Dermatitis post Anal Rimming

[centralintelligence]

Hi Doc,

2 weeks ago I developed anal itching which slowly progressed. Over the last few days actual skin changes were noted. (redness in intergluteal cleft). I managed to see a dermatologist yesterday who confidently diagnosed me with Perianal Dermatitis. She couldn't figure the cause but wondered if it could be an allergic contact dermatitis.
Ive been using the Clobetasol ointment she prescribed for 24 hours with no relief yet. I am now getting itching in areas without rash such as the lower scrotum. It woke me from sleep a few hours ago.

Anyhow, I did not reveal to the doc that 2 weeks before the onset of the problem I was on the receptive end of anal rimming from a CSW that lasted 10 minutes. Does this introduce the possibility of other diagnoses which the doctor wasn't able to consider? (i.e. parasites, std's, etc). Or is the timing just a coincidence?

Your thoughts are most appreciated.

[Edward W Hook, MD]

Welcome to the Forum. Perhaps I can help.  I suspect that your itch is coincidence and unrelated to the rimming you received two weeks ago.  The term "perianal dermatitis" means nothing more than irritation around the anus- it does nothing to tell you what the cause might be.  This is not a typical consequence of rimming.  Further that you are now experiencing itching in other areas suggests to me that your focus on the area and vigilance looking for symptoms is leading you to notice normal sensations as itching - this too is common.  When we focus on an area of the body looking for symptoms, typically one begins to notice sensations that are overlooked otherwise and these are experienced as itching.  

I hope this comment is helpful. I suspect your perianal itch is coincidental and unrelated to any infection acquired through your encounter several weeks ago.  EWH

[Edward W Hook, MD]

While I have not examined you and thus cannot be sure, this sounds more like hemmorrhoids than herpes.  If this had been herpes the lesions would have been expected to last 1-2 weeks.  I am very skeptical this started as herpes.

My advice is to do your best to stop worrying and move forward.  EWH

[centralintelligence]

to help answer the above, after the initial feeling of a 'cut' (worse when i would  sit down for example or sit right on that spot),

I also felt itching only while wiping during toileting for a few days

Maybe 3 times I felt my anal canal 'spasm' briefly.

Thanks

[centralintelligence]

Hi Dr. Hook,

Thanks for the response. Things were not getting better so I saw another dermatologist.

He examined me and said everything was entirely normal and whatever was there resolved (4 days after other derm saw me); As you said, he felt I am now very focused on the area explaining the ongoing symptoms.

However, by the history, he felt Herpetic infection was most likely initial cause. ( a big surprise to me as I was more worried about worms, crabs when i posted my question).

I did forget to mention however the earliest symptoms felt like a small cut at the top of the gluteal cleft. This seems to fit descriptions people give of herpes, although the subsequent rash doesn't seem common based on information out there; You obviously would know more

So...

1) with the new info does this change your opinion?
2) if this was herpes from rimming is it more likely hsv-1?
3) when first massaging me, she was briefly sitting on top of my buttocks with her exposed genital area..could this have caused transmission?

Your thoughts would be appreciated.