Mr Q has had a persistent itch around his anus for four months. The problem has escalated to the point where it affects his concentration at work and he struggle to fall asleep some nights. Mr Q has tried several over-the-counter haemorrhoid creams, but nothing seems to work.
He has never suffered from allergies, and does not take any medication. He is generally healthy and exercises on a daily basis by cycling and going to the gym.
Mr Q has no family history of disease, never had any surgeries before and does not smoke.
On further enquiry, the doctor made the following notes:
1. Persistent itch: not confined to a certain time of the day, but worse at night
2. Occasionally some slight bleeding after an intense bout of itching
3. Diet not optimal due to work: eats a lot of junk food
4. No other areas of skin on body irritated
5. Changed body soap about 6 months ago
On examination:
Normal heart, lung and abdominal examination
Anal and rectal examination:
1. Red, irritated perianal skin
2. Two small skin tags around the anus
3. No sign of infection of the skin or skin tags
4. Normal anal sphincter tonus
5. No noticeable external haemorrhoids
Based on the information above, what is the most likely cause(s) for Mr Q's problem? What would be appropriate treatment?
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