male pt of age 38yrs , c/o severe itching in anal region since 15 yrs on and off but raised since 2mths watery discharge during evening hrs n after mid night no pain no bleeding p/r after examining came to know he is having vitiligo in anal region done some investigation CBP, rbs thyroid ,hiv,hbsAg ,vdrl, watery discharge also I hv send for c/s all reports are normal other 2anorectal consultant hv diagnosed fistula in ano but I don't think so that's y send all investigations tsh levels are 7.18 kindly suggest dx and rx too given t/t bavachi oil for local application bavachi churna khadirarishta avipattikar churna bed time with like warm water he is hving family h/o of vitiligo first I thought that he has gone for surgical procedure but it seems just like vitiligo only little bit confusing

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That discoloration is because of Healed Fissure in Ano I don't think its Shwitra.... Bakuchi Tailam is too Ushna for local application at anal orifice Better to go with Digital Examination first rule out the Fissure and Elasticity of the sphincter If needed then go with Dilation Waiting for expert opinion from @P. G. Shah @Dr. Dinesh Vats @Satyanarayana Reddy Sunku @Aniruddha Lele sir

Thank you doctor
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Agree with@Hemant Adhikari sir. I also don't think it is vitiligo. As hemant sir said anal region is very delicate so it is advisable not to use Bakuchi tail for local application. It might be healed lesion of fissure or fistula. Advice Contrast CT or MRI abdomen and pelvis so that you can confirm diagnosis. @Pooja Sunnap mam

@P. G. Shah sir waiting for your expert opinion
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Area of hypopigmentation on anoderm, Sphincter muscles appears prominent in Image, and it appears a case of spasmodic anus and local dermatitis of the region, hypopigmentation could be due to ischaemia of fissure bed. Subject to clinical examination. DGR and Anal manometry may be helpful to say anything about Sphincter spasm and fissure.

Thanks for your valuable opinion @Dinesh Vats sir
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It's an chronic fissure in ano according to the picture ask history weather there was bleeding like strik of blood in the past and burning due to unhygienic conduction it's infected and pus discharge is there

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Lichen planus on anal region...

Agree with Dr Hemanth

there is some persistent infection in the area.even if it is a closed tract right now it may again open up and it may develop into fistula too. but as u say right now there is no discharge and no inflammation. u just wait and watch. ask patient not to strain or develop any constipation. next when she complains of the same problem may be that time try to check thoroughly with probing. rest wait for dr rao s opinion.

पुत्री डॉ पूजा आप का चिकित्सा संबंधी योग बिल्कुल ठीक है चिकित्सा लम्बी चलेंगी

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