Efectividad de dos protocolos de tratamiento como una alternativa no quirúrgica para el hematoma auricular canino

Keloids are prevalent fibro-proliferative tumors, and treating them is still a challenge although intralesional injections of triamcinolone acetonide (TAC) are effective, they have frequently linked adverse effects. Pentoxifylline (PTX) is an anti-fibrotic and anti-inflammatory, and vasodilator. It has not yet been tested for intralesional injection in keloids. The aim of the study is to study the efficacy of intralesional pentoxifylline versus triamcinolone acetonide in keloid scars of 40 patients. In this study, 40 patients with keloid scars regardless of the cause of keloid born, 20 patients have injected with intralesional triamcinolone acetonide, and 20 patients with intralesional pentoxifylline every two weeks until the lesion flatted or a maximum 6 sessions. Evaluation of Patient response to treatment was done by utilizing the verbal rating scale and Vancouver scar scale. Between groups A& B there is no statistically significant difference in height, color, the surface of the keloid, pigmentation consistency, verbal rating scale, visual analog scale (improvement in keloid), patient satisfaction, and several sessions for best results.

Keloids are abnormal cutaneous wound healing responses extending beyond the borders of the initial wound, usually appearing pink-purplish to hyperpigmented nodules or plaques with a hard consistency, irregular shape, uneven border, and smooth shiny surface. Most often occur on the chest, shoulder, upper arms, earlobes, and cheeks. This case report aims to compare a case of keloid treated with intralesional triamcinolone acetonide (TAC) alone with intralesional triamcinolone acetonide-5-fluorouracil (TAC + 5-FU) combination injection. A 21-year-old Minahasa male complains of growing pruritic scars in the back area and right and left upper arms since five years ago. Physical examination of the right and left upper arms revealed multiple hyperpigmented nodules and plaques, irregularly shaped, smooth, and shiny surfaces with defined borders and varying sizes. A clinical diagnosis of keloid was made. Treatment was initiated with weekly intralesional TAC alone on the left upper arm vs. intralesional TAC + 5-FU combination injection on the right upper arm. The evaluation was made based on the clinical and modified Vancouver scar scale. One of the most commonly used therapeutic options for keloid is TAC. However, the combination of TAC + 5-FU may be opted for due to its mechanism through the corticosteroid mechanism of action in conjunction with the antimetabolite activity of 5-FU. The combination may yield a more effective and faster outcome with fewer side effects. Intralesional combination TAC + 5-FU injection may be a therapeutic option for keloid with minimal side effects.

Background: Management of keloid is difficult as well as challenging. Intralesional triamcinolone acetonide (TAC) injections have remained a gold standard in non-surgical management of keloid. TAC is generally used in the concentration of 40mg/ml, which causes adverse effects such as local dermal atrophy and hypopigmentation. Aim was to study efficacy and adverse effects of TAC in treatment of keloid, in a lesser concentration of 20mg/ml.Methods: An open label study was conducted from November 2015 to May 2017 on 25 subjects of either gender, in the age group 11-55 years, at a medical college hospital. Intralesional injection TAC 20 was administered in the keloid at an interval of 3 weeks, for a total of 6 sessions, over a period of 18 weeks. Vancouver scar scale (VSS) was used to assess the improvement and SPSS 21 for statistical analysis.Results: Mean age of keloid subjects was 30.72 years and median duration of keloid was 8 months. The mean VSS score before treatment was 8.36 which reduced to 3.20 after treatment. Mean percentage change in VSS score was 62.79%, which was very highly significant (p <0.001). Physician’s assessment was ‘Very Good’ in 52.0% and ‘Excellent’ in 5 (20%). Adverse effect of atrophy was seen in 3 (12%), hypopigmentation in 11 (44%) and telangiectasia in 4 (16%).Conclusions: Intralesional injection triamcinolone acetonide 20mg/ml gives very good to excellent improvement in the majority of patients of keloid. Local adverse effects seen were hypopigmentation, atrophy and telengiectasia.

Objectives: Keloids are often difficult to treat and have a high chance of recurrence. Multiple modalities of therapy have been tried with variable success rates. Intralesional triamcinolone acetonide (TA) remains the most common modality of treatment of keloids. We have conducted a randomized controlled trial comparing the efficacy of intralesional injection TA versus intralesional vitamin D3 (VD3) in keloids. Material and Methods: Group TA (n = 30) received an intralesional TA 40 mg/mL, and group vitamin D (VD) (n = 30) received intralesional VD3 (cholecalciferol) 60000 IU every 4 weekly till 12 weeks and all the patients were followed up for another 4 weeks. At each session, the scar size was assessed by the Vancouver Scar Scale (VSS), and the Visual Analog Scale assessed the pain. Results: The mean score of VSS was significantly decreased in both group TA (7.91 ± 1.5–4.9 ± 1.6, P < 0.001) and group VD (7.84 ± 0.8–5.0 ± 1.6, P < 0.001). The pain was severe in group VD compared to group TA. There was fluid discharge with severe itching and pain in one keloid site in the VD group. The keloids reduced faster in size in the TA group compared to the VD group. There was no significant difference in response to TA versus VD. Conclusion: Both intralesional triamcinolone and VD3 were found to be efficacious with triamcinolone achieving a faster effect. The pain was a limiting factor in the intralesional VD group.

Background: Effective keloid management is still a distant dream in spite of many recent modalities being tried for the same.Objective: To compare the efficacy of intralesional 5-Fluorouracil, intralesional triamcinolone acetonide and CO2 laser in the treatment of keloids. Materials andMethods: This randomized controlled trial was conducted on 45 patients with keloids, randomly divided into three groups, treated with intralesional 5-fluorouracil (Group A), CO2 laser (Group B) and triamcinolone acetonide (Group C). The groups were compared for reduction in the size of keloid, symptoms (pain and itching) and the incidence of adverse effects.Results: The reduction in the size of the keloid was found to be significantly better in Group A (86.33%) than in Group B (80%) and in Group C (66.66%).Conclusion: Reduction in the size of the keloid was significantly better in those treated with 5-fluorouracil than those treated with triamcinolone acetonide and CO2 laser. The incidence of adverse effects like immediate burning sensation, ulceration are more with intralesional 5-fluorouracil. The incidence of recurrence was higher with CO laser than the other modalities.

Objective To compare the clinical efficacy of intralesional betamethasone versus triamcinolone acetonide acetate in the treatment of active alopecia areata. Methods A total of 160 patients with active alopecia areata were divided into two groups, test group (n = 100) treated with intralesional betamethasone, and control group (n = 60) treated with intralesional triamcinolone acetonide. Both injections were given once every 3 weeks for 12 consecutive weeks. Results After 12-week treatment, the cure rate, response rate, and total response rate were 60.0%, 32.0% and 92.0% in the test group, respectively, compared to 41.7%, 31.67% and 73.3% in the control group, respectively. A significant increase was observed in the cure rate and response rate in the test group compared with the control group (χ2 = 10.25, 5.06, P 0.05). Conclusion Intralesional use of compound betamethasone injection has a notable therapeutic effect on alopecia areata.

Background: Alopecia areata is a common auto-immune condition, characterized by circumscribed, patches of hair loss usually of the scalp. There are various treatment modalities available but no treatment is fully curative or preventive. Also, alopecia areata can have devastating effects on the patient’s quality of life and self-esteem. The aim of this study was to determine dermoscopy findings of alopecia areata that could be used as a clinical indicator of disease and also to evaluate the efficacy of intralesional injection Triamcinolone acetonide in the treatment of alopecia areata.Methods: Seventy patients with alopecia areata, aged between 11 and 56 years were injected with intralesional triamcinolone acetonide at a 4 weeks interval. Treatment response was evaluated using re-growth scale approach. Dermlite DL3 dermoscope was used to assess disease activity, response to treatment and side effects. Using Wilcoxon signed rank test, changes were assessed in the severity of the disease during follow-ups.Results: Baseline mean percentage area of scalp involved was 23.21±10.70. All the patients had black dots, 98.6% had yellow dots, 27.1% had broken hair, 74.3% had tapering hair and only 71.4% had vellus hair. At baseline, 15 (21.4%) patients had Alopecia Grading Score (AGS) 1, 29 (41.4%) had score 2 and 26 (37.1%) had a score of 3. Injection Triamcinolone acetonide (5 mg/ml) was injected at 1 cm intervals with 0.1 ml on each site and the procedure was repeated every 4 weeks for a maximum period of 24 weeks. From baseline level to the last follow up, proportion of patients with black dots reduced from 100% to 4.3%, yellow dots from 98.6% to 0%, broken hair from 17% to 0% and tapering hair from 74.3% to 0%. Vellus hair increased from 71.4% to 100%. Overall success rate in terms of achievement of re-growth Ssore 4 at last follow up was 60%.Conclusions: Dermoscopic characteristics, such as black dots, yellow dots, broken hair, tapering hair and clustered short vellus hair are primary indicators of alopecia areata.

Background: Keloids and hypertrophic scars are dermal fibro-proliferative disorders lead to disfigurement, pain and pruritus. Their management is still challenging as there is no universally accepted treatment regimen. Corticosteroid injections, most commonly triamcinolone acetonide, continue to play a major role in the management of keloids. Verapamil is a phenylalkylamine calcium channel blocker antiarrhythmic agent that has antifibrotic effect. Objective: To compare efficacy of intralesional verapamil hydrochloride and triamcinolone acetonide in hypertrophic scars and keloids. Patients and methods: Forty Egyptian patients with keloids or hypertrophic scars were divided into two equal groups. The patients were recruited from the Dermatology outpatient clinics of Al-Zahraa University Hospital during the period from May 2016 to May 2017. Informed written consents were obtained from all patients. Group A: Intralesional Verapamil Hydrochloride. Group B: Intralesional Triamcinolone Acetonide. The efficacy of treatment was evaluated by Digital photography and Vancouver scar scale before and after treatment. Two- fine millimeter punch biopsies were taken from 5 patients of the verapamil group before and after treatment to demonstrate the histopathological changes induced by verapamil. Results: Both drugs improved total Vancouver scar scale, vascularity score and pliability score of keloid or hypertrophic scar nearly equally with no statistical significant difference. Both drugs improved height of keloid or hypertrophic scar significantly, but triamcinolone showed better improvement. Verapamil highly improved pigmentation score of keloids and hypertrophic scars, but triamcinolone showed non- significant improvement. Side effects were reported in 4 patients of triamcinolone group with no side effects in verapamil group. The histopathological examination after treatment with verapamil injection showed marked reduction of collagen deposition and alteration of the fibroblast shape (from elongated to spherical), and these changes are similar to histopathological changes which occur after corticosteroids injection. Conclusion: Verapamil was among the several therapeutic modalities, have an option for keloids and hypertrophic scars with an extremely low cost and fewer adverse effects.

Background: Effective keloid management is still a distant dream in spite of many recent modalities being tried for the same. Although many treatment protocols have shown efficacy of varying degrees, there are few systematic randomized trials comparing them. Objective: To compare the efficacy of intralesional 5-Fluorouracil versus Triamcinolone acetonide in the treatment of Keloids. Materials and Methods: This randomized controlled trial was conducted on 30 patients with keloids, randomly divided into two groups of 15 each, treated with intralesional 5-fluorouracil (Group A) or triamcinolone acetonide (Group B). The groups were compared for reduction in the size of keloid, pain relief, and the incidence of adverse effects. Statistical analysis was done using the unpaired student t- test and test of proportion. Results: The reduction in the size of the keloid was found to be significantly better in Group B (71.23%) than in Group A (57.48%) with a P value of 0.04. The difference in the reduction of pain, as assessed by the visual analog scale, between Groups A (18%) and B (24%), was found to be insignificant (P value - 0.47). Although the incidence of complications in Group A was three times higher than those in Group B, the difference was not statistically significant (P value - 0.13). Conclusion: Reduction in the size of the keloid, which was the main aim of this study was significantly better in those treated with triamcinolone acetonide than those treated with 5-fluorouracil. The other parameters like reduction of pain and the incidence of adverse effects were comparable in both the groups.

Background:Hypertrophic scars (HTS) and keloids are the proliferative responses of the fibroblastic. Surgical excision lead to changes, but postoperative recurrence rate seems to be still high. The topical use of mitomycin C (MMC) has been thus documented to suppress fibroblast proliferation. We aimed to investigate the effects of MMC injection on HTS and keloids in burn wounds, and compare the results with intralesional Triamcinolone Acetonide (TAC) injection in with regard to scar size reduction.Methods:This randomized clinical trial was conducted on 90 burn patients (divided into two groups) with hypertrophic scars and keloids at Taleghani Burn Hospital, Ahvaz, Iran, in 2023. Patients were randomly assigned to receive intralesional MMC (0.4 mg/dL) or TAC (0.4 mg/dL). Scar characteristics were assessed pre- and post-treatment using the Vancouver Scar Scale (VSS) over six months.Results:The average size of the scars at the pre- and post-intervention stages was 15.71 and 4.81 mm. No significant difference was observed between both groups. Effect of MMC was over and above TAC. There was a significant difference between both groups. Significant difference was found between the Vancouver Scar Scale (VSS) mean scores before and after the intervention, so the TAC value was greater than that of MMC, and the scores at the pre- and post-intervention stages were significantly different.Conclusion:MMC and TAC were considered as effective methods for HTS and keloid management. In spite of this, the VSS scores and the scar size denoted that MMC was much more effective in the treatment of such scars than TAC.

Background and Aim: The management of alopecia areata is often challenging. Available treatment modalities include intralesional triamcinolone, topical steroids, and immunotherapy to name a few. The current study was designed to compare the efficacy, safety, and patient satisfaction of platelet-rich plasma (PRP) versus intralesional triamcinolone acetonide (IT) (10 mg/ml) given 3-weekly for 3 doses in the treatment of localised alopecia areata of the scalp. Method: This was a single-blind, randomised controlled study wherein 60 patients with localised alopecia areata of the scalp were enrolled. Thirty patients each received either IT or PRP therapy at 3 weekly intervals for 3 sessions at 0, 3, and 6 weeks, and follow-up was done at 9 and 18 weeks. The response was assessed using the mean severity of alopecia tool score (SALT) score, SALT score reduction, regrowth of fully pigmented hair, hair regrowth grade scale, complete regrowth, side effect profile, and patient satisfaction scale. Results: The mean SALT score in IT and PRP groups at baseline was 4.04 ± 2.19 and 3.92 ± 2.22, respectively. The mean SALT scores in IT and PRP groups decreased to 2.22 ± 1.74 and 1.46 ± 3.25, respectively ( P = 0.625) at 9 weeks follow-up. The percentage reduction in mean SALT score in IT and PRP groups was 54.86 ± 44.4 and 48.77 ± 56.5, respectively ( P = 0.976) at 9 weeks. The percentage of patients showing complete regrowth was higher in the IT group ( P = 0.292), while regrowth of fully pigmented hair was more frequent in PRP group ( P = 0.272), although both were not statistically significant. Pain and bleeding were more frequently reported in the PRP group. Atrophy and telangiectasia were exclusively seen in the IT group. The patient satisfaction score (PSS) was similar in both groups ( P = 0.691). Conclusion: Platelet-rich plasma therapy was as effective as intralesional triamcinolone acetonide (10 mg/ml) in treating patients of localised alopecia areata. Trial Registration: Clinical Trials Registry of India number CTRI/2023/01/048750 [Registered on: 04/01/2023]

Treatment of keloids is a challenge as a result of paucity of effective treatment modalities, significant side effects, and their recurrent nature. In this study, various treatment modalities were compared to search for a treatment option with maximum efficacy and minimum side effects. One hundred patients were recruited into five treatment groups of 20 patients in each. Intralesional triamcinolone acetonide, intralesional triamcinolone acetonide with hyaluronidase, intralesional verapamil hydrochloride, intralesional radiofrequency, and intralesional radiofrequency with triamcinolone acetonide were the different modalities received. The treatment in groups 1, 2, and 3 were given at 3-week intervals for 8 times or till complete flattening, whichever was earlier. In groups 4 and 5, treatment was given at six weekly intervals for 4 times or till complete flattening. For statistical comparison, all patients were followed up at three weekly intervals. In total, 16, 16, 15, 17, and 16 patients completed the study in groups 1, 2, 3, 4, and 5, respectively. Treatment modalities in groups 1, 2, and 5 were more or less equally efficacious with clearance rate of 75, 68.75, and 75% respectively, whereas groups 3 and 4 had clearance rate of 0 and 11.76%, respectively (P value <0.01, Chi-square test). Intralesional triamcinolone acetonide, intralesional triamcinolone acetonide with hyaluronidase, and intralesional radiofrequency with triamcinolone acetonide are effective modalities for the treatment of keloids. However, intralesional triamcinolone acetonide with hyaluronidase fares better than other two as far as safety is concerned with least side effects.

IntroductionAlopecia areata (AA) is a common autoimmune hair loss disorder. Intralesional triamcinolone acetonide (IL-TAC) and cryotherapy are both used for patchy AA, but their comparative efficacy and safety have not been systematically evaluated.ObjectivesThe primary objective was to compare the efficacy of IL-TAC versus cryotherapy in achieving ≥50% hair regrowth in patchy AA. Secondary objectives included comparing safety profiles and conducting subgroup analyses.MethodsWe conducted a systematic review and meta-analysis per PRISMA 2020 guidelines (PROSPERO: CRD420251036356). Databases (PubMed, Scopus, CENTRAL, Google Scholar) were searched up to April 2025. Comparative studies of patients with patchy AA receiving IL-TAC or cryotherapy were included. Risk of bias was assessed using ROB2 and ROBINS-I tools. A random-effects meta-analysis was performed for the primary outcome.Results640 patients across five trials were included. Sensitivity analysis of four studies demonstrated IL-TAC significantly increased the likelihood of ≥50% hair regrowth compared to cryotherapy (RR: 1.57; 95% CI: 1.36–1.81, *p*<0.001), with low heterogeneity (I2=21%). Subgroup analyses by study design and randomization status found no significant differences. Adverse event profiles differed: IL-TAC was associated with injection-site pain and skin atrophy, while cryotherapy caused transient pain, swelling, and bullae.ConclusionsCurrent evidence suggests IL-TAC is more effective than cryotherapy for significant hair regrowth in patchy AA, though both have distinct tolerability profiles. These findings support IL-TAC as a first-line procedural option, with cryotherapy remaining a viable alternative. Higher-quality comparative trials with standardized protocols and long-term follow-up are needed to confirm these findings.

Cushing's syndrome after intralesional triamcinolone acetonide: A systematic review of the literature and multinational survey

Various treatment regimens have been used in scars. The literature offers little consensus about appropriate therapy. To compare intralesional triamcinolone acetonide (TAC) alone or combined with onion extract in keloidal and hypertrophic scars. Fourteen patients were treated with intralesional TAC and onion extract gel, and 13 patients were treated with intralesional TAC alone. Findings were recorded and graded at each visit (weeks 0, 4, 12, and 20). The scores before treatment and at week 20 were compared. Twenty-seven patients [17 men (63%) and 10 women (37%) aged 15 to 73 (average age 28.1 +/- 11.7)] were enrolled in the study. At baseline, the difference in the two treatment groups was not statistically significant (p>.05). At week 20, there was statistically significant improvement in both treatment groups (p<.05). TAC with onion extract was more effective than TAC alone in terms of pain-sensitiveness, itching, and elevation but not in erythema and induration. Treatment was well tolerated, without any adverse effect. Treatment with intralesional TAC and onion extract and TAC alone were effective. Combined with onion extract gel, intralesional TAC appears to be superior to TAC alone in the treatment of keloids and hypertrophic scars.