N013. Experience with metronidazole topical therapy to treat dermatological lesions related to inflammatory bowel disease (IBD)
M.C. Morete Pérez1, R. Fraga Iriso1, L. Fúster Sanjurjo2, A. Echarri Piudo1, 1Complejo Hospitalario Universitario de Ferrol, IBD Unit. Gastroenterology, Ferrol, Spain, 2Complejo Hospitalario Universitario de Ferrol, Pharmacy Service, Ferrol, Spain
Study of the effectiveness of 10 per cent topical treatment with Metronidazole in the treatment of cutaneous lesions from subjects with a diagnosis of IBD.
Topical treatment with 10 per cent metronidazole were used in 27 dermatological lesions (4 perianal fistulas, 8 anal fissures, 2 perianal abscesses, 3 anal ulcer, 2 intergluteus fistulas after total coloprotectomy, 2 intergluteus fissures, 2 abdominal fistulas, 1 preauricular abscess, 2 digital abscess and 1 hidradenitis suppurativa) from 16 subjects (9 women and 7 men) with IBD diagnosis (12 with Crohn's disease and 4 with Ulcerative colitis), during 18 months (May 2012 to October 2013); 12 of the subjects had been undergone to previous topical treatments.
The dose of 10 per cent metronidazole ointment was prepared in Pharmacy Service, based on previous studies and literature about pharmaceutical prescription of this treatment.
Indications to treatment administration, consisted in ointment applied 2–3 times daily after previous cleaning and draining of the lesion, at the beginning of treatment and in 1–2 times daily during maintenance period, in those cases which improve the lesion but without total recovery. At this time, 7 subjects used 10 per cent metronidazole ointment as maintenance treatment.
Evolution of cutaneous lesions and treatment effects was realized during programmed medical care visits by the nurse of IBD Unit from CHUF; the number of ointment applications and cutaneous lesions evolution were monitorized by writing report and photography.
After observational period, was performed a prospective analyses of cutaneous lesions evolution and treatment level efficacy.
In our study, only 1 subject gave up the treatment (3.70%). Our result showed a complete healing at 4 to 8 weeks of daily treatment with metronidazole 10 per cent, in 10 cutaneous lesions (37.03%). In other 12 cutaneous lesions (44.44%) we observed a partial healing and improvement, with a decrease in pain and local inflammation, with 1 or 2 applications daily as maintenance doses, and without secondary effects in spite of long treatment period. We did not appreciate recurrences or needed of systemic treatment with antibiotics by oral or intravenous administration. In 4 cutaneous lesions (14.81%), a partial improvement and a decrease in symptoms were achieve, so we decided to stop metronidazole 10 per cent topical treatment in one of them and in other (hidradenitis suppurative) combined it with hormonal treatment.
Based in our results, we considered that metronidazole 10 per cent ointment is useful as topical therapy in simple cutaneous lesions (fistulas and fissures), without topical secondary effects, nor resistance to other systemic treatments.