hautambulanz wien
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(BVDD), Association of German Coloproctologists (Berufsverband der Coloproktologen Deutschlands e.V.) geb. While patients may report a long history of sleep disturbance due to nocturnal pruritus of varying severity, the clinical findings may only be very subtle. Heiligenstädter Straße 55-63, 1190 Wien +43 1 36066-5000 ambulatorium@pkd.at Heiligenstädter Straße 55-63, 1190 Wien +43 1 36066-5000 ambulatorium@pkd.at Suchbegriffe Optimization of bowel movement habits, e.g., by modifying dietary habits with the goal of achieving formed stool, may have positive effects, as it reduces the frequency of bowel movements and thus also the frequency and duration of exposure (of perianal skin) to stool and rectal secretions. A significant increase in the number of bowel movements in combination with very soft/liquid stool (e.g., with chronic inflammatory bowel disease or after partial colectomy) can have the same irritant‐toxic effect and thus trigger or perpetuate perianal dermatitis. Im Jahr 2012 eröffnete sie in Wien Meidling das Hautzentrum Wien. Detailed information on the methodology used in the development of these guidelines as well as their scope, target audience and conflicts of interest can be found in the long version of these guidelines (www.awmf.org). A history and/or family history of atopic disorders (atopic dermatitis, allergic bronchial asthma, or allergic rhinitis) or an increased Erlangen atopy score 16 may point to the diagnosis of atopic perianal dermatitis. Perianal dermatitis (anal eczema, perianal eczema) is one of the most common proctological conditions.
Topical anti‐inflammatory and specific symptomatic treatment shall only be employed if rapid symptom relief is required or if the abovementioned measures have failed. The most important measure for patients with allergic contact dermatitis in the perianal region is strict avoidance of relevant contact allergens. For some patients, especially those with chronic recurrent atopic perianal dermatitis, a fatty ointment base may also be suitable for skin care purposes. Topical corticosteroids with a high therapeutic index (TIX) are characterized by a good risk‐benefit ratio (e.g., methylprednisolone aceponate, prednicarbate, hydrocortisone butyrate). Treatment of other forms of perianal dermatitis with topical calcineurin inhibitors corresponds to an off‐label use. Fissuring of the mucosa of the distal anal canal may also occur.
Besides rapid symptom relief and complete resolution, treatment of perianal dermatitis is also aimed at long‐term prevention of recurrence by treating or eliminating underlying causative factors. Schnell und einfach. Learn more. The three main types are irritant‐toxic, atopic and allergic contact dermatitis 1, 3, 4. ▸ Hidradenitis suppurativa (acne inversa), ▸ Symptoms (pruritus, pain, oozing, anal bleeding, anal discharge, mucus on the stool): onset, duration, type of symptoms, circadian variations (if present), ▸ Bowel movement behavior, bowel movement frequency and stool consistency, impaired continence, ▸ Exposure to exogenous agents: hygiene behavior (in particular, moist toilet paper, ‘hygiene wipes’), skin care products, topical over‐the‐counter and prescription drugs, ▸ Sexual behavior (receptive anal intercourse, lubricants), ▸ Temporal course of the symptoms and correlation with exposures, ▸ Atopic and other skin disorders, known contact sensitizations, proctological disorders and surgical interventions in the lower gastrointestinal tract/anogenital region, ▸ Inspection of the anogenital region, having the patient strain, checking for anocutaneous reflex, ▸ Digital rectal examination (DRE): palpation of the anal canal (length, indurations, tumors), assess resting sphincter tone and squeeze sphincter pressure, digital examination of the entire circumference of the rectal ampulla, ▸ Dermatological examination, depending on the morphology of the perianal skin lesions (e.g., nails, oral mucosa, scalp), ▸ Proctoscopy: distal rectum, hemorrhoids, dentate line, anal canal (anoderm), ▸ Possibly, speculum examination if fissures or inflammatory/purulent lesions are present, ▸ Rectoscopy, colonoscopy, gastroduodenoscopy in case of unclear anal bleeding, passing of mucus and irregularities in bowel movements, ▸ Suspected superinfection or pathogen‐induced perianal dermatitis (impetigo), ▸ Suspected perianal mycosis (e.g., candidiasis, tinea), ▸ Suspected perianal streptococcal dermatitis, ▸ Suspected sexually transmitted infection of the rectum (e.g., chlamydia, gonorrhea, mycoplasma), ▸ Clinical uncertainty as to the diagnosis of perianal dermatitis, ▸ Treatment‐refractory perianal dermatitis (4 [–6] weeks) of any origin, ▸ To rule out other differential diagnoses or concomitant diagnoses, ▸ Treatment or elimination of causative factors, – Treatment of underlying proctological conditions, – Treatment of internal or other causative comorbidities, or avoidance of specific irritant stimuli, – Strict avoidance of relevant contact allergens, ▸ Nonpharmacological treatment (avoidance of aggravating factors), ▸ Topical anti‐inflammatory treatment, specific symptomatic treatment and treatment of concomitant diseases, – Anti‐inflammatory: corticosteroids, calcineurin inhibitors, – Antibacterial, antifungal and antiseptic agents, – Detergent‐free cleansing with tepid water (anal douching or sitz baths), – Gentle drying with cotton pads, soft towels or unbleached, fragrance‐free paper towels, – Dietary modifications aimed at achieving formed stool, – If applicable: reduction in the frequency of bowel movements, – If applicable: supplemental intake of bulking agents (e.g., psyllium), – Gentle, allergen‐free skin care products (e.g., hydrophilic oil‐in‐water preparations), – Use of loose cotton underwear (to avoid constriction), ▸ For acute, oozing dermatitis and/or highly inflammatory lesions, creams and lotions should be used, ▸ In hair‐bearing regions, lotions should preferably be used, ▸ Chronic or chronic recurrent dermatitis should preferably be treated with hydrophilic pastes, ▸ If the anoderm is also involved, intraanal application of pastes or ointments (adhesive properties) is suitable, ▸ In cases marked by highly inflammatory lesions to ensure rapid symptom relief, ▸ Whenever treatment or elimination of causative factors as well as nonpharmacological measures have failed or are insufficiently effective, ▸ Depending on the clinical presentation: Use of low‐to‐medium‐potency topical corticosteroids, ▸ The duration of once or twice‐daily application should be kept as short as possible (one to four weeks), ▸ If required, long‐term treatment using low‐to‐medium‐potency topical corticosteroids should be administered in the form of intermittent therapy (once or twice a week), ▸ Following induction therapy with topical corticosteroids, treatment may be continued in the form of “proactive” intermittent maintenance therapy (once or twice weekly) using topical calcineurin inhibitors (pimecrolimus, tacrolimus)*, ▸ In between treatment days, allergen‐free oil‐in‐water skin care products should be used.
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