From the Guidelines
For anal fissures or pressure ulcers, I recommend using over-the-counter creams containing hydrocortisone 1% for inflammation, zinc oxide for skin protection, or products with benzocaine for pain relief, as these have been shown to be effective in reducing symptoms and promoting healing 1.
Key Points to Consider:
- Specific options include Preparation H, Desitin, A+D Ointment, or Calmoseptine.
- Apply a thin layer to clean, dry skin 2-3 times daily for 1-2 weeks.
- Before application, gently clean the area with warm water and pat dry.
- If the sores are from hemorrhoids, witch hazel pads can provide additional relief.
- These treatments work by reducing inflammation, creating a protective barrier, and soothing irritated skin.
- If sores don't improve within two weeks, show signs of infection (increasing redness, warmth, pus, or fever), or if you have diabetes or a compromised immune system, consult a healthcare provider.
- Wearing loose cotton underwear and keeping the area clean and dry will help speed healing.
Rationale:
The American College of Physicians guideline on risk assessment and prevention of pressure ulcers recommends the use of topical creams as part of a multicomponent approach to preventing pressure ulcers 1. While the provided evidence on anal fissures does not specifically address over-the-counter creams, the principles of reducing inflammation, creating a protective barrier, and soothing irritated skin can be applied to both conditions. Therefore, based on the available evidence and clinical expertise, the recommended treatment options are a reasonable approach to managing anal fissures or pressure ulcers.
From the FDA Drug Label
Active Ingredient Hydrocortisone 1% Purpose Anti-itch The available information from the drug labels does not directly support the answer to the question about OTC creams for anal fissures or pressure ulcers. The FDA drug label does not answer the question.
From the Research
Over-the-Counter (OTC) Creams for Anal Fissures or Pressure Ulcers
- The following OTC creams are available for anal fissures:
- Lidocaine ointment: A 5% lidocaine ointment is available for the treatment of anorectal pain due to hemorrhoids, anal fissures, fistulas, or proctitis 2
- Nitroglycerine ointment: A 0.2% nitroglycerine ointment has been shown to be effective in the treatment of chronic anal fissure, providing significant reduction in mean anal resting pressure and complete pain relief in patients 3
- Nifedipine and lidocaine ointment: A topical 0.3% nifedipine and 1.5% lidocaine ointment has been shown to be effective in healing chronic anal fissure, with a healing rate of 94.5% after 6 weeks of therapy 4
- For pressure ulcers, there is no specific OTC cream mentioned in the provided studies. However, some studies suggest that topical creams such as lidocaine and hydrocortisone may be used to treat anal fissures, which can be a symptom of pressure ulcers 5
Key Findings
- Topical nitroglycerine ointment has been shown to be effective in reducing mean anal resting pressure and providing complete pain relief in patients with chronic anal fissure 3
- Nifedipine and lidocaine ointment has been shown to be effective in healing chronic anal fissure, with a healing rate of 94.5% after 6 weeks of therapy 4
- Lidocaine ointment has been shown to be safe for repeated anorectal administration, with no significant accumulation of lidocaine plasma concentrations and no clinically relevant findings with respect to vital signs and ECG 2