What is the use of rectal steroid cream (topical corticosteroids) for?

From the Guidelines

Rectal steroid cream (topical corticosteroids) is used to treat ulcerative proctitis and proctosigmoiditis, particularly in patients who are refractory to or intolerant of mesalamine suppositories.

Key Points

• The use of rectal corticosteroids is generally reserved for patients who have not responded to or cannot tolerate mesalamine suppositories 1.
• Rectal corticosteroids, such as budesonide foam or enemas, can be effective in inducing remission in patients with ulcerative proctitis and proctosigmoiditis 1.
• However, rectal 5-ASA (mesalamine) is generally preferred over rectal corticosteroids due to its superior efficacy and safety profile 1.
• The choice between rectal corticosteroids and mesalamine suppositories may depend on patient preference, tolerance, and disease severity 1.
• Rectal corticosteroids may be associated with short-term adverse events, although generally at lower frequency and severity compared to oral corticosteroids 1.

Treatment Options

• Mesalamine suppositories (1-1.5 grams per day) are recommended for patients with mild-moderate ulcerative proctitis who opt for rectal therapy 1.
• Rectal corticosteroids, such as budesonide foam or enemas, may be considered for patients who are refractory to or intolerant of mesalamine suppositories 1.
• Combination therapy with oral and rectal 5-ASA, or addition of oral corticosteroids, may be considered for patients with inadequate response to optimized 5-ASA therapy 1.

From the Research

Use of Rectal Steroid Cream

The use of rectal steroid cream, also known as topical corticosteroids, is a common treatment for various conditions. Some of the key uses include:

• Treatment of inflammatory bowel diseases, such as ulcerative colitis and Crohn's disease 2
• Treatment of nonspecific proctocolitis, with rectal hydrocortisone acetate foam showing effectiveness in inducing remission 3
• Management of ulcerative colitis, with budesonide being a synthetic corticosteroid characterized by enhanced topical potency and limited systemic bioavailability 4

Benefits and Characteristics

Some of the benefits and characteristics of rectal steroid cream include:

• Decreased bioavailability, eliminating systemic complications 2
• Ease of retention and apparent nonabsorption of the active component 3
• Enhanced topical potency and limited systemic bioavailability, making it a good choice for inducing remission in mild-moderate ulcerative colitis 4

Comparison to Other Treatments

Rectal steroid cream has been compared to other treatments, including:

• 5-aminosalicylates, which are effective in the majority of patients with ulcerative colitis 2
• Systemic steroids, which are more effective than oral budesonide in inducing remission 4
• Other rectal steroid preparations, which are comparable to rectal budesonide 4