**2.3 Systemic diseases**

Multiple systemic diseases have been associated with pruritus ani. While the underline triggering mechanisms are not known, treating the primary problem appears to alleviate the symptoms. Diabetes mellitus is one of the common diseases associated with anal pruritus, followed by liver disease (cholestasis), leukemia, lymphoma, chronic renal failure (uremic pruritus), pellagra, iron deficiency anemia, vitamin A and D deficiency, and hyperthyroidism [2, 3, 8].
