What steroid cream can be applied on hemorrhoids?

Steroid Creams for Hemorrhoids

Topical hydrocortisone cream should be used for hemorrhoids, but only for short-term treatment (no more than 7 days) to avoid potential thinning of perianal and anal mucosa. 1, 2

Recommended Topical Treatments

• Hydrocortisone cream is effective for reducing local perianal inflammation in patients with hemorrhoids, particularly when there is irritation and itching 2, 3
• Steroid creams should be limited to a maximum of 7 days of use to prevent thinning of perianal and anal mucosa, which could increase the risk of injury 1, 2
• Diflucortolone valerate cream has shown superior anti-inflammatory effects compared to other steroids (prednisolone, hydrocortisone caproate, and hydrocortisone) in experimental hemorrhoid models 4
• Combination products containing both a steroid and local anesthetic (such as lidocaine) can provide both anti-inflammatory and analgesic effects 4

Alternative Topical Treatments

• Topical 0.3% nifedipine with 1.5% lidocaine ointment applied every 12 hours for two weeks has shown a 92% resolution rate for thrombosed hemorrhoids, compared to 45.8% with lidocaine alone 1, 2
• Lidocaine-containing preparations can provide symptomatic relief of local pain and itching associated with hemorrhoids 2
• Topical nitrates have shown good results in relieving pain due to thrombosed external hemorrhoids, but high incidence of headache may limit their use 2
• Topical heparin treatment has been found to significantly improve healing and resolution of acute hemorrhoids, although evidence is limited 1

Treatment Algorithm Based on Hemorrhoid Type

For External Hemorrhoids:

• First-line: Topical 0.3% nifedipine with 1.5% lidocaine ointment applied every 12 hours for two weeks 1, 2
• Second-line: Short-term hydrocortisone cream (≤7 days) for inflammation and itching 1, 2

For Internal Hemorrhoids:

• Conservative management with dietary modifications and lifestyle changes should be first-line 2, 5
• Topical treatments may provide symptomatic relief but have limited efficacy for internal hemorrhoids 2
• For persistent symptoms, office-based procedures like rubber band ligation should be considered 2

Important Considerations and Pitfalls

• Never use steroid creams for longer than 7 days due to risk of perianal tissue thinning 1, 2
• Avoid assuming all anorectal symptoms are due to hemorrhoids - other conditions like anal fissures, abscesses, or fistulas may coexist or be the primary cause 2
• If symptoms worsen or fail to improve within 1-2 weeks of treatment, further evaluation is necessary 2
• For thrombosed hemorrhoids presenting within 72 hours of symptom onset, surgical excision may provide faster pain relief than topical treatments 2

Special Populations

• In pregnant women, hydrocortisone cream has been used safely in the third trimester with no adverse events compared to placebo 2, 6
• For postpartum women with thrombosed external hemorrhoids present for more than 72 hours with improving pain, conservative management including short-term topical steroids is appropriate 2