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March 12, 1938


JAMA. 1938;110(11):831. doi:10.1001/jama.1938.02790110057021

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To the Editor:—  In his article on pruritus ani (The Journal, February 12, p. 509) Dr. Howard Lilienthal describes a simple cleansing and protective method as commonly prescribed for the anal region by proctologists; this method is not confined to pruritus ani particularly. He suggested that "dirt" or fecal contamination accounted for the so-called pruritus.The fact that thousands of people under exactly the same conditions as described do not develop pruritus ani is evidence, in my opinion, against his theory.His simple analysis may be misleading. Pruritus ani is not so simple, as an immense amount of research over many years has disclosed; the condition is a symptom, and the etiology is commonly undiscovered. Allergic manifestations offer much promise in individual cases of identifying the cause. A large percentage of cases of pruritus ani are allergic to the fungi and these are remediable. Food allergic manifestations in the perianal region are not unusual, and a common food is the

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