Q: I have found that anal fissures and inflamed (not thrombosed) external hemorrhoids heal faster with a combination of triamcinolone and nystatin (Mycolog) cream b.i.d. for five days than with hydrocortisone cream, Tucks pads, or sitz baths. My theory is that yeast is nvolved in propagating the problem just as it is in angular cheilitis and the combination of nystatin and a slightly stronger steroid is effective.
A: The prevalence of hemorrhoids in the United States and England has been estimated at about 4% of the population (Gastroenterology. 1990;98:380-386), and I'm sure that many patients would be eager to embrace Dr. Muller's suggestion. A literature search turned up just one article entitled “Hemorrhoids and anal pruritis: The value of local Mycolog treatment” (Med Chir Dig. 1978;7:277-278). Unfortunately, it is in French, no abstract is available online, and I could not find it referenced elsewhere, so one can only hypothesize as to what the authors conclude. Keep in mind that the use of topical corticosteroids beyond a week can lead to mucosal atrophy, and so I agree with Dr. Muller that the length of treatment with steroids should be limited. Also, the key to treating anal fissures is to limit sphincter spasm and mucosal tearing while allowing time for the fissure to heal. There is little evidence that an antifungal-corticosteroid preparation will accomplish this, and the steroid component may in fact slow the healing process.