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Efficacy and safety of methylene blue injection for intractable idiopathic pruritus ani: a single-arm metaanalysis and systematic review

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Abstract

Purpose

To evaluate how effective methylene blue injection was at treating intractable idiopathic pruritus ani.

Methods

A comprehensive literature search of the PubMed, Embase, Cochrane library, and Web of Science databases was conducted. All clinical studies (prospective and retrospective) that evaluated the efficacy of methylene blue in treating intractable idiopathic pruritus ani were included. Studies that reported the resolution rate, after a single injection and after a second injection, the recurrence rate, symptom scores, and transient complications of methylene blue injections in treating intractable idiopathic pruritus ani were included.

Results

The seven selected studies included 225 patients with idiopathic pruritus ani. The resolution rates after a single injection and after a second injection was 0.761 (0.649–0.873, P < 0.01, I2 = 69.06%) and 0.854 (0.752–0.955, P < 0.01, I2 = 77.391%), respectively, the remission rates at 1, 3, and 5 years were 0.753 (0.612–0.893, P < 0.001), 0.773 (0.675–0.871, P < 0.001) and 0.240 (0.033–0.447, P < 0.001), respectively, the effect value of the merger was 0.569 (0.367–0.772, P < 0.001, I2 = 79.199%), and the recurrence rates at 1, 2, 3, and < 1 year were 0.202 (0.083–0.322, P < 0.001), 0.533 (0.285–0.781, P < 0.001), 0.437 (−0.044, 0.917, P < 0.001) and 0.067 (0.023–0.111, P < 0.001), respectively. The effect value of the merger was 0.223 (0.126–0.319, P < 0.001, I2 = 75.840).

Conclusion

Using methylene blue injections to treat intractable idiopathic pruritus ani is relatively efficacious, resulting in a relatively low recurrence rate and no severe complications. However, the available literature was of poor quality. Therefore, higher quality studies are necessary to confirm that methylene blue injection is efficacious for pruritus ani, such as a randomized prospective multicenter studies.

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References

  1. Abramowitz L, Benabderrahmane M, Pospait D, Philip J, Laouénan C (2014) The prevalence of proctological symptoms amongst patients who see general practitioners in France. Eur J Gen Pract 20(4):301–306

    Article  PubMed  Google Scholar 

  2. Hsieh JC, Hägermark O, Ståhle-Bäckdahl M, Ericson K, Eriksson L, Stone-Elander S, Ingvar M (1994) Urge to scratch represented in the human cerebral cortex during itch. J Neurophysiol 72(6):3004–3008

    Article  CAS  PubMed  Google Scholar 

  3. Nasseri YY, Osborne MC (2013) Pruritus ani: diagnosis and treatment. Gastroenterol Clin North Am 42(4):801–813

    Article  PubMed  Google Scholar 

  4. Oueidat D, Bou Assi T, Jurjus A (2014) Pruritus ani: more than a decade of personal experience in Lebanon. J med liban Leb med J 62(4):203–206

    Google Scholar 

  5. Etter L, Myers SA (2002) Pruritus in systemic disease: mechanisms and management. Dermatol Clin 20(3):459–472

    Article  PubMed  Google Scholar 

  6. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71

    Article  PubMed  PubMed Central  Google Scholar 

  7. Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716

    Article  PubMed  Google Scholar 

  8. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  9. Wolloch Y, Dintsman M (1979) A simple and effective method of treatment for intractable pruritus ani. Am J Proctol Gastroenterol Colon Rectal Surg 30(1):34–36

    CAS  PubMed  Google Scholar 

  10. Farouk R, Lee PW (1997) Intradermal methylene blue injection for the treatment of intractable idiopathic pruritus ani. Br J Surg 84(5):670

    CAS  PubMed  Google Scholar 

  11. Botterill ID, Sagar PM (2002) Intra-dermal methylene blue, hydrocortisone and lignocaine for chronic, intractable pruritus ani. Col Dis 4(2):144–146

    Article  Google Scholar 

  12. Mentes BB, Akin M, Leventoglu S, Gultekin FA, Oguz M (2004) Intradermal methylene blue injection for the treatment of intractable idiopathic pruritus ani: results of 30 cases. Tech Coloproctol 8(1):11–14

    Article  CAS  PubMed  Google Scholar 

  13. Sutherland AD, Faragher IG, Frizelle FA (2009) Intradermal injection of methylene blue for the treatment of refractory pruritus ani. Col Dis 11(3):282–287

    Article  CAS  Google Scholar 

  14. Samalavicius NE, Poskus T, Gupta RK, Lunevicius R (2012) Long-term results of single intradermal 1 % methylene blue injection for intractable idiopathic pruritus ani: a prospective study. Tech Coloproctol 16(4):295–299

    Article  CAS  PubMed  Google Scholar 

  15. Kim JH, Kim DH, Lee YP (2019) Long-term follow-up of intradermal injection of methylene blue for intractable, idiopathic pruritus ani. Tech Coloproctol 23(2):143–149

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Oz M, Lorke DE, Hasan M, Petroianu GA (2011) Cellular and molecular actions of methylene blue in the nervous system. Med Res Rev 31(1):93–117

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Wainwright M, Crossley KB (2002) Methylene blue a therapeutic dye for all seasons? J Chemother 14(5):431–443

    Article  CAS  PubMed  Google Scholar 

  18. An R (1968) Atlas of the Operations on the Rectum and Colon. Moscow Meduch Posovie. 14:431

    Google Scholar 

  19. Eusebio EB, Graham J, Mody N (1990) Treatment of intractable pruritus ani. Dis Colon Rectum 33(9):770–772

    Article  CAS  PubMed  Google Scholar 

  20. Ortega AE, Delgadillo X (2019) Idiopathic pruritus ani and acute perianal dermatitis. Clin Colon Rectal Surg 32(5):327–332

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lysy J, Sistiery-Ittah M, Israelit Y, Shmueli A, Strauss-Liviatan N, Mindrul V, Keret D, Goldin E (2003) Topical capsaicin–a novel and effective treatment for idiopathic intractable pruritus ani: a randomised, placebo controlled, crossover study. Gut 52(9):1323–1326

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Suys E (2012) Randomized study of topical tacrolimus ointment as possible treatment for resistant idiopathic pruritus ani. J Am Acad Dermatol 66(2):327–328

    Article  PubMed  Google Scholar 

  23. Ucak H, Demir B, Cicek D, Dertlioglu SB, Akkurt ZM, Ucmak D, Halisdemir N (2013) Efficacy of topical tacrolimus for the treatment of persistent pruritus ani in patients with atopic dermatitis. J Dermatolog Treat 24(6):454–457

    Article  CAS  PubMed  Google Scholar 

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Funding

This study was supported by the National Natural Science Foundation of China [grant number 81704082], the Medical Scientific Research Foundation of Zhejiang Province, China [grant number 2020RC086], the Zhejiang Traditional Chinese Medicine Scientific Research Foundation [grant number 2020ZB095], and the Zhejiang Provincial Natural Science Foundation of China [grant number LQ20G030015].

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Author notes

  1. W. Jia and Q. Li are the co-first authors of the article.

Authors and Affiliations

  1. The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), 54 Youdian Road, Hangzhou, 310006, Zhejiang Province, China

    W. Jia, J. Ni, Y. Zhang, L. Wu & L. Xu

  2. School of Basic Medical Sciences, Zhejiang Chinese Medical University, 548 Binwen Road, Hangzhou, 310053, Zhejiang Province, China

    Q. Li

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  1. W. Jia
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Correspondence to L. Xu.

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Jia, W., Li, Q., Ni, J. et al. Efficacy and safety of methylene blue injection for intractable idiopathic pruritus ani: a single-arm metaanalysis and systematic review. Tech Coloproctol 27, 813–825 (2023). https://doi.org/10.1007/s10151-023-02825-y

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  • DOI: https://doi.org/10.1007/s10151-023-02825-y

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