Combination Of Triamcinolone Acetonide Research Articles

Comparison of Intralesional Triamcinolone Acetonide Alone with Intralesional Triamcinolone Acetonide-5-Fluorouracil Combination Injection in Keloid: A Case Report

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.

Efficacy and Safety of Intralesional Triamcinolone Versus Combination of Triamcinolone with 5-Fluorouracil in the Treatment of Keloids and Hypertrophic Scars: A Systematic Review and Meta-analysis

Although keloids and hypertrophic scars are common benign hyperproliferative growths of dermal fibroblasts, the clinical problems including physical and psychological problems are significant and impairing, with few proven treatments. Intralesional triamcinolone acetonide (TAC) and combination of TAC with 5-fluorouracil (5-FU) are widely used to treat keloids and hypertrophic scars, but their efficacy and safety remain controversial. We systematically searched MEDLINE, EMBASE, Cochrane Library, and CNKI for relevant trials. The mean scar height and the erythema score in the TAC + 5-FU group were lower than those in the TAC group after treatment (P < 0.05). The effectiveness based on observer assessment after treatment in the TAC + 5-FU group was superior than that in the TAC group (P < 0.05); further, the subgroup analysis showed the TAC + 5-FU group was also superior than the TAC group in the treatment of hypertrophic scars (P = 0.01), and there were no significant differences in the treatment of keloid (P = 0.12). The effectiveness based on patient self-assessment after treatment in the TAC + 5-FU group was also superior than the TAC group (P < 0.05). The overall complication rate in the TAC + 5-FU group was lower than the TAC group (P < 0.05). Combination of TAC with 5-FU is more effective and safer than TAC alone therapy in the treatment of keloids and hypertrophic scars. Data on keloids alone or hypertrophic scars alone are, however, limited. A better understanding of effective after intralesional combination of TAC with 5-FU in the treatment of keloids alone or hypertrophic scars alone is imperative. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of Efficacy of Topical Curcumin Gel with Triamcinolone-hyaluronidase Gel Individually and in Combination in the Treatment of Oral Submucous Fibrosis

To study the efficacy of topical curcumin mucoadhesive semisolid gel, triamcinolone acetonide/hyaluronidase mucoadhesive semisolid gel, and a combination of both in the treatment of oral submucous fibrosis (OSMF). One hundred and twenty patients diagnosed with OSMF were randomly divided into groups I, II, and III. Each patients in groups I, II, and III was given professionally prepared mucoadhesive semisolid gel of curcumin, a combination of triamcinolone acetonide and hyaluronidase mucoadhesive semisolid gel, and a combination of all three, respectively. Patients were instructed to apply the gel thrice daily for 6 weeks on buccal mucosa bilaterally using the tip of index finger. Three parameters were evaluated at the end of each week, namely, mouth opening, burning on visual analog scale (VAS), and the color of oral mucosa on the binary scale. The results were subjected to statistical analysis. It was observed that the group administered the three drug combinations achieved the greatest mouth opening (mean increase 4.05 mm) as compared to the other two groups. It was observed that triamcinolone and hyaluronidase group reported reduction in burning sensation on VAS (mean difference 6) as compared to the other two groups. It was observed that group III (1% curcumin, 1% hyaluronidase and 0.1% triamcinolone acetonide combined) drug therapy showed better change in mucosa color as compared to groups I (1% curcumin) and II. Thus, we can conclude that curcumin has a therapeutic effect on patients diagnosed with OSMF. Maximum utilization and enhanced drug delivery were achieved with the help of a combination other two active drugs, namely, triamcinolone and hyaluronidase. Curcumin role in the treatment of oral cancers and the precancer lesion is very promising.

Expression of C-C motif chemokines and their receptors in bovine placentomes at spontaneous and induced parturition.

In bovine placentomes, the inflammatory response is considered important for the detachment of the fetal membrane from the caruncle after parturition. Glucocorticoids, a trigger of the onset of parturition, facilitate functional maturation of placentomes via prostaglandin (PG) and estrogen production in cattle. This study investigated how exogeneous glucocorticoids, which exert immunosuppressive effects, affect placental inflammation at parturition. Placentomes were collected immediately after spontaneous or induced parturition. Parturition was conventionally induced using PGF2α or dexamethasone or with a combination of triamcinolone acetonide and high-dose betamethasone (TABET treatment). Polymerase chain reaction (PCR) array analysis indicated that 9/13 C–C motif chemokine ligands (CCLs) were upregulated > two-fold in spontaneous parturition, with CCL2 and CCL8 being highly expressed. The expressions of CCL2, CCL8, C–C motif chemokine receptor 1 (CCR1), and CCR5 in caruncles were significantly higher in spontaneous parturition than in induced parturition. Although the clinical dose of dexamethasone did not influence the expression of these CCLs and CCRs, TABET treatment increased CCR1 expression. CCL8, CCR1, CCR2, and CCR5 were localized in the caruncular epithelial cells. CCR2 was also localized in the epithelial cells of the cotyledonary villi. This study is the first report to reveal the disruption in CCL and CCR expression in bovine placentomes at induced parturition. Enhanced glucocorticoid exposure for the induction of parturition may upregulate CCR1 expression in placentomes, but the treatment does not adequately promote CCL expression. Additionally, immunohistochemistry suggested that the CCL–CCR system is involved in the functional regulation of maternal and fetal epithelial cells in placentomes at parturition.

Enhanced glucocorticoid exposure facilitates the expression of genes involved in prostaglandin and estrogen syntheses in bovine placentomes at induced parturition

The mechanism by which the fetal membrane detaches after parturition in cattle is poorly understood, but the upregulation of placentomal prostaglandin and estrogen synthesis are considered to be important. This study investigated whether enhanced glucocorticoid exposure affected the functional maturation of placentomes at induced parturition. Placentomes were collected immediately after spontaneous (beef; n = 5, dairy; n = 5) or induced parturition in beef and dairy cattle. Parturition was induced conventionally using prostaglandin F2α (beef; n = 7, dairy; n = 6) or dexamethasone (beef; n = 6) or with a combination of triamcinolone acetonide (a long-acting glucocorticoid) and a high dose of betamethasone (TABET treatment, beef; n = 6, dairy; n = 9). Gene expression levels and protein localization in placentomes were analyzed by RT-qPCR and immunohistochemistry, respectively. Compared with the conventional methods, TABET treatment resulted in upregulated PTGS2 expression in cotyledons. The expression levels of PTGS2 and PGES were positively correlated in both cotyledons and caruncles. TABET treatment also upregulated the expression of CYP17A1, but not of CYP19A1, in cotyledons. The results revealed, for the first time, that PLA2G4A was localized in microvascular endothelial cells in the cotyledonary villi and the maternal septum. PTGS2 and PGES were colocalized in mononucleated cells of the cotyledonary villi and caruncle epithelial cells adjacent to the chorionic plate. TABET treatment upregulated the expression of placentomal genes involved in PGE2 synthesis and the conversion of pregnenolone to androstenedione. Thus, enhanced glucocorticoid exposure might partially facilitate the functional maturation of placentomes at induced parturition in cattle.

Comparison of Intralesional Triamcinolone Acetonide, 5-Fluorouracil, and Their Combination for the Treatment of Keloids.

Objective: Despite the myriad options available, there is no universally accepted treatment for keloids. Our objective was to compare three regimens and establish superiority in terms of objective and subjective outcomes. Approach: In this randomized parallel group study, 60 patients were enrolled and randomly allocated to three groups. Patients received intralesional injections of triamcinolone acetonide (TAC) in Group TAC, 5-fluorouracil (5FU) in Group 5FU, and a combination in Group T + F every 3 weeks till 24 weeks or till the keloid resolved. Results: There was a reduction in all parameters at every successive assessment in all three groups. Improvement in terms of height, vascularity, and pliability was fastest with 5FU, TAC, and T + F group, respectively, which was statistically significant. Decrease in pigmentation was significantly faster with T+F. Reduction in pruritus, however, was significantly faster with 5FU than the other groups, but the difference in reduction of pain among the three groups was not significant. Telangiectasias and skin atrophy were seen most commonly in TAC group, while skin ulceration was a common problem in 5FU group. Conclusion: TAC, 5FU, and their combination are all effective in keloid scars. A combination of TAC +5FU seems to offer the balanced benefit of faster and more efficacious response with lesser adverse effects when compared to individual drugs.

Triamcinolone Acetonide and 5-Fluorouracil Intralesional Combination Injection in Keloid Treatment

Objective: To evaluate the effectiveness of steroid and 5-fluorouracil (5-FU) injection combination for keloid management. Methods: A 22-year-old female patient was presented with recurrent skin lesions. The skin lesions first appeared 10 years prior to consultation, had been surgically excised, and were given triamcinolone acetonide injection. However, no improvement was observed. A decision was made to use and evaluate treatment using an intralesional 4 mg (0.1 ml of 40 mg/ml) triamcinolone acetonide and 45 mg (0.9 ml of 50 mg/ml ) 5-FU injection combination for 5 weeks. Results: Clinical improvements were observed in the third week as the lesions softened and pruritic sensation dinimished. At the end of the fifth week, improvements in the form of keloid lesion flattening and size reduction were observed. Conclusions: Intralesional injection using a combination of triamcinolone acetonide and 5-fluorouracil is effective for keloid lesion treatment. Keywords: 5-fluorouracil, intralesional injection, keloid, triamcinolone acetonide DOI: 10.15850/ijihs.v5n1.959

Comparative study of intralesional triamcinolone alone and in combination with 5-flurourouracil for the treatment of keloid and hypertrophic scars

Keloids and hypertrophic scars are benign growths of dermal collagen that can cause physical and psychological (cosmetic) problems for patients. Many modalities of treatment have been advocated for the treatment of keloids, without convincing results. A randomised controlled trial was conducted in the Department of Surgery at Silchar Medical College and Hospital, Silchar, Assam for the period from January 2015 to June 2016. Keloids or hypertrophic scars (1cm to 5cm in size) having no history of treatment for the scars in preceding 6 months were included. The subjects were divided into two groups: Group A received intralesional triamcinolone acetonide alone and Group B received triamcinolone acetonide + 5 flourouracil. Eight injections were given at weekly interval. Scars were assessed at 4, 8 weeks during and 4 weeks after the completion of treatment on a five-point scale. 50 patients were included in the study and were divided in two equal groups of 25 each. Good to excellent results were seen in 14 (56%) cases in Group A, compared to 20 (80%) in Group B (p value <0.05). Group B lesions showed better improvement than Group A lesions in pruritus, pain, tenderness, restriction of movements and cosmetic problem. Recurrence was seen in 16% and 4% in both groups respectively. The combination of triamcinolone acetonide and 5 flourouracil is superior to triamcinolone acetonide alone in treatment of keloids and hypertrophied scars.

Comparative study between intralesional injection of bleomycin and 5-fluorouracil in the treatment of keloids and hypertrophic scars

The aim of this work was to evaluate the efficacy and safety of intralesional injection of 5-fluorouracil and bleomycin in the treatment of keloids and hypertrophic scars. One hundred and twenty patients were divided into the following groups: group IA was injected intralesionally with 5-fluorouracil; group IB was injected intralesionally with a combination of triamcinolone acetonide and 5-fluorouracil; group II was injected intralesionally with bleomycin. Patients underwent follow up by photographing and Vancouver scar scale system. There was a significant improvement in the Vancouver scar scale in group II compared to group I after treatment. There was hyperpigmentation, pain and ulceration in all the studied groups. Pain was significantly decreased in group IB compared to that in group IA, ulceration was significantly decreased in group II than in group I while pain after injection was increased in group II than in group I. Relapse occurred in 12 patients of group IA, 14 patients of group IB and no relapse occurred in group II. So, intralesional injection of bleomycin was more effective and better in remission than intralesional 5-fluorouracil injection in the treatment of keloids and hypertrophic scars regardless of patient’s age, sex, disease duration or site of the lesion.

Combined treatment of intravitreal bevacizumab and intravitreal triamcinolone in patients with retinal vein occlusion: 6 months of follow-up

To report 6 months of results of combined treatment of intravitreal bevacizumab and triamcinolone in patients with retinal vein occlusion (RVO). Retrospective consecutive case series. Intravitreal bevacizumab (1.25 mg) combined with intravitreal triamcinolone (2 mg) was injected to 16 patients with RVO: eight with branch retinal vein occlusion (BRVO) and eight with central retinal vein occlusion (CRVO). Patient's charts were reviewed for age, sex, previous ocular interventions, duration of follow-up, number of intraocular injections, intraocular pressure (IOP) and central macular thickness measured by optical coherence tomography (OCT). We included only patients that completed 6 months of follow-up. Mean age and number of injections were 72.9 +/- 11.99 years, and 2 +/- 0.81 respectively. In eight patients with CRVO, initial visual acuity was logMAR 1.09 +/- 0.67 and mean visual acuity at 1, 3 and 6 months was logMAR 0.98 +/- 0.55 (p = 0.59), 1.33 +/- 1.05 (p = 0.4) and 1.4 +/- 1.2 (p = 0.34) respectively. In eight patients with BRVO, initial visual acuity was logMAR 1.025 +/- 0.58 and mean visual acuity at 1, 3, and 6 months was 0.56 +/- 0.21 (p = 0.05), 0.61 +/- 0.17 (p = 0.03) and 0.66 +/- 0.34 (p = 0.12) respectively. Mean initial central macular thickness for the whole group was 527 +/- 182 microm and mean central macular thickness at 6 months was 379 +/- 156 microm (p < 0.001). This study suggests that combined treatment with intravitreal bevacizumab and intravitreal triamcinolone improves structural outcome in patients with retinal vein occlusion. In our study, the combination of triamcinolone acetonide and bevacizumab offered no advantage over previously published results with intravitreal bevacizumab injections alone for improving vision at 6 months.

Intravitreal Combination of Triamcinolone Acetonide and Bevacizumab (Kenacort-Avastin) in Diffuse Diabetic Macular Edema

Purpose: To evaluate the effect of intravitreal injection of the combination of Triamcinolone Acetonide and Bevacizumab in patients with diabetic macular edema.Materials and Methods: Twenty seven eyes of 17 patients with diabetic macular edema were treated with an intravitreal injection of triamcinolone acetonide (2 mg) combined with bevacizumab (1.25 mg).Results: During the 6 months follow-up period 24 eyes (89%) had to repeat the treatment according to the monthly follow-up examination.The mean visual acuity and the central macular thickness improved significantly (P<0.05) throughout the follow-up period.Conclusion: Intravitreal combination of Triamcinolone Acetonide and Bevacizumab seems to be effective in improving visual acuity and macular edema in patients with diabetic maculopathy.

Intralesional triamcinolone alone or in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars

Keloids and hypertrophic scars are benign growths of dermal collagen that can cause physical and psychological (cosmetic) problems for patients. In this 12-week, double-blind, clinical trial, 40 patients were randomized into two study groups. Patients in group 1 were given intralesional triamcinolone acetonide (TAC), and patients in group 2 were given a combination of TAC and 5-fluorouracil (5-FU); both groups received injections at weekly intervals for 8 weeks. Lesions were assessed for erythema, pruritus, pliability, height, length and width. Four patients in group 1 and three patients in group 2 failed to complete the study. At the 8-week and 12-week follow-up visits, both groups showed an acceptable improvement in nearly all parameters, but these were more significant in the TAC + 5-FU group (P < 0.05 for all except pruritus and percentage of itch reduction). Good to excellent (> 50%) improvement were reported by 20% of the patients in group 1 and 55% of the patients in group 2, which was significantly different (P = 0.02). Good to excellent responses was reported by trained observers as 15% in group 1 and 40% in group 2. Their difference was not significant (P = 0.08). The overall efficacy of TAC + 5-FU was comparable with TAC, but the TAC + 5-FU combination was more acceptable to patients and produced better results.

Inhibition of Experimental Angiogenesis of Cornea by Various Doses of Doxycycline and Combination of Triamcinolone Acetonide With Low-molecular-weight Heparin and Doxycycline

To evaluate the effect of topically administered doxycycline in various doses; the combination of triamcinolone acetonide and low-molecular-weight heparin (LMWH); and the combination of triamcinolone acetonide and doxycycline on experimental corneal neovascularization in rats. This project is the combination of 2 separate studies. First, the chemical cauterization of corneas in 36 eyes of 36 Long Evans male rats was performed by using silver nitrate/potassium nitrate sticks. Topical instillation of doxycycline at 0.05% (pH = 3.3), 0.1% (pH = 3.1), 1% (pH = 2.3), 2% (pH = 2.1), 2% (pH neutralized to 7.4), and normal saline continued for 7 days. Second, the chemical cauterization of the corneas in 24 eyes of 24 rats was achieved by application of silver nitrate/potassium nitrate sticks. Topical instillation of triamcinolone acetonide (10 microg/mL) and either LMWH (10 mg/mL) or doxycycline (10 mg/mL) was compared with normal saline treatment of 7 days. For both studies, the percent area of the cornea covered by neovascularization and scar in each group was calculated separately by using computer software on digital photographs. All corneas were evaluated histopathologically in study and control groups. The mean percent area of corneal neovascularization determined in the eyes given doxycycline 0.05%, 0.1%, 1%, 2%, and 2% (pH neutralized) study groups and control groups was 69.8% +/- 18.0%, 64.5% +/- 14.0%, 56.4% +/- 20.8%, 54.8% +/- 6.0%, 36.2% +/- 4.3%, and 69.4% +/- 5.7%, respectively. The mean of percent area of neovascularization in the 2% doxycycline (pH neutralized) doxycycline group was significantly less than that of the control group and the <1% doxycycline concentrations (P < 0.05). The percent corneal neovascularization in the 2% (pH neutralized) doxycycline group was not significantly different from that of the 1% and 2% doxycycline groups (P < 0.05). There was no significant difference in percent area of corneal scar between control and study groups (P > 0.05). The mean percent area of corneal neovascularization in triamcinolone acetonide and LMWH, triamcinolone acetonide and doxycycline, and control groups was 2.35% +/- 4.42%, 9.42% +/- 6.8%, and 64.7% +/- 10.0%, respectively. The mean percent area of neovascularization in the triamcinolone acetonide plus LMWH or triamcinolone acetonide plus doxycycline groups was significantly different from that of the control group (P = 0.001 for both). There was no significant difference between study groups with regard to percent area of neovascularization or percent area of corneal scar between the control and study groups. Topically administered combinations of triamcinolone acetonide plus LMWH or triamcinolone acetonide plus doxycycline had effects that contributed to efficient suppression of corneal neovascularization; these drugs were ineffective at similar concentrations used alone. Topically administered 2% (pH neutralized) doxycycline has antiangiogenic effects, which contributed to significant suppression on corneal neovascularization. This drug may be therapeutically beneficial in treatment of corneal neovascularization in clinical trials.

Treatment of Carpal and Digital Ganglions by Simple Aspiration, or Aspiration and Injection of Corticosteroid And/Or Hyaluronidase

This retrospective study examined the treatment outcome of 178 carpal and digital ganglion cysts by simple aspiration or aspiration and injection of corticosteroid (triamcinolone acetonide 40 mg/mL) and/or hyaluronidase in 174 patients between 1987 and 1995. A total of 106 ganglions were treated with aspiration and triamcinolone acetonide injection; the cumulative cure rates were 45.3%, 50.0% and 53.8% following one, two or three treatments, respectively. The cure rates were similar in 23 ganglions in the hyaluronidase group: 43.5%, 52.2% and 56.5%, respectively. Seventeen of the 23 ganglions treated with a combination of triamcinolone acetonide and hyaluronidase recurred, yielding success rates of 17.4% and 26.1% following two or three treatments, respectively. Twenty-six ganglions were treated with simple aspiration. Of these, 23 were volar digital ganglions. The success rates were 61.5% and 69.2% following one or two treatments, respectively. The overall success rate was 94 of 178 (52.8%) after a maximum of three treatments, regardless of the type of treatment and the anatomical location of the ganglions. This study provided baseline data following nonoperative management of ganglions; the data can be compared with those from a planned prospective randomized clinical trial involving the use of rolitetracycline as a sclerosing agent, which is currently under review by the Ethics Committee at the authors’ institution.

Topical Retinoic Acid Does Not Alter the Vasoconstrictive Properties of Topical Corticosteroids in Humans

Dermo-epidermal atrophy is one of the main side effects of long-term treatment with topical corticosteroids. Retinoic acid may prevent and even reverse these effects in animals. Extension of this concept to therapy in humans implies that several studies have been performed; among others, it has to be established that treatment with topical retinoic acid does not interfere with the anti-inflammatory action of topical corticosteroids. The present study on the cutaneous vasoconstriction test comprised two different double-blind approaches: (i) vasoconstriction tests with betamethasone dipropionate (Diprolene) and clobetasone butyrate (Emovate) were carried out on skin that had previously been treated for 10 days with retinoic acid 0.01, 0.025 or 0.05% (or excipient); (ii) vasoconstriction tests with a combination of triamcinolone acetonide 0.1% and retinoic acid 0.025% were compared with triamcinolone acetonide 0.1% alone. Pretreatment for 10 days with retinoic acid did not alter the vasoconstriction induced by corticosteroids: no decrease or increase in the vasoconstriction score was observed, whether the skin had been previously treated with retinoic acid or with excipient. The vasoconstriction scores obtained with a combination of retinoic acid and triamcinolone acetonide were identical with those obtained with the steroid alone. This study indicates that retinoic acid does not inhibit the vasoconstriction induced by topical corticosteroids and suggests that the anti-inflammatory effect of the latter should be maintained in association with retinoic acid.