Background: Idiopathic perianal pruritus is a poorly managed condition. Topical corticosteroids are effective in idiopathic perianal pruritus, but they may cause some side effects. In this study, the effectiveness of topical steroids were compared with perianal cleansers in the treatment of idiopathic perianal pruritus. Patients and methods: Seventy two patients with the complaint of perianal pruritus were evaluated; 60 of the 72 patients were found to be idiopathic. Twenty eight patients were treated with topical steroids and 32 patients were treated only with a liquid cleanser. Results: At the end of this two week period, cleansers were found to be as effective as topical corticosteroids. Conclusion: This study shows that perianal cleansers can be used as a safe first step treatment in idiopathic perianal pruritus.