1% hydrocortisone ointment is an effective treatment of pruritus ani: a pilot randomized controlled crossover trial.
BACKGROUND
Pruritus ani (PA) is a common condition which is difficult to treat in the absence of obvious predisposing factors. There is paucity of evidence-based guidelines on the treatment of this condition. We examined whether 1% hydrocortisone ointment is an effective treatment for PA.


METHODS
A pilot randomized, double-blind, placebo-controlled, crossover trial was carried out. Eleven patients consented to take part in the trial and ten completed the study. After a 2-week run-in period, patients with primary PA were randomly allocated to receive 1% hydrocortisone ointment or placebo for 2 weeks followed by the opposite treatment for a further 2-week period. There was a washout period of 2 weeks between treatments. The primary outcome measure was reduction in itch using a visual analogue score (VAS). The secondary outcome measures were improvement in quality of life measured using a validated questionnaire (Dermatology Life Quality Index, DLQI) and improvement in clinical appearance of the perianal skin using the Eczema Area and Severity Index (EASI) score.


RESULTS
Treatment with 1% hydrocortisone ointment resulted in a 68% reduction in VAS compared with placebo (P=0.019), a 75% reduction in DLQI score (P=0.067), and 81% reduction in EASI score (P=0.01).


CONCLUSIONS
A short course of mild steroid ointment is an effective treatment for PA.
Al-Ghnaniem
R
R
Department of Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK. reyad@doctors.org.uk.
Short
K
K
Department of Dermatology, King's College Hospital, London, UK.
Pullen
A
A
Department of Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
Fuller
L C
LC
Department of Dermatology, King's College Hospital, London, UK.
Rennie
J A
JA
Department of Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
Leather
A J M
AJM
Department of Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
D000287:Administration, Topical; D000328:Adult; D000982:Antipruritics / Q000008:administration & dosage*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D009824:Ointments; D010865:Pilot Projects; D011538:Pruritus Ani / Q000188:drug therapy* / Q000473:pathology; D011788:Quality of Life; D012720:Severity of Illness Index; D012867:Skin / Q000187:drug effects* / Q000473:pathology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000982:Antipruritics; D009824:Ointments; D006854:Hydrocortisone