Therapeutic Aspects and Prognosis

The overall strategy facing perianal CD is conservative [20, 21]. The control of sepsis is the first objective. Antibiotics (metronidazole, cip-rofloxacin, and clofazimine) are used for self-limited complications (small abscesses, acute exacerbations without abscess formation), but not as a maintenance therapy. Surgical intervention is required for drainage of an abscess, non-cutting seton drainage of complex fistulas with deep pus collection [22, 23], and dilatation of a symptomatic anal stenosis.

The effect of immunosuppressants is not as favorable as it is on the intestinal disease. In children, purine analogs have been shown to improve perianal tenderness and induration in most patients and to achieve fistula closure in some [24]. In adults, although purine analogs may induce the closure of perianal fistulas [25], only one-third of patients with perianal lesions clearly improve. Patients aged 40 years or more, with recent perianal lesions, and without fistula are the best responders [26].

The management of perianal fistulizing disease resistant to standard treatment has greatly improved with the introduction of infliximab [27]. The complete arrest of the drainage of fistulas is obtained in 46% of patients 10 weeks after the administration of 5-10 mg/kg of infliximab at weeks 0, 2 and 6 and lasts on average for 12 weeks. However, fistula closure is often incomplete or superficial, fistulous tracts can persist despite closure of the external opening, and relapses are common. This may lead to a resumption of infliximab and to its being administered on a chronic basis (5-10 mg/kg every 2 months), with a tendency to a loss of efficacy with time. In cases of incontinence or when the lesions are severely disabling, proctectomy may become necessary (10%-38% of patients).

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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