For your question about using Pilorute cream for a large and chronic fissure, here are some important points to consider:

• Understanding the medication components:
  Pilorute cream contains several active ingredients:

  • Calcium Dobesilate may improve blood flow and reduce inflammation.
  • Hydrocortisone is a mild steroid that helps reduce inflammation and itching.
  • Lidocaine provides local pain relief.
  • Troxerutin is a flavonoid that can strengthen blood vessels and reduce swelling.
  • Zinc Oxide acts as a protective barrier and promotes healing.
  • Phenylephrine is a vasoconstrictor that reduces swelling by narrowing blood vessels.

• Suitability for chronic fissures:
  While these ingredients can help reduce pain, inflammation, and promote healing, chronic and large fissures often require more comprehensive treatment. The cream might provide symptomatic relief but may not be sufficient alone to heal a large, long-standing fissure.

• When to seek medical advice:
  It is very important to consult a colorectal surgeon or a specialist doctor experienced in treating anal fissures. Chronic fissures can sometimes need additional interventions such as prescription medications, specialized ointments, or even minor surgical procedures.

• Additional treatment options:
  Other treatments may include:

  • Prescription topical nitrates or calcium channel blockers to relax the anal sphincter.
  • Botox injections to reduce muscle spasm.
  • Surgical options if conservative treatments fail.

In summary, while Pilorute cream may help with symptoms, a large and chronic fissure requires evaluation by a specialist to determine the best treatment plan. Please consult a colorectal surgeon or a doctor for a thorough assessment and appropriate management.