Therapeutic advances in the management of anal fissures: exploring the synergy between Pharmacology and Nanotechnology

Introduction: Anal fissure is a common proctological condition characterized by painful lesions caused by hypertonia of the internal anal sphincter smooth muscle. Despite its impact, conventional treatments available may be limited in terms of reproducibility, efficacy, and long-term tolerability. Therefore, exploring new pharmacological therapies, in sync with nanocarriers enabling their specific targeting to the site of action, offers a potential alternative to improve its treatment. Method: This study adopts a retrospective and longitudinal approach. Results: Different therapeutic approaches are applied, ranging from hygienic-sanitary measures and non-invasive pharmacological treatments to surgery, most of them aimed at reducing hypertonia. The most commonly used drugs in hospitals are lidocaine, diltiazem, nifedipine, nimodipine, isosorbide nitrate, and botulinum toxin. Leveraging the advantages of pharmaceutical nanotechnology to enhance therapeutic efficacy, reduce adverse effects from systemic administration, and increase healing rates, studies have been found on the application of polymeric nanoparticles, vesicular nanoparticles, and micro-nano emulsions to deliver drugs for the symptomatic treatment of anal fissure. Some formulations are already authorized for use, while others are still under research. Conclusions: It has been demonstrated that new formulations, especially those based on nanotechnology, show significant potential in improving the healing of fissures compared to conventional treatments. However, further studies on the safe use of these systems are necessary before their widespread clinical implementation.