From the Guidelines
Steroids should not be used in the treatment of perianal abscesses due to the risk of worsening the infection and masking its symptoms. The primary treatment for a perianal abscess is surgical drainage, which is recommended by recent guidelines such as the WSES-AAST guidelines 1. Using steroids with an active infection can be dangerous as they suppress the immune system, potentially allowing the infection to worsen or spread.
Key Considerations
- The standard treatment for perianal abscesses involves incision and drainage performed by a healthcare provider, often followed by antibiotics such as metronidazole (Flagyl) 500mg three times daily or ciprofloxacin (Cipro) 500mg twice daily for 7-10 days if there are signs of surrounding cellulitis or systemic infection.
- After proper healing, if the abscess was related to inflammatory bowel disease like Crohn's disease, steroids might be considered as part of the management plan for the underlying condition, but only after the infection has been completely resolved and under close medical supervision.
- The British Society of Gastroenterology consensus guidelines on the management of inflammatory bowel disease in adults also emphasize the importance of optimizing physical condition prior to elective surgery, which includes treatment of abscesses and sepsis 1.
Treatment Approach
- The timing of surgery for perianal abscesses is dictated by the presence and severity of sepsis, with emergent drainage recommended for patients with sepsis, severe sepsis, or septic shock 1.
- Young, fit patients without signs of sepsis may undergo surgery in an ambulatory setting, and small simple perianal abscesses may be treated under local anesthesia.
- The use of packing after drainage of an anorectal abscess remains unproven, and its use should be left to individual unit policy and patient discussion 1.
From the Research
Steroids and Perianal Abscess
- The use of steroids with a perianal abscess is a topic of interest, and research has been conducted to understand its effects.
- A study published in 1981 2 found that prolonged high-dose steroid administration decreased the magnitude of the acute inflammatory reaction responsible for abscess formation in soft tissue, but did not interfere significantly with the process of containment and encapsulation of subcutaneous abscesses.
- However, another study published in 2019 3 suggested that the use of adjunctive, short-term, high-dose corticosteroids in cervicofacial infections may be safe and effective, but the evidence for perianal abscess is limited.
- A study published in 1991 4 found that steroid therapy was safe and effective in patients with Crohn's disease and a palpable abdominal mass, including those with an abscess cavity.
- On the other hand, a case report published in 2000 5 described a spinal extradural abscess following local steroid injection, highlighting the potential risks of steroid use.
- While there is some evidence to suggest that steroids may be beneficial in the treatment of certain types of abscesses, such as peritonsillar abscess 6, the evidence for perianal abscess is limited, and more research is needed to fully understand the effects of steroids in this context.
Key Findings
- Prolonged high-dose steroid administration may decrease the magnitude of the acute inflammatory reaction responsible for abscess formation 2.
- Short-term, high-dose corticosteroids may be safe and effective in cervicofacial infections, but the evidence for perianal abscess is limited 3.
- Steroid therapy may be safe and effective in patients with Crohn's disease and a palpable abdominal mass, including those with an abscess cavity 4.
- Local steroid injection can increase the risk of infection, including abscess formation 5.
- Steroids may be beneficial in the treatment of certain types of abscesses, such as peritonsillar abscess 6.