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Had Inflamed Perianal Glands. Prescribed Hydrocortisone Cream, No Improvement. Continue?

Posted on Tue, 2 Jul 2013

Question: Hi. I have had inflamed perianal glands for a while now, and was advised to use hydrocortisone cream for some few days. I have used it twice a day for a week now, but no improvement has been discovered. Should I continue using the cream, change to something else, or what do you think?

Thank you very much in acvance and I will hear back from you soon.

Answered by Dr. Dr. Ivan Romich (19 minutes later)

Hi and welcome to XXXXXXX

Thank you for your query.

Hydrocortisone cream is effective only as symptomatic treatment and it might relieve pain and swelling, but in most cases it cant cure it if there is infection or abscess.

So, this cream should be combined with antibiotic because perianal infections are caused by bacteria and steroids wont kill them by itself.

Also, if there is significant swelling,pain and pus, it should be surgically drained and this is the most optimal and effective treatment for such lesions. Otherwise, infection can spread and cause more serious abscesses and perianal fistulas.

Wish you good health. If you have any question I ll be glad to help.

Regards,

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Ivan Romich (2 hours later)

Thank you! What antibiotic would you suggest me to get? If I need to surgically drain, how does this work? Painfull, local anaesthesia,...?

Thanks!

Answered by Dr. Dr. Ivan Romich (11 minutes later)

Hi again,

Usually amoxicillin + acid clavulanic is used( ask your GP about the commercial name in your place).
It is advisable to manage most of perianal localized infections surgically and we do it because it is likely to recur and not to heal completely after conservative treatment. Surgical incision and drainage is simple, very efficient and permanent cure. It relieves pain immidiately and patients are very satisfied. It might be unpleasant at the beginning where the wound is left open and should be dressed daily, but this is minor problem.

Some small abscesses can be left to heal without surgery and I dont know the opinion of your doctor or institution about this, but you can always wait, try with other methods and if unsuccessful, you can decide to do surgical procedure.

It can be done in local anasthesia but we recommend short general anasthesia with mask since sometimes it can be unpleasant for patient if he is awake. Linear incision is done and pus evacuated, wound is left open and small drain placed into abscess hole. It is then cleaned by hydrogen daily in next 5-7 days till it heals spontaneously.

Wish you good health.

Regards,

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Ivan Romich (14 hours later)

Ok, thank you! Actually, I am allergic to Amoxicillin, so I think in my case it is better to treat it surgically. Yes, I would prefer general anasthesia for the surgery. How long would the actual surgery take? After surgery you mention cleaning daily by hydrogen for the next 5-7 days. How is this done? Do I do it myself at home?

Thank you for your prompt and detailed replies!

Answered by Dr. Dr. Ivan Romich (49 minutes later)

Hi.

There are some other non-betalactamic antibiotics which can be used,but as I said there is a possibility that it wont be efficient.

I cant evaluate all this more detailed since i didnt see the area of inflammation, but usually this is short and simple surgical procedure, it last for 20 minutes XXXXXXX and you are back home 1-2 hours after it. There is no need to be afraid of it, this is really minor surgical procedure.
We usually do wound care next 2 days at surgery department, and next 3-5 days it should do GP. After this you can remove bandages and shower it normally.
Maybe there is another medical practice in your place, but this is in general how it all should look like.

Wish you good health and quick recovery.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Ivan Romich (37 minutes later)

Ok, thanks! I am glad to hear that it would only be a minor surgery. I uploaded a Picture of the area to "My Report". You could click the link and look at the Picture if that helps. I know that it is not the best Picture to evaluate, but it gives an idea. If you study closely, you will see a couple white bumps at the center surrounded by redness. Thanks for taking Your time to look at this.

Answered by Dr. Dr. Ivan Romich (4 hours later)

Hi,

I don't see your photo. Try to attaching this again. If you face any difficulties while uploading, you can mail it to YYYY@YYYY with the subject as 'Attn: Dr. Ivan"

Regards

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Dr. Ivan Romich (25 hours later)

Ok, I uploaded the picture to "My reports". Try to open it now. It definitively should work now :)

Answered by Dr. Dr. Ivan Romich (4 hours later)

Hi. Yes, I can see it now.

This is nothing to worry, it is just minor inflammation which may even heal spontaneously so there is no need for surgical procedure at this stage.

If steroid cream wasn't helpful and it persists you can try with 2 week course of antibiotics. Surgery should be considered only if there is significant swelling and pain. Till than try to take some stool softeners, drink enough fluids, do Sitz baths and eat high fiber food.

I am sure you will recover soon. Wish you good health.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Dr. Ivan Romich (47 hours later)

Ok, thank you. So for the 2-week use of antibiotics, which kind should I get and how could I obtain it?

Also, for the Sitz baths, is sitting in a bathtub filled with water enough or should I add something to it (salt, baking soda,..)?

Answered by Dr. Dr. Ivan Romich (15 hours later)

Hi.
Well, since you are allergic to betalactamsthen some ciprofoxacin or klyndamicine may be used but it depends is it available in your place or what your GP thinks about it. I wouldnt start with antibiotics at this point. Wait bit more and see the progresion. It might subside sontaneously after sutz baths.
You can Mix 2 ounces of baking soda or 1/2 cup of salt and white vinegar,it can have antibacterial and relaxing effect.

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Ivan Romich (1 hour later)

Hi. I may order the Ciprofloxacin from an online drugstore: WWW.WWWW.WW

I will wait to order (if I do), but if I do, how do I know which kind to get and how much to take daily?

I am just afraid I won't get rid of this, since I have had it for such a long time.

Thanks!

Answered by Dr. Dr. Ivan Romich (2 hours later)

Hi again,

Since you have already had antibiotics related allergic reactions, you shouldn't take it without the consultation to your doctor.

It is usually taken twice daily for 10 days, but it depends on kind and intensity of infection. It can't be evaluated without physical examination so don't take any drugs on your own without doctor's prescription and examination.

Regards,

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Raju A.T