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Suggest Treatment For Red And Itchy Skin In The Rectal Area

Posted on Thu, 27 Aug 2015

Question: I am a 69 year old Vietnam vet with agent orange exposure. I have diabetes and glaucoma, had my prostrate removed at 54. I have been treated for skin problems in the past with Triamcinolone Acetonide cream 0.1% and Clobetasol Propionate for most of my skin problems but they gave me Elidel to use in the rectal and scrotal areas. I have found that constant use of the creams and ointments actually irratates my skin so I am putting Jojoba oil on daily and then just using the creams sparingly. That seems to work OK. My problem is the rectal area. The Elidel seems to be less and less effective. I thought maybe I was wiping too hard causing it to bleed so I switched to wet wipes. No change. The adjacent skin for about 3" to 4" is red and itchy. Also there is a clear substance that seems to weep in this area. I have tried Aloe Vera with only minor relief from the itching. Any progress I make is destroyed everytime I move. Sitting causes my underwear to get stuck and has to be pulled away. I even sense that liquid is running down my leg. I do not know if any of this is coming out of my rectum.
When open enrollment comes around I plan to try to change back to civilian care. What would you suggest I do first?

Answered by Dr. Dr. Kakkar (1 hour later)

Brief Answer:
intertrigo & Scrotal LSC; antifungal powder & topical steroid cream/ elidel

Detailed Answer:
Hello. Thank you for writing to us.

I have gone through your query and I understand your concern regarding itching in rectal and scrotal area.
I think the problem that you have is perianal intertrigo i.e inflammation of body folds in perianal area and scrotal dermatitis i.e Lichen Simplex chronicus / LSC.
Body folds trap sweat/ moisture and warmth and therefore encourage candidal growth which causes inflammation and itching of folds. In intertrigo body folds are bright red and are moist/ wet.
Using oil in body folds would further occlude the folds and favor retention of moisture which would further encouage candidal growth. If I was the treating doctor I would have suggested you to use an antifungal dusting powder in folds at least 3-4 times in a day. This would not only keep the folds dry but being antifungal it will also discourage candidal growth. I would have also suggested an Oral antifungal e.g Fluconazole tablet once every week for 4-6 weeks.
You must immediately stop applying jojoba oil in perianal area. Keeping this area moist is going to worsen the condition.
I also suggest an otc oral antihistamine e.g cetrizine 10 mg tablet once Or twice daily for symptomatic relief from itching.
For scrotal dermatitis I would suggest a topical steroid cream e.g triamcinolone acetonide 0.1% cream, twice daily for 2 weeks, thereafter substituting it with elidel.

Regards

Above answer was peer-reviewed by : Dr. Neel Kudchadkar

Follow up: Dr. Dr. Kakkar (4 hours later)

I was able to get the powder and one that sprays on dry. I chose the spray for my after shower application. Since they are not the same ingredients, is it permissible to mix the powder and the spray intermittently?
The pharmacy would not give Fluconazole without a perscription.
I was able to get the cetrizine. I already have a lifetime supply of the creams from the VA.
What triggered this outbreak was a recent surgery(strabismus). I had thought I had a reaction to the antithetic as I broke out in little red bumps all over my body with the worst areas being my lower legs, lower arms and abdomen. The creams took care of that except for the problem area.
You have shown me that I have a fungal problem. Any advice on a long term strategy?
Thank you so much for your efforts. The VA is reluctant to discuss the matter.

Answered by Dr. Dr. Kakkar (10 hours later)

Brief Answer:
Antifungal dusting powder frequently; oral fluconazole and cetrizine

Detailed Answer:
Hi.

I would suggest you to just use antifungal powder, thrice or more daily. drying/ Antiperspirant sprays might irritate already irritated skin.

Once a week oral fluconazole tablets for 4-6 weeks would have been great. If possible visit a local doctor for a prescription. Tablet cetrizine once or twice daily will provide you symptomatic relief from itching. Expect this condition to improve significantly within 2-4 weeks.

Haemorrhoids should also be addressed appropriately as they are a common cause of blood on wiping, anal and perianal itching/ irritation secondary to mucus discharge that might irritate perianal skin.

One rare possibility is perianal Pagets disease which also presents with anal /perianal itching and anal bleeding that might be mistaken for haemorrhoids.
This possibility might have to be considered in case there is no significant improvement with antifungal treatment during this time period.

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Kakkar (22 hours later)

My wife says my rear is looking better from the use of the powder but now I am getting outbreaks of little red bumps about 1/8" apart on the back of my hands. Do I use the powder on them also?

Answered by Dr. Dr. Kakkar (6 hours later)

Brief Answer:
Kindly upload an Image

Detailed Answer:
Hi.

I request you to kindly upload an Image of these little red bumps on the back of your hands so that I am able to guide you better.

You may upload Images either at "Reports Section"

Or

You may also mail me Images at YYYY@YYYY with the subject line as Attn:Dr. Kakkar.

Also let me know are they itchy?

Regards

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar