosis and treatment from the surgeon’s perspective.
