Pruritus ani in a school age boy

A school age boy presented to the emergency department with a five day history of worsening pruritis ani. Itching was the only symptom, but it was severe enough to affect his quality of life and disrupt sleep. He had no diarrhoea, faecal soiling, perianal discharge, perirectal bleeding, or abdominal discomfort. He had a normal appetite and his weight was within range for his age. He had experienced perianal itch three months previously, which had resolved spontaneously after two days. His family members, including one other sibling of school age, were not affected.

On examination, the boy was fidgety and appeared to be in discomfort. He showed good hygiene. Systemic examination was unremarkable, including the absence of eczema and candidiasis. Figure 1 shows the perianal region.