[Genitoanal pruritus].

BACKGROUND: Genitoanal pruritus is usually characterized by intense pruritus in the genital area, possibly also extending to the anal and gluteal regions. Besides pruritus, other sensations such as burning, stinging, heat sensations and pain may occur. Genital pruritus may be associated with specific skin lesions of dermatoses such as eczema, lichen sclerosus or others. The skin is often without pathological findings, but one should be alert to transient erythemas, fetor and excretions in the genital area. Caused by intense scratching, secondary lesions such as papules, excoriations and crusts may appear. Maceration also frequently develops. In chronic dermatoses such as eczema and psoriasis, the anogenital area is commonly involved, but often not mentioned by patients due to feelings of shame or because skin changes in other body areas are more prominent.

DIAGNOSIS: In addition to a complete medical history and thorough physical examination, special attention must be paid to the anogenital area including the mucosa surfaces. Diagnostics should be performed according to the guidelines on chronic pruritus. Besides a gynecological and if necessary urological examination, allergy testing (patch test) and, in case of possible neuropathic causes, magnetic resonance tomography (MRT) should be performed.

THERAPY: Therapy depends on the underlying cause. Symptomatic-antipruritic measures are available. Interdisciplinary medical care is often necessary, usually leading to a clarification of the causes and satisfactory therapy. Somatoform disorders should also be taken into account.

CONCLUSION: In summary, genital pruritus forms a challenge that can, however, be met well by careful diagnostics, therapy and interdisciplinary care in the daily clinical practice.