title: Pruritus ani as a manifestation of systemic contact dermatitis: resolution with dietary nickel restriction.
abstract: Pruritus ani is a common distressing problem with numerous possible causes. When locally applied agents trigger irritation or allergic response, skin changes of dermatitis usually accompany the itch. Focal pruritus in the absence of dermatitis is not generally considered to be a manifestation of contact allergy. Furthermore, focal pruritus is not listed among the possible diverse presentations of the systemic delivery of a proven contact allergen. We report a case of a gentleman with a 1.5-year history of treatment-resistant pruritus ani. When patch testing revealed a positive reaction to nickel sulfate, he admitted to daily peanut butter consumption. His symptoms resolved with dietary nickel restriction. Patch testing may be useful in patients with pruritus of the anogenital region, not only to elucidate potential contact exposures contributing to the symptom but also to suggest possible dietary precipitants.
authors.affiliation: Division of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Dianne L
authors.initials: DL
authors.lastname: Silvestri
authors.forename: Sara
authors.initials: S
authors.lastname: Barmettler
mesh_terms: D010367:Arachis / Q000009:adverse effects / Q000737:chemistry; D003877:Dermatitis, Contact / Q000178:diet therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009532:Nickel / Q000009:adverse effects*; D010328:Patch Tests; D011538:Pruritus Ani / Q000139:chemically induced* / Q000178:diet therapy; D016896:Treatment Outcome
chemical_list: D009532:Nickel