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I have found that perianal comedos have been the cause of severe pruritus ani in at least 1 patient.
An experienced dermatologist came to me for treatment of pruritus ani. Inspection revealed about six large comedos around the anal orifice. One was as large as a small pea. All had hard, horny spines projecting above the surface of the skin. Removal of the comedos was followed within a few minutes by disappearance of the pruritus.
Several years later the pruritus recurred; more comedos were found and were expressed, and the pruritus immediately disappeared.
The fact that the projecting horny portions of the comedos came in contact with the fecal mass may have accounted for the intense pruritus which followed each defecation.
Microscopic examination of the comedos revealed the presence of many Demodex folliculorum organisms.
3115 Webster Street (9).
ALLINGTON HV. ANAL COMEDOS AND PRURITUS ANI. Arch Derm Syphilol. 1949;59(4):490. doi:10.1001/archderm.1949.01520290126015
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