THE 3AM GUIDE TO ANAL ITCHING: WHEN YOUR ARSE WON'T LET YOU SLEEP
Share
If you're reading this at 3am, scratching yourself raw—you're not alone.
You've tried everything. Different toilet paper. Baby wipes. Sitting in the bath. Ice packs. Nothing works. The itch wakes you up at night. You're scratching until you bleed. The skin around your anus is red, raw, and burning.
Here's what nobody told you: it might be fungal. Or it might be psoriasis. And once you know which, you can fix it in 3-14 days.
This guide is for the person who's been suffering for weeks or months, tried every cream in the chemist, and is ready to try literally anything.
It took me 8 months of salt baths and a red raw anus to figure this out. You don't need to wait that long.
The Two Most Common Causes (And Why Nobody Talks About Them)
Most anal itching comes down to two things:
1. Fungal infection (candida or tinea)
2. Psoriasis (inverse/perianal psoriasis)
Both look similar. Both itch like hell at night. Both respond to different treatments.
Here's how to tell the difference—and what to do about each one.
CAUSE #1: FUNGAL INFECTION
What it is:
The same fungus that causes athlete's foot, jock itch, and thrush. Thrives in warm, moist environments (hello, your arse).
Why it happens:
- Antibiotics killed your good bacteria
- Diet high in sugar (feeds fungus)
- Tight clothing traps moisture
- Not drying properly after showers
- Sweating
How to recognise it:
✓ Worse at night
✓ Red, raw, inflamed skin
✓ Sometimes white discharge
✓ Small cracks or fissures
✓ May have athlete's foot or jock itch elsewhere
The fix:
Go to the chemist. Ask for antifungal cream for tinea or jock itch.
You don't need a prescription. Common names:
- Clotrimazole 1% (Canesten)
- Miconazole 2% (Daktarin)
- Terbinafine 1% (Lamisil)
How to use:
- Clean and dry the area completely
- Apply thin layer twice daily
- Continue for 7-14 days AFTER symptoms clear
- Don't stop early (it'll come back)
You should see improvement in 3-5 days. If not, it's probably not fungal.
CAUSE #2: PSORIASIS
What it is:
Autoimmune condition where skin cells grow too fast. Creates red, inflamed, itchy patches. When it happens in skin folds (like your arse), it's called inverse or perianal psoriasis.
Why nobody suspects this:
- Doesn't look like "typical" psoriasis (no silvery scales)
- Moisture in the area keeps scales from forming
- Looks exactly like fungal infection
- Most people don't know psoriasis can happen "down there"
How to recognise it:
✓ Smooth, red, shiny patches (not scaly)
✓ Very itchy, especially at night
✓ Symmetric appearance
✓ Antifungal cream doesn't help after 2 weeks
✓ You might have psoriasis elsewhere (scalp, elbows, knees)
✓ Family history of psoriasis
The fix:
This is what actually worked for me after 8 months of suffering.
The game-changer: LOTION, not cream.
I tried every psoriasis cream. They were all too wet, too greasy, rubbed off immediately, and kept the area moist (making everything worse).
What finally worked: Elocon lotion (mometasone furoate) — prescription corticosteroid lotion for scalp psoriasis.
Why lotion worked when creams didn't:
- Dries fast (you can get dressed immediately)
- Stays put (doesn't rub off)
- Not greasy or wet
- Actually penetrates the skin
- Alcohol-based formula evaporates quickly
Within 3 days, the itch reduced by 70%. Within 2 weeks, mostly healed.
YOUR OPTIONS:
OPTION 1: See a GP for prescription lotion (most effective)
Ask for: Corticosteroid lotion for perianal psoriasis
Common prescriptions:
- Elocon lotion (mometasone furoate) — what worked for me
- Betnovate lotion (betamethasone)
- Dermovate lotion (clobetasol) — stronger, for severe cases
Pros: More effective, faster results
Cons: Need GP appointment, stronger steroids need medical supervision
OPTION 2: Try over-the-counter lotion first (no prescription needed)
Coal tar lotion or salicylic acid lotion:
Go to chemist and ask for: "Coal tar or salicylic acid lotion for psoriasis"
Common brands:
- Polytar liquid
- T/Gel liquid
- MG217 Coal Tar solution
- DHS Sal (salicylic acid)
These are also in lotion/liquid form (not cream), so they have the same fast-drying benefit.
Pros: No prescription needed, available now
Cons: Less potent than prescription, takes longer to work (7-14 days vs 3-7 days)
OPTION 3: 1% Hydrocortisone cream (weakest option, but accessible)
Over-the-counter mild steroid cream. Better than nothing, but:
- Cream formulation (wetter than lotion)
- Weaker potency
- Use maximum 7-14 days only
HOW TO USE LOTION:
- Clean and dry area completely
- Apply thin layer of lotion once or twice daily
- Let dry for 2-3 minutes (dries fast)
- Should see improvement in 3-7 days (prescription) or 7-14 days (OTC)
Important: If this works, you have psoriasis. See a dermatologist for long-term management. You can't use strong steroids indefinitely.
THE KEY INSIGHT: FORMULATION MATTERS
CREAM = wet, greasy, traps moisture, rubs off
LOTION = dries fast, stays on, penetrates
This applies whether you're using:
- Prescription steroid lotion (Elocon)
- OTC coal tar lotion
- Any psoriasis treatment
For perianal psoriasis, always ask for lotion/liquid formulation, not cream.
THE DIAGNOSTIC PROTOCOL: WHICH ONE DO YOU HAVE?
If you don't know whether it's fungal or psoriasis, try this:
WEEK 1: Antifungal Trial
- Use antifungal cream 2x daily for 7 days
- If significantly better by day 5-7 → It's fungal. Continue for full 14 days.
- If no improvement → Stop antifungal. Move to Week 2.
WEEK 2-3: Psoriasis Trial
- Stop antifungal
- Use prescription lotion (if you can get GP appointment) OR coal tar lotion from chemist
- Apply 1-2x daily
- If significantly better in 7-14 days → It's psoriasis. See dermatologist.
- If still no improvement → See a GP for proper diagnosis.
THE HYGIENE PROTOCOL (DO THIS REGARDLESS OF CAUSE)
The goal: Clean and DRY. Not too much, not too little.
After every bowel movement:
- Wipe gently with unscented toilet paper
- Follow with unscented flushable wipes (plain, no antibacterial)
- Pat completely dry with soft toilet paper or cotton pad
- Let it air out for 1-2 minutes before getting dressed
Key principle: Moisture is the enemy. Fungus and inflamed skin both thrive in wetness.
After every shower:
- Wash with plain water or very mild unscented soap
- Rinse thoroughly
- Dry completely — pat with clean towel, then air dry
- Some people use hairdryer on cool setting (weird but it works)
Throughout the day:
- Wear 100% cotton underwear (or go commando at home)
- Avoid tight pants and activewear
- Change underwear daily (obviously)
- If you sweat, shower and change immediately
THE BARRIER REPAIR STEP (CRITICAL FOR HEALING)
By the time you've been itching for weeks or months, your skin is destroyed:
- Raw, inflamed tissue
- Micro-tears from scratching
- Broken skin barrier
- Hypersensitive nerve endings
Even after you kill the fungus or control the psoriasis, your skin needs to heal.
This is where most people get stuck. The original problem is gone, but the skin is so damaged it keeps itching.
Why petroleum jelly isn't enough:
Vaseline just sits on top of skin. It doesn't deliver anti-inflammatory ingredients. It doesn't speed healing. It's just occlusion.
Why steroid creams aren't the answer:
They reduce inflammation short-term, but thin the skin over time. You can't use them indefinitely. And they don't repair the barrier.
What actually works: NOOKS Universal Balm
Food-grade barrier repair designed for mucous membranes and damaged skin.
What it does:
- Creates breathable protective barrier (not suffocating like petroleum)
- Delivers anti-inflammatory botanicals (calendula, marshmallow root)
- Speeds wound healing (plantain leaf, manuka oil)
- Calms nerve endings (bisabolol from chamomile)
- Won't sting or burn (mucosa-safe formula)
- Doesn't interfere with medicated treatments
How to use:
- Apply medicated treatment first (antifungal or lotion)
- Wait 10 minutes for it to absorb
- Scoop small amount of NOOKS
- Apply thin layer to affected area
- Use 2-3x daily, especially before bed
Within 3-5 days, the raw/burning sensation improves dramatically.
Get NOOKS → — $29.95 | 60g lasts 3+ months
OTHER CAUSES TO CONSIDER
If antifungal AND psoriasis treatments don't work after 3 weeks, it might be:
Systemic candida overgrowth
- Brain fog, fatigue, sugar cravings
- Recurrent thrush/yeast infections
- Bloating, digestive issues
- Need to address gut health + topical treatment
Contact dermatitis
- Reaction to detergent, soap, toilet paper, fabric
- Switch to unscented everything
Eczema
- Atopic dermatitis can affect perianal area
- Similar treatment to psoriasis
Haemorrhoids or anal fissures
- Pain during bowel movements
- Visible bleeding
- May need medical treatment
Pinworms
- More common in kids but adults get them
- Itching worse at night (when they lay eggs)
- Easy to treat with medication
Food sensitivities
- Spicy foods, caffeine, dairy, alcohol
- Try elimination diet
WHEN TO SEE A DOCTOR
See a GP or dermatologist if:
⚠️ No improvement after 3 weeks of proper treatment
⚠️ Bleeding that's not from scratching
⚠️ Discharge (pus, mucus, unusual)
⚠️ Fever or feeling unwell
⚠️ Lump or mass you can feel
⚠️ Bowel changes (pain, constipation, diarrhoea)
⚠️ Spreading beyond anal area
⚠️ Severe pain
⚠️ Weight loss or systemic symptoms
Don't be embarrassed. Doctors see this constantly. It's a medical problem that needs proper diagnosis.
Some serious conditions can present as anal itching (including anal cancer, inflammatory bowel disease, diabetes complications, liver/kidney disease). If in doubt, get checked.
MY STORY: 8 MONTHS OF SUFFERING
I spent 8 months with a red raw anus. Salt baths every night. Couldn't sit comfortably. Couldn't sleep. The itch consumed my life.
What I tried:
- Antifungal creams (multiple rounds) — didn't work
- Steroid creams — helped temporarily, came back
- Petroleum jelly — made it worse
- Coconut oil — didn't help
- Every haemorrhoid cream — nothing
- Ice packs — temporary relief only
- Salt baths daily — soothing but didn't fix it
What I assumed: "It must be fungal. Or haemorrhoids. Or just hygiene."
What it actually was: Psoriasis.
Nobody mentioned perianal psoriasis. I didn't know psoriasis could happen there. The antifungal didn't work, so I kept trying different things, never considering it might be autoimmune.
What finally worked: Elocon lotion — a prescription corticosteroid lotion normally used for scalp psoriasis.
My GP prescribed it when I finally went in after 8 months. I was sceptical. I'd tried steroid creams before.
But the lotion was different.
Applied it that night. It dried fast (no greasy mess). Stayed on the skin (didn't rub off). Actually penetrated instead of sitting on top.
Within 3 days, the itch reduced by 70%.
Within a week, the redness was fading.
Within 2 weeks, I was mostly healed.
The difference: Every cream was too wet. It would trap moisture, rub off, make things worse. The lotion dried immediately and actually worked.
I wasted 8 months because:
- I didn't know perianal psoriasis was a thing
- Nobody suggested it
- I assumed steroid creams and lotions were the same (they're not)
- I thought I just needed to "clean better"
You don't have to waste 8 months.
THE 3AM ACTION PLAN
If you're reading this right now, desperate for relief:
TONIGHT (RIGHT NOW):
- Salt bath for 10 minutes
- Pat completely dry
- Apply any plain barrier cream you have (petroleum jelly if that's all there is)
- Try not to scratch
TOMORROW:
Go to chemist. Buy:
- Antifungal cream (clotrimazole or miconazole)
- Coal tar lotion OR salicylic acid lotion (if you can't get GP appointment immediately)
- Unscented flushable wipes
- 100% cotton underwear
- NOOKS for barrier repair
Book GP appointment if:
- You think it might be psoriasis
- You want prescription lotion (more effective)
- Antifungal doesn't work after 1 week
WEEK 1:
- Try antifungal cream 2x daily
- Follow hygiene protocol religiously
- Use NOOKS for barrier repair 2-3x daily
- Wear cotton underwear only
- Keep area DRY
WEEK 2-3 (if antifungal didn't work):
- Stop antifungal
- Try coal tar lotion 1-2x daily OR see GP for prescription lotion
- Continue hygiene + barrier repair
- Consider dermatologist referral
WEEK 4:
- If still no improvement → GP appointment
- Get proper diagnosis
- May need prescription treatments or further investigation
QUICK REFERENCE SUMMARY
| If it's FUNGAL | If it's PSORIASIS |
|---|---|
| Antifungal cream 2x daily for 14 days | Prescription lotion (Elocon) OR coal tar lotion |
| Should improve in 3-5 days | Should improve in 3-7 days (Rx) or 7-14 days (OTC) |
| Clotrimazole/Miconazole (OTC) | Elocon/Betnovate (Rx) OR Polytar/T-Gel (OTC) |
| If it comes back, may have systemic candida | Need dermatologist for long-term management |
For BOTH:
- Keep area clean and DRY
- Use barrier repair (NOOKS)
- Wear cotton underwear
- Stop scratching
- LOTION formulation better than cream
YOU'RE NOT ALONE
1-5% of people have anal itching at any given time.
Most suffer in silence for months.
Most try the wrong treatments because they don't know about:
- Fungal infections "down there"
- Perianal psoriasis
- The difference between lotion and cream formulations
The two most common causes:
- Fungal → Try antifungal first
- Psoriasis → Try lotion (prescription or OTC) if antifungal doesn't work
You found this guide. You're taking action. You're going to fix this.
NEED BARRIER REPAIR?
NOOKS Universal Balm — Food-grade formula designed for damaged, inflamed perianal skin.
✓ Mucosa-safe (won't sting)
✓ Anti-inflammatory botanicals
✓ Speeds healing
✓ Breathable barrier
✓ Works with medicated treatments
$29.95 | 60g lasts 3+ months
MEDICAL DISCLAIMER
This article is based on personal experience and general information, not professional medical advice. Different people have different causes of anal itching. What worked for the author may not work for you.
Some conditions require medical diagnosis and treatment. Do not delay seeking professional medical advice because of information in this article.
If you're experiencing persistent symptoms, severe pain, bleeding, discharge, or concerning symptoms, consult a qualified healthcare provider immediately.
The author is not a doctor and this content should not replace professional medical diagnosis or treatment.
Keywords: anal itching, pruritus ani, itchy anus at night, fungal infection anus, perianal psoriasis, inverse psoriasis, candida anal itch, perianal dermatitis, how to stop anal itching, antifungal cream for anus, psoriasis lotion, Elocon lotion, coal tar treatment, barrier repair cream