Indian Journal of Dermatology
  Publication of IADVL, WB
  Official organ of AADV
 
Users online: 27  
Home  Editorial Board  Current Issue Archives Coming Soon Guidelines Subscriptions  e-Alerts    Login  
    Small font sizeDefault font sizeIncrease font size Print this page Email this page


 
ORIGINAL ARTICLE
Year : 2007  |  Volume : 52  |  Issue : 1  |  Page : 27-29
Clinical efficacy of combined therapy for perianal eczema caused by anal diseases in 160 cases


1 Department of Dermatology, QiLu Hospital of Shandong University, Ji'nan 250012, Shandong Province (now work at Department of Dermatology, JiNing Medical College, Ji'ning 272013, Shandong Province), China
2 Department of Surgical Generalization, JiNing Medical College, Ji'ning 272013, Shandong Province, China
3 Department of Colorectal Surgery, Taian Central Hospital, Tai'an 271000, Shandong Province, China

Correspondence Address:
SUN Qing
Department of Dermatology, QiLu Hospital of Shandong University, Ji'nan 250012 Shandong Province
China
Login to access the Email id


DOI: 10.4103/0019-5154.31920

Get Permissions

   Abstract 

Perianal eczema is a kind of inflammatory dermatosis on the perianal skin and mucosa. The aim of the study was to evaluate the clinical efficacy of the combined therapy of medicine and operation for the perianal eczema caused by the anal diseases such as hemorrhoids, fissures and fistulas. One hundred and sixty patients with perianal eczema were involved in this study. They were randomly divided into four groups and treated by different therapies for four weeks respectively. Group A (40 patients) was only treated with medicine, Group B (40 patients) only with operation, Group C (40 patients) firstly with medicine and then with operation and Group D (40 patients) firstly with operation and then with medicine. The efficacy was determined as reduction of lesion size relative to initial size. The cure rate was 22.50%, 32.50%, 57.50% and 45.00% in Group A, B, C and D, respectively. The effective rate was 40.00%, 52.50%, 85.00% and 75.00%, respectively. The efficacy was significantly different (H=20.8689, g = 3, P value =0.0001). The results of group comparison showed that there were significant difference between Group C and Group A, Group C and Group B, Group D and Group A (all P values, < 0.05). It was concluded that the combined therapy of medicine and operation is optimal choice for the perianal eczema caused by the anal diseases such as hemorrhoids, fissures, and fistula. It highly improves the cure rate and efficacy rate.


Keywords: Combined therapy, perianal eczema


How to cite this article:
Zhi-Chao L, Jian-Gang L, Zhe L, Qing S. Clinical efficacy of combined therapy for perianal eczema caused by anal diseases in 160 cases. Indian J Dermatol 2007;52:27-9

How to cite this URL:
Zhi-Chao L, Jian-Gang L, Zhe L, Qing S. Clinical efficacy of combined therapy for perianal eczema caused by anal diseases in 160 cases. Indian J Dermatol [serial online] 2007 [cited 2014 Nov 25];52:27-9. Available from: http://www.e-ijd.org/text.asp?2007/52/1/27/31920



   Introduction Top


Perianal eczema is characterized by complicated pathogenesis, stubborn refractoriness and easy recurrence. It is caused by external and internal factors such as allergy, disease agents, functional disturbance of nervous system, and functional disorder of endocrine system. Traditional treatment of perianal eczema is focused on the use of anti-inflammatory drugs such as topical corticosteroids, but the unwanted side effects and recurrence is inevitable. So far there have been few reports on the combined therapy of medicine and operation for perianal eczema. In order to evaluate the clinical efficacy of the combined therapy for perianal eczema caused by the anal diseases such as hemorrhoids, fissures and fistulas, a randomized controlled study was performed from July 2002 through September 2004.


   Materials and Methods Top


160 patients with perianal eczema caused by anal diseases were obtained from QiLu Hospital of Shandong University, Ji'nan, P.R.China, Taian Central Hospital and Affiliated Hospital of Taishan Medical College, Taian, P.R. China. There were 96 males and 64 females with an average age of 46 years (ranging from 18 to 65) and an average duration of 6 years (ranging from 1 month to 28 years). They did not suffer from endocrine diseases or malignancy in the past. The patients have used medicines including traditional Chinese medicine and Zinc Oxide Ointment. The traditional Chinese medicine included Natrii Suifas Exsiccatub (9g), Pericarpium zanthoryli (9g), Herba schizonepetae (9g), Fructus cnidii (9g), Flos lonicerae (9g), Radix Sophorae Flavescentis (9g), Rhizoma atractylodis (9g) and Radix glycyrrhizae (9g). The traditional Chinese medicine was soaked into 3000 ml of water and boiled with Slow fire for 30 minutes. The perianal lesion was fumigated and washed by this solution for 20 minutes each time, twice a day. After that, Zinc Oxide Ointment was administered locally to the perianal lesion for two courses with one course of seven days. Operations included a series of standard Milligan-Morgan ectomies, which were performed for symptomatic anal diseases such as hemorrhoids, fissures and fistulas.

The 160 patients were randomly divided into four groups and treated by different therapies for four weeks respectively. Patients in Group A (n=40) were treated with medicine to improve perianal skin. Patients in Group B (n=40) were treated with operation to cure anal diseases. Patients in Group C (n=40) were firstly treated with medicine and then with operation. Patients in Group D (n=40) were firstly treated with operation and then with medicine.

Evaluation criteria

  1. Cure: The signs and symptoms disappear and the lesion clears.
  2. Excellence: The signs and symptoms are improved markedly and more than 60 percent of the lesions clear.
  3. Efficiency: The signs and symptoms are improved and more than 30 percent of the lesions clear.
  4. Inefficiency: The signs and symptoms are not improved and less than 30 percent of the lesions clear.


Cure rate = (cured cases/ original group cases) x 100%

Effective rate = [ (cured cases + excellent cases) / original group cases] x 100%

Statistics

The statistical analysis was done using SAS 8.0 statistical software. Kruskal-Wallis statistics and Radit statistics are used to test the difference among groups. And the Nemenyi method is used to test the difference between groups. A P -value of less than 0.05 was considered statistically significant.


   Results Top


After four weeks of treatment, the results in four groups were as follows [Table - 1]. The cure rate was 22.50%, 32.50%, 57.50% and 45.00% in Group A, B, C and D, respectively. The effective rate was 40.00%, 52.50%, 85.00% and 75.00%, respectively [Table - 2]. The efficacy was significantly different. (H=20.8689, g = 3, P value =0.0001), the smallest mean Radit value occurred in Group C, indicating its efficacy was the best (the mean Radit value in Group C=0.3680 P value =0.0001). The results of group comparison showed that there were significant difference in the efficacy between Group C and Group A, Group C and Group B, Group D and Group A (all P values, < 0.05). But there was no significant difference in the efficacy between Group A and Group B , Group B and Group C, Group C and Group D (all P value, >0.05) [Table - 3].


   Discussion Top


Perianal eczema is a kind of inflammatory dermatosis on the perianal skin and mucosa, It is characterized by a long course, unbearable pruritus, stubborn refractoriness and easy recurrence. It is caused by external and internal factors such as allergy, disease agents, functional disturbance of nervous system, functional disorder of endocrine system.[1],[2],[3],[4],[5] The anal diseases, such as hemorrhoids, fissures and fistulas, cause anal looseness[6],[7] and then lead to mucus discharging which persistently erode the perianal skin and finally result in eczema.[8] Traditional treatment for this kind of perianal eczema is focused on anti-inflammatory agents including topical corticosteroids, but unwanted side-effects and recurrence is inevitable.[9] The results of the present study showed that the efficacy of Group C in which patients were treated with medicine first and then with operation was superior to that of Group A (treated with medicine) and Group B (treated with operation), the efficacy of Group D (treated with operation and then with medicine) was superior to that of Group A, as there were significant difference between them (all P values, < 0.05). The normal value of pH on the perianal skin surface is 5.5~7.0. Various kinds of anal diseases lead to the anal looseness and disturbance of anus closure, which causes discharge of alkaline mucus. The persistent erosion by the mucus destructs the alkali buffer capacity of the perianal region and finally results in eczema. Because of the persistent of the stimulating factors on the perianal region, recurrence emerges easily if only medicine is employed. In order to heal the eczema thoroughly, all of these causes should be eliminated. The application of traditional Chinese medicine to fumigate and wash the perianal region cause dilatation of anal vessels, promote regional circulation of blood and lymph.[10] Fructus cnidii and Radix Sophorae flavescentis can inhibit allergic reaction and Pericarpium zanthoryli can resist microorganism and has the function of narcotism.[11] Zinc oxide ointment can not only constrict and protect skin, but also form a protective film to prevent further erosion of mucus. Operation can rectify anal looseness, tighten the anus close, eliminate the causes of eczema and therefore prevent the recurrence.


   Conclusion Top


The combined therapy of medicine and operation highly improves the cure rate and effective rate of the perianal eczema, caused by anal diseases such as hemorrhoids, fissures and fistulas. So it is the optimal for this kind of perianal eczema.


   Acknowledgments Top


The authors gratefully acknowledge Prof. Chuan Yong Liu (Institute of Physiology, Medical School of Shandong University, P. R. China) for providing great help and guidance in improving the manuscript.

 
   References Top

1.Lenhard BH. The diagnosis and treatment of perianal dermatitis. Wien Med Wochenschr 2004;154:88-91.  Back to cited text no. 1  [PUBMED]    
2.Wacker J, Hartschuh W. Differential diagnosis of chronic perianal dermatitis. Premalignant and malignant disorders. Hautarzt 2004;55:266-72.  Back to cited text no. 2      
3.Giordano M, Rebesco B, Blanco G, Torelli I. Anal and perianal lesions in Crohn's disease. Minerva Chir 2001;56:599-610.  Back to cited text no. 3  [PUBMED]    
4.Bauer A, Geier J, Elsner P. Allergic contact dermatitis in patients with anogenital complaints. J Reprod Med 2000;45:649-54.  Back to cited text no. 4      
5.de Groot AC. Contact allergy for perfume ingredients in cosmetics and toilet articles. Ned Tijdschr Geneeskd 1997;141:571-4.  Back to cited text no. 5      
6.Wienert V. Perianal and anal diseases. Phlebologie 1980;33:689-95.  Back to cited text no. 6      
7.Bock JU, Jongen J, Peleikis HG, Stubinger SH. Proctological diseases in routine urologic practice. Urologe A 2003;42:1105-15;quiz 1116.   Back to cited text no. 7      
8.Mauss J. Perianal dermatitis. Ther Umsch 1997;54:205-8.   Back to cited text no. 8      
9.Meinhof W. Therapy of eczematous diseases in general practice. Fortschr Med 1977;95:1113-7.  Back to cited text no. 9      
10.CAI Xiao-Song. Chinese medicine fumigating and washing cooperating with suppository treat 97 cases with perianal dermatitis. Shiyong Zhongyiyao Zazhi 2000;16:32.  Back to cited text no. 10      
11.XIONG Ya-Xing, SU Bao-Lian. Clinical observation of combination of TCM with Western medicine on 78 cases with perianal eczema. Anhui Zhongyi Linchuang Zazhi 2003;15:138.  Back to cited text no. 11      



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3]

This article has been cited by
1 Therapeutic management of anal eczema: an evidence-based review
B. Havlickova,G. H. Weyandt
International Journal of Clinical Practice. 2014; : n/a
[Pubmed]



 

Top
Print this article  Email this article
 
  Search
 
   Next article
   Previous article 
   Table of Contents
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (450 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    Conclusion
    Acknowledgments
    References
    Article Tables

 Article Access Statistics
    Viewed10159    
    Printed182    
    Emailed1    
    PDF Downloaded273    
    Comments [Add]    
    Cited by others 1    

Recommend this journal

Site supported by Galderma