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Updated 05 October 2015

What's your diagnosis? – Case 30: persistent anal itch

Mr Q is a 31-year-old chemical engineer with an embarrassing problem. He's been struggling with a persistent anal itch for the past four months. Use the information below to figure out this week's case.

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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?

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis? -  Case 1: vomiting and weight loss

What's your diagnosis? -  Case 2: eye pain

What's your diagnosis? -  Case 3: strange behaviour and a bullet in the back

What's your diagnosis? -  Case 4: seeing odd things

What's your diagnosis? - Case 5: mysterious lungs

What's your diagnosis? - Case 6: runner with seizures

What's your diagnosis? - Case 7: swollen knee

What's your diagnosis? - Case 8: bloody semen

What's your diagnosis? - Case 9: confusing neurological signs

What's your diagnosis? - Case 10: diabetic teenager with unusual signs and symptoms

What's your diagnosis? - Case 11: bruising with no apparent reason

What's your diagnosis? - Case 12: severe tummy pain

What's your diagnosis? - Case 13: severe sore throat

What's your diagnosis? - Case 14: abdominal pain and swelling

What's your diagnosis? - Case 15: the world is spinning

What's your diagnosis? - Case 16: numbness in forearm

What's your diagnosis? - Case 17: burning urine

What's your diagnosis? - Case 18: boy with persistent fever

What's your diagnosis? – Case 19: lady who can't lose weight

What's your diagnosis? – Case 20: chest pain next to breastbone

What's your diagnosis? – Case 21: burning sensation in vagina

What's your diagnosis? – Case 22: vomiting and headaches

What's your diagnosis? – Case 23: frequent urination

What's your diagnosis? – Case 24: painful and swollen leg

What's your diagnosis? – Case 25: swollen knee and fever

What's your diagnosis? – Case 26: swelling of face

What's your diagnosis? – Case 27: sudden severe leg pain

What's your diagnosis? – Case 28: painful ear

What's your diagnosis? – Case 29: tired and drained

 
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