Steroid Use and Its Effects on Anal Fissures

Anal fissure issues and steroid intake concerns?

How much steroid should be used in a day and for how long before it may cause skin thinning? I have been dealing with an anal fissure for a long time.
Initially, my doctor prescribed Hemorrhoid Ointment, and recently I switched to Clobetasol Cream.
When using the Hemorrhoid Ointment, I typically applied it once a day until I felt less pain, then stopped the medication.
However, I still experienced pain later on.
With the Clobetasol Cream, the prescription indicated a treatment duration of one week, so I applied it for a week and then stopped.
The pain subsided, but it seems to have recurred.
Could it be that long-term application of these ointments has led to excessive steroid absorption and skin thinning? (I apply about the size of a third of a quarter coin each time.) I have difficulty understanding the ingredients of the medications, so I hope the doctor can help answer these questions.
Thank you.
I read online that using no more than 5 grams a day is unlikely to cause side effects, but "improper use" may lead to some side effects.
I do not fully understand what is meant by "improper use."

Adam, 20~29 year old female. Ask Date: 2018/08/10

Dr. Ke Fangxu reply Surgery

The active ingredient in Gan-Demai ointment is gramicidin, and it does not contain steroids.
Although the Hi-Yu hemorrhoid ointment contains steroids, the concentration is very low, and generally, long-term use is not a problem.
However, if you have sensitive skin, it is advisable to discontinue the use of such ointments and consider alternative treatment methods.
Improper use refers to not following the recommended dosage and application instructions.

Reply Date: 2018/08/10

More Info

When it comes to the use of topical steroids for conditions like anal fissures, understanding the potential effects and proper usage is crucial. Topical steroids, such as those found in medications like "Hiyu Zhi" ointment and "Gan De Mei" cream, can be effective in reducing inflammation and pain associated with anal fissures. However, their long-term use can lead to side effects, including skin thinning (atrophy).

Understanding Topical Steroid Use
Topical steroids work by reducing inflammation and suppressing the immune response in the area where they are applied. They are commonly prescribed for various skin conditions, including dermatitis, eczema, and fissures. The potency of the steroid, the area of application, and the duration of use all play significant roles in determining the risk of side effects.

Dosage and Duration
The amount of topical steroid that can lead to skin thinning varies based on the potency of the steroid and individual skin sensitivity. Generally, using a small amount—like a third of a dime-sized amount—once daily is considered a low dose. However, prolonged use, especially in sensitive areas like the anal region, can increase the risk of skin atrophy.
The guideline you mentioned about not exceeding 5 grams per day is a general recommendation for topical steroids. However, "improper use" can refer to several factors:
1. Overuse: Applying the steroid more frequently than prescribed or using it for longer than recommended can lead to increased absorption and side effects.

2. High Potency Steroids: Using a high-potency steroid on sensitive skin areas can increase the risk of skin thinning.

3. Occlusive Dressings: Covering the area with occlusive dressings after applying the steroid can enhance absorption, leading to higher systemic exposure.

4. Inadequate Breaks: Not allowing breaks between treatment courses can contribute to cumulative effects.

Skin Thinning and Other Side Effects
Skin thinning is a common concern with prolonged topical steroid use. It occurs because steroids can inhibit collagen synthesis and alter the skin's structural integrity. Other potential side effects include:
- Telangiectasia: Small, dilated blood vessels can appear on the skin.

- Striae: Stretch marks may develop, particularly in areas of high skin tension.

- Perioral Dermatitis: A rash around the mouth can occur with prolonged use.

Recommendations for Anal Fissures
For managing anal fissures, it is essential to balance effective treatment with minimizing side effects. Here are some recommendations:
1. Follow Prescribing Guidelines: Use the medication as directed by your healthcare provider. If the instructions suggest a one-week course, adhere to that unless advised otherwise.

2. Monitor Symptoms: Keep track of your symptoms. If pain returns after stopping the medication, consult your doctor for alternative treatments or further evaluation.

3. Consider Non-Steroidal Options: If you are concerned about the side effects of steroids, discuss non-steroidal options with your healthcare provider. These may include topical anesthetics or other medications that promote healing without the risks associated with steroids.

4. Regular Follow-ups: Schedule regular check-ups with your healthcare provider to assess the condition and adjust treatment as necessary.

5. Educate Yourself: Understanding the medications you are using, including their ingredients and potential side effects, can empower you to make informed decisions about your treatment.

In conclusion, while topical steroids can be effective for treating anal fissures, it is essential to use them judiciously to avoid potential side effects like skin thinning. Always consult your healthcare provider for personalized advice and treatment options tailored to your specific condition.

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