Sahnan et al comment that "Most patients have idiopathic itching and can be managed in primary care" and "most patients do not consult a doctor". Hence this article is based on the minority who find their way to secondary care. From the GP point of view, the main problem here is that he is a lorry driver, many of whom spend many hours sitting in their (the vast majority are male) cabs. This creates a warm moist perianal area, ideal for causing pruritis ani. Advice in Primary Care would be given on suitable "breathable" seating and clothing in that area to minimise the risk of recurrence, once treated. Even moving the bottom frequently is useful, rather than sitting still in one place for hours at a time. Pruritis ani is almost an occupational hazard for long distance lorry drivers.
Perhaps some Primary Care input would have helped this article - which is excellent for the minority that reach hospital outpatients.
Also, as others have stated, the photos are mislabelled on BMJ.com, although they are correct on the print version!
Rapid Response:
Re: Anal itching
Sahnan et al comment that "Most patients have idiopathic itching and can be managed in primary care" and "most patients do not consult a doctor". Hence this article is based on the minority who find their way to secondary care. From the GP point of view, the main problem here is that he is a lorry driver, many of whom spend many hours sitting in their (the vast majority are male) cabs. This creates a warm moist perianal area, ideal for causing pruritis ani. Advice in Primary Care would be given on suitable "breathable" seating and clothing in that area to minimise the risk of recurrence, once treated. Even moving the bottom frequently is useful, rather than sitting still in one place for hours at a time. Pruritis ani is almost an occupational hazard for long distance lorry drivers.
Perhaps some Primary Care input would have helped this article - which is excellent for the minority that reach hospital outpatients.
Also, as others have stated, the photos are mislabelled on BMJ.com, although they are correct on the print version!
Competing interests: No competing interests