growth on skin outside anus

[Jim-C]

  I recently noticed that there are two roundish growths on my skin just outside of my anus. They occasional bleed upon wiping of the area.
  In addition, there is an itching present both from them and a redish color around the surrounding area. I thought maybe the redness and itching where a result of a"jock-itch" fungus and that the two circumstances were in fact unrealted.
  I tried applying an antifungal ointmnet and this in fact provides some temporary relief. What do you make of this?
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Dear Jim C,
The lumps that you feel around your anus could represent several different structures.  External hemarrhoids, hypertrophied papilla, skin tags, hperkeratotoic nodules can all be palpable.  In addition, there are two conditions that can be associated with rectal itch: Bowen's tumor and Paget;'s tumor.  If these lumps are not increasing in size, I would suggest that you treat the rectal itch (called pruritus ani).  If you still have itching after three months of treatment or the lumps are growing, then you should be seen by a colorectal surgeon.
Rectal itch results from chronic irritation of the skin around the anus. The basic aims of treatment are 1) to keep the skin of the anal area clean and dry and  2) to avoid injury to the skin from excessive wiping, rubbing or scratching.  This will allow the skin to heal and the itching will resolve.  Several general suggestions follow:
a) When showering or bathing avoid the excess use of soap, especially rubbing the bar in the anal area or rubbing the washcloth at the site of itching. The soap residue can remain in this area for several hours and will irritate the perianal skin. Additionally, soap is alkaline and will alter the normal acidity of the skin
b) After bowel movements wash the anal area with water or use moist cotton or tissue. PAT the area dry. DO NOT RUB WITH TOILET PAPER.  If the symptom is very uncomfortable a hair dryer can be used to dry the area.
c) During the day have a thin piece of cooton  (drawn off the side of the roll of cotton; DO Not Use a cotton ball) placed directly against the anus.  This will facilitate keeping the area dry.  The cotton should be thin enough that you are not aware of its presence.  The cotton may be dusted with baby powder or cornstarch.  Change frequently for maximal dryness.  A snaitary napkin is NOT a substitute.
d) Take a Sitz bath morning and/or night. Remember no soap and pat dry!
e) Avoid Preparation H, other creams and lotions.  Application of these substances keeps the anal skin moist and promotes breakdown.  In some cases, steroids may be tried.
f) Wear gloves at night if you scratch in your sleep.
If you have pruritus ani without any disease cause, you must remember that recurrences are common.  The cotton pledget should be the first treatment started and the last abandoned.
If you are in the Detroit area and wish to see one of our colorectal surgeons, you should call the Henry Ford Physician Referral Line at [phone] and request an appoinment with Dr. John Eggenburger.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.