resistant peri-anal rash

Have red circular non pruritic,well marginated perianal rash for past 2 months.
treated by a dermatologist with both oral penVK and fluconozole plus clotrimazole cream-------  
Resulted in some lightening of rash and decrease in size.Another dose of penvk resulted in no improvement.
Now on 1% clindamycin gel for 1 week with no improvement.(KOH stain neg)
The area was treated with 2.5% HC cream for about a yr for anal fissures prior to the rash which made
us feel that fungal was most likely etiology.
Would you bipsy area now to r/o extramammary Pagets? Or would you try itraconozole?
What are the chances this is Pagets? Or a resistant fungal/yeast infection?
Bacterial infection seems very unlikely in view of non-response to antibiotics.
Also what is the morbidity of biopsy in this area?
TIA

[Zonker]

have the same thing for the past 6 months..now on pramasone cream and it's red and on fire after 3 days...not working!

[FarFar]

Have either of you had a sigmoidoscopy or colonoscopy?

[BhumikaMD]

Hi,

There could be several causes for the symptoms you are having. You should reconsult with your doctor to rule out the following possible causes -

'Perfumes, chemicals, or dye on toilet paper can cause an allergic reaction.

Moisture from sweat or diarrhea may cause itching. If the anal skin stays wet, the skin begins to break down.

Some foods irritate the anus when they are expelled during a bowel movement. The most common culprits are caffeine, chocolate, beer, nuts, dairy products, and spicy food.

Infections such as pinworms, yeast, and genital warts can cause itching.

Hemorrhoids, which cause painful swelling of blood vessels in the anal area, can cause itching.

Cancer, in rare instances, may be a cause.'

There are certain factors which predispose to the risk of developing anal itching as a symptom.

'Factors that put people most at risk for anal itching are as follows:

Diabetes

Recent antibiotic use

Chronic dry skin conditions such as psoriasis and seborrhea

Profuse sweating.'

Do discuss these with your doctor and exclude any possible causes in your case.

Post us if you need any further information and let us know about how you are doing.

Regards.