Surgical debridement and intralesional steroid injection in the treatment of idiopathic AIDS-related anal ulcerations.
BACKGROUND
The treatment of idiopathic anal ulcerations in AIDS patients is still evolving. These patients suffer with severe incapacitating anal pain.


METHODS
Relief of pain was achieved with the use of intralesional steroid injections. Twenty-one patients from 1990 to 1993 presented with severe anal pain of 4.5 months average durations (range 3 weeks to 2 years). The average CD4 count was 52.1 (range 0 to 150). Fourteen (67%) patients had a solitary ulcer, while 7 (33%) had complex ulcerations.


RESULTS
All patients were treated by debridement of the ulcer, biopsy, and intralesional injection of steroids. Microscopic evaluation revealed nonspecific inflammatory changes, without histopathologic evidence of viral infection or malignancy. Viral tissue cultures were negative. Fifty-seven percent of patients required only one injection to achieve dramatic relief of pain. Forty-three percent necessitated additional injections at 2-week intervals. The average patient was injected 1.9 times (range 1 to 7), with 20 of 21 patients (95%) reporting good to excellent pain relief.


CONCLUSIONS
AIDS anal ulcerations should be treated aggressively with surgical debridement, biopsy and intralesional steroids. The efficacy of this therapy suggests that symptoms are partially due to inflammatory mediators.
Modesto
V L
VL
Department of Surgery, Womack Army Medical Center, Fort Bragg, North Carolina 28307-5000, USA.
Gottesman
L
L
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001004:Anus Diseases / Q000150:complications* / Q000628:therapy*; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000077555:Methylprednisolone Acetate; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D014456:Ulcer / Q000150:complications* / Q000628:therapy*
D000893:Anti-Inflammatory Agents; D000077555:Methylprednisolone Acetate; D008775:Methylprednisolone