Cholestyramine ointment to treat buttocks rash and anal excoriation in an infant.
OBJECTIVE
To describe a novel treatment for perianal excoriation in an infant receiving a promotility agent.


METHODS
A 2-month-old boy with reflux, and regurgitation was treated with cisapride. Shortly after cisapride therapy he developed a rash on his buttocks and anal irritation that progressed in severity despite the use of numerous topical products and extended diaper-free periods. A topical cholestyramine ointment compound was prepared and administered, resulting in complete resolution within 3 days.


CONCLUSIONS
Cisapride can decrease the gastrointestinal transit time, which can lead to less time for bile acid reabsorption in the distal ileum. If high concentrations of bile acids are contained in the stool, they can irritate the anus and buttocks in a manner similar to the skin irritation experienced by patients with ostomies. Cholestyramine, a bile acid sequestrant, can irreversibly bind the bile when applied topically and bring relief to the patient.


CONCLUSIONS
Topical cholestyramine ointment may be a safe and efficacious treatment option for perianal irritation due to bile acids.
White
C M
CM
Albany College of Pharmacy, NY 12208, USA.
Gailey
R A
RA
Lippe
S
S
D000982:Antipruritics / Q000627:therapeutic use*; D002081:Buttocks; D002792:Cholestyramine Resin / Q000627:therapeutic use*; D020117:Cisapride; D003875:Drug Eruptions / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D009824:Ointments; D010880:Piperidines / Q000009:adverse effects*; D012871:Skin Diseases / Q000139:chemically induced / Q000188:drug therapy*; D013566:Sympathomimetics / Q000009:adverse effects*
D000982:Antipruritics; D009824:Ointments; D010880:Piperidines; D013566:Sympathomimetics; D002792:Cholestyramine Resin; D020117:Cisapride