What is the difference between Preparation H (hydrocortisone) External Cream and Preparation H (hydrocortisone) External Gel for treating external hemorrhoids?

Preparation H External Gel vs. Cream for Hemorrhoids

For external hemorrhoids, Preparation H hydrocortisone gel is preferable to cream as it provides better adherence to the anal area, especially for moist or weeping hemorrhoids, while delivering the same anti-inflammatory benefits. The American Gastroenterological Association recognizes topical hydrocortisone preparations as safe and effective for treating hemorrhoid symptoms such as itching and discomfort 1.

Key Differences Between Gel and Cream Formulations

• Base formulation:

  • Gel: Water-based, lighter consistency, non-greasy
  • Cream: Oil-in-water emulsion, thicker consistency

• Application characteristics:

  • Gel: Better adherence to moist areas, absorbs quickly, less messy
  • Cream: More occlusive, longer-lasting barrier, better for dry skin

• Therapeutic considerations:

  • Both contain hydrocortisone (anti-inflammatory steroid)
  • Both effectively reduce inflammation, itching, and discomfort 1, 2
  • Gel may be more comfortable for painful, thrombosed hemorrhoids

Clinical Decision-Making Algorithm

1. Assess hemorrhoid characteristics:

   • Moist/weeping hemorrhoids → Choose gel (better adherence)
   • Dry/irritated skin → Consider cream (more moisturizing)
   • Painful/thrombosed → Choose gel (less friction during application)

2. Consider patient preferences:

   • Concern about staining clothes → Choose gel (less greasy)
   • Need for longer barrier protection → Consider cream

Efficacy and Treatment Context

Both formulations are part of conservative management for hemorrhoids, which should include:

• Increased dietary fiber (25-30g daily) and adequate hydration
• Sitz baths 2-3 times daily
• Avoidance of straining during defecation
• Avoidance of prolonged sitting 1

Topical hydrocortisone preparations are particularly useful for:

• Reducing inflammation
• Relieving itching and discomfort
• Short-term symptom management 1, 3

Important Caveats and Limitations

• Duration of use: Limit use of either formulation to 1-2 weeks due to potential skin thinning with prolonged steroid use
• Pregnancy considerations: Both formulations are considered safe for pregnant women with hemorrhoids 1
• Efficacy limitations: For grade III-IV hemorrhoids, topical treatments alone may be insufficient, and procedural interventions like rubber band ligation may be necessary 1, 3
• Thrombosed hemorrhoids: If acutely thrombosed, excision may be required rather than topical treatment alone 2

When to Consider Alternative Treatments

• Persistent bleeding or pain despite topical treatment for 1-2 weeks
• Grade III-IV hemorrhoids (permanently prolapsed)
• Signs of thrombosis (severe pain, purple discoloration)

In these cases, office-based procedures like rubber band ligation or surgical interventions may be necessary 1, 3.