What are the best topical and other treatments for abraded perirectal skin?

From the Guidelines

For abraded perirectal skin, the best treatment approach combines gentle cleansing, moisture barrier products, and targeted medications, prioritizing the reduction of morbidity, mortality, and improvement of quality of life. The treatment should start with gentle cleansing using warm water or alcohol-free, fragrance-free wipes after bowel movements, followed by patting the area dry 1.

Key Treatment Components

• Apply a moisture barrier product such as zinc oxide ointment (like Desitin or Calmoseptine), petroleum jelly (Vaseline), or dimethicone-based products to protect the skin from moisture and irritants.
• For inflammation, use hydrocortisone cream 1% sparingly for up to 7 days.
• If fungal infection is present, apply an antifungal cream like clotrimazole 1% or miconazole 2% twice daily for 7-14 days.
• For bacterial involvement, mupirocin 2% ointment can be applied three times daily for 5-7 days.
• Sitz baths with warm water for 10-15 minutes 2-3 times daily can provide relief, as suggested by general wound care principles 1.

Additional Considerations

• Avoid harsh soaps, scented products, and rough toilet paper.
• Wear loose cotton underwear and change promptly if soiled or moist.
• Consider the use of skin moisturizers and water-soluble sodium cromolyn cream for pruritus or urticaria, but avoid using such creams on denuded lesions and instead consider topical antibiotics 1. These treatments work by creating a protective barrier, reducing inflammation, addressing infections, and promoting healing while preventing further irritation from stool or urine contact. It is crucial to prioritize the most recent and highest quality evidence, which in this case, supports a multi-faceted approach to treating abraded perirectal skin, focusing on gentle care, protection, and targeted treatment of infections or inflammation. If symptoms persist beyond 2 weeks or worsen despite treatment, medical evaluation is necessary to rule out underlying conditions.

From the FDA Drug Label

Warnings For external use only Do not use ◆ on large areas of the body or on cut, irritated or swollen skin Directions Adults and children over 12 years: ◆ Apply to affected area not more than 3 to 4 times daily Directions adults and children 2 years of age and older: clean the affected area apply a small amount of this product (an amount equal to the surface area of the tip of a finger) on the area 1 to 3 times daily may be covered with a sterile bandage

The best topical treatments for abraded perirectal skin are lidocaine (TOP) 2 and bacitracin (TOP) 3. However, lidocaine (TOP) should not be used on cut, irritated or swollen skin 2.

• For lidocaine (TOP), apply to the affected area not more than 3 to 4 times daily 2.
• For bacitracin (TOP), apply a small amount to the affected area 1 to 3 times daily 3. It is essential to follow the directions and warnings on the label and consult a doctor if the condition worsens or if symptoms persist for more than 7 days 2.

From the Research

Topical Treatments for Abraded Perirectal Skin

• The use of skin protectants is considered the standard of care for preventing perineal skin injury secondary to incontinence 4.
• Triple-antibiotic ointment (TAO) is a safe and effective topical agent for preventing infections in minor skin trauma, and may be an attractive alternative to oral therapy in select circumstances 5.
• Xenaderm ointment, which combines three active ingredients in a hydrophobic ointment, promotes healing while acting as a moisture barrier to prevent further irritation and damage 6.
• A zinc oxide/petrolatum formulation has been shown to provide skin benefits from continuous topical administration, reducing skin irritation and barrier damage 7.
• No Sting Barrier Film (NSBF) may be used for peri-wound skin protection in patients with chronic wounds, with urinary or fecal incontinence, and for women undergoing post-mastectomy irradiation, although more robust experimental studies are needed 8.

Other Treatments for Abraded Perirectal Skin

• A routine cleansing regimen that removes irritants and moisturizes while protecting the skin from additional irritation is effective for prevention of dermatitis and for managing mild cases 6.
• Aggressive care is required when perineal dermatitis occurs, especially when it is associated with epidermal erosion 6.
• The use of a novel disposable diaper that delivers a zinc oxide and petrolatum-based formulation continuously to the skin during use has been shown to reduce skin erythema and diaper rash in infants 7.