Honestly, Pranicure may not be an absolute cure, but by far and away it's been the best solution for me. I started itching my bum about 8 years ago and it steadily got more and more intense. Like you, my pruritus ani was always the worst at night, and my lack of sleep declined my productivity during the day. It's literally a nightmare trying to find treatments that actually help: banana peels to witch hazel to hydrocortisone creams…it's like my anus was a laboratory for a mad scientist! Thankfully, I also came across Pranicure and wow…what a game changer! It has zinc oxide in it like a lot of other creams/ointments do, so I was skeptical that it would make a difference, but it must be the proper proportions of the other ingredients in combination with it because I experienced more relief from my first application of Pranicure than anything else I've tried. I started using it a year ago, and although I still need to apply it every now and again, I can sleep through the night and I don't consider pruritus ani to be a problem for me anymore. Just be happy you found Pranicure, it's about as close to a cure as I've found.