Compound Betamethasone Injection Research Articles

Serum cytokine profiles predict response to systemic glucocorticoid in active vitiligo.

Vitiligo is an immune-related skin disease. Cytokines regulate immune response and inflammation and are involved in the pathogenesis of vitiligo. To assess the serum levels of pro-inflammatory cytokines pre- and post- systemic glucocorticoid treatment in patients with active vitiligo. We measured serum cytokine levels using the enzyme-linked immunosorbent assay in 31 patients with active vitiligo before and after treatment. All patients received systemic glucocorticoid (compound betamethasone injection) in combination with topical halometasone cream and tacrolimus ointment for 3 months. Twenty healthy controls were also examined. The cytokines measured included TNF-α, IL-1β, IL-6, IFN-γ, IL-2, IL-17, IL-10, IL-8, and CXCL10. The serum levels of TNF-α, IL-1β, IL-6, IFN-γ, IL-2, IL-17, IL-8, and CXCL10 were significantly higher, and levels of IL-10 were lower in vitiligo patients compared to controls. Additionally, serum IFN-γ (r = 0.378; p = 0.036), IL-17 (r = 0.426; p = 0.017), and CXCL10 (r = 0.514; p = 0.003) showed a positive correlation with affected body surface area in vitiligo patients. After 3 months of systemic glucocorticoid treatment, the levels of IL-1β, IFN-γ, IL-2, IL-17, and CXCL10 in responders were significantly decreased and nearly restored to normal levels. The IL-10 level was also increased in response to treatment. In contrast, the non-responder group had persistently high IL-6, IL-17, IL-8, and CXCL10 levels, and negligible changes in TNF-α, IL-1β, IFN-γ, IL-2, and IL-10. Our study indicated that the levels of inflammatory cytokines were significantly ameliorated in the glucocorticoid responder group. Altered cell-mediated immunity may contribute to the resistance in vitiligo. The cytokines such as TNF-α, IL-1β, IFN-γ and IL-2 could serve as therapeutic targets for managing glucocorticoid-resistant vitiligo.

Evaluating the Extent of Ultrasound-Guided Cervical Selective Nerve Root Block in the Lower Cervical Spine: Evidence Based on Computed Tomography Images.

To verify the injectate dispersal patterns (IDP) and therapeutic outcome of ultrasound-guided cervical selective nerve root block (UG-SCNRB) in treating cervical radiculopathy (CR). Overall, 18 CR patients were recruited to undergo UG-SCNRB in the CT room. Following placement of the puncture needle tip between the target nerve root and posterior tubercle, 3 mL of the drug was administered per root (0.33% lidocaine 0.5 mL + Compound betamethasone injection 0.5mL + methylcobalamin injection 1mL + iohexol 1mL). Subsequently, the IDP was assessed on postintervention CT scan images. In all, 18 participants were analyzed. We injected 21 target cervical nerve roots, namely, 1 C4 nerve, 9 C5 nerves, and 11 C6 nerves. Among the IDPs on postintervention CT scan images, two IDPs were most prevalent, namely, the contrast spread into the extraforaminal spaces (Zone I, the interscalene) in 100% (21/21) of cases, and the foraminal space spread (Zone II) in 61.90% (13/21) of cases. The injectate spread into the epidural spaces (Zone III) in only 2 out of 21 cases (9.52%). The pain relief was significantly improved two hours after surgery, compared to the preoperative VAS pain scores (2 hours, 1.39±0.50 vs VAS at baseline, P<0.01). The VAS pain scores during follow-up were significantly lower than preoperation (1 weeks, 1.94±0.54 vs VAS at baseline; 2 weeks, 2.61±0.70, P<0.01 vs VAS at baseline; 4 weeks, 2.67±0.59, P<0.01 vs VAS at baseline). We verified, via CT imaging, that the UG-SCNRB drug diffusion was within safe range (the injectate mainly spread to the extraforaminal spaces), and without any serious complications, such as, intravascular drug injection, extensive diffusion of the epidural space, and general spinal anesthesia.

"Clinical Observation of Microplasma Radiofrequency Technology Combined With Glucocorticoid Injection in the Treatment of Hundreds of Cases of Hypertrophic Scar After Early Deep Burn and Scald".

To investigate the clinical efficacy and safety of microplasma radiofrequency technology combined with glucocorticoid injection in the treatment of hypertrophic scarring after early deep burns and scalding. A total of 150 patients with hypertrophic scars after early deep burns from June 2018 to June 2021 were randomly divided into 3 groups, with 50 cases in each group. The patients were treated with compound betamethasone injection (Group A), microplasma radiofrequency technique (Group B), and compound betamethasone injection combined with microplasma radiofrequency technology (Group C). Each course of treatment included 5 standard treatments, and they were performed 6 weeks apart. Each patient was analyzed using the Vancouver scar scale and visual analogy scale after each treatment. The results were compared over time and across groups using repeated measurement analysis of variance. A total of 138 patients in these 3 groups completed this study. As treatment continued, the Vancouver scar scale value of Group C decreased more rapidly than that of Group A and Group B, and the difference was statistically significant (P<0.05). In the improvement of scar pain and itching, there was little difference between Group C and Group A (P>0.05), but both were better than Group B, and the difference was statistically significant (P<0.05). Regarding the incidence of adverse reactions, there was little difference between Group C and Group B (P>0.05), but the incidence of adverse reactions was lower than that of Group A, and the difference was statistically significant (P<0.05). Microplasma radiofrequency combined with glucocorticoid injection in the treatment of hypertrophic scarring after early deep burns is effective, safe, and has a low incidence of adverse reactions, and it merits clinical promotion.

Evaluation of Adverse Reactions and Effects of Triamcinolone Acetonide Combined with Compound Betamethasone in Keloid

To explore the drug effect and adverse reaction of triamcinolone acetonide combined with compound betamethasone in keloid is the objective of the study. 100 patients were randomly divided into study group and control group (50 patients in each group). The research group received sequential treatment with triamcinolone acetonide injection combined with compound betamethasone injection and the control group received compound betamethasone injection. Both groups had 3 courses of treatment and each course of treatment lasted for 3 w. The Vancouver scar scale score, treatment effect and adverse reactions were compared between the two groups and the recurrence rate was followed up for 1 y after the end of medication. Before treatment, there was no significant difference in Vancouver scar scale scores between the two groups but after medication, the study group was better than that of the control group (p<0.05). The total effective rate of the study group (82 %) was higher than that of the control group (54 %, p<0.05). The total incidence of adverse drug reactions in the study group was 8 % while in the control group it was 6 % and the comparison between the two groups was not statistically significant. The recurrence rates of the study group and the control group were 28 % and 34 % 6 mo after the end of medication and 32 % and 42 % after 12 mo. There was a significant difference between the two groups. The sequential injection of triamcinolone acetonide combined with compound betamethasone is effective in the treatment of keloids, with high safety and low recurrence rate, which is worthy of clinical recommendation.

A retrospective study of ultrasound-guided intervention for frozen shoulder in the frozen stage.

To investigate the clinical value of ultrasound (US)-guided intervention for frozen shoulder (FS) in the frozen stage. This study included 40 patients who had primary FS in the frozen stage and were evaluated by US. These 40 patients have all received conservative treatment elsewhere, and no satisfactory results have been achieved, with no improvement in active and passive movement angles, and no improvement in scores within 3 months. Therefore, their previous treatment was set as comparison. All patients underwent US-guided shoulder joint capsule distension by injection of sterilized water. Of these participants, 22 patients with scapulohumeral periarthritis received a compound betamethasone injection, and 14 patients with thickened coracohumeral ligaments (CHLs) underwent acupotomy lysis, and the remaining 4 patients had no extra treatments. The Constant-Murley score (CMS) was evaluated before and after the operation and analysed for each patient. Before treatment, the indices for the thickening of the subaxillary joint capsule, subacromial bursa (with or without effusion), long head of the biceps brachii tendon (LHBBT) and CHL were 40, 22, 16 and 14, respectively. After treatment, all the indices were significantly decreased (all P < 0.010) except for that of the LHBBT (P = 0.123). The patients' CMSs improved, with the median total CMS increasing from 59 points (interquartile range: 53-64 points) to 86 points (interquartile range: 78-90 points) (P < 0.010). While the internal rotation (Ir) of the shoulder joint did not improve (FDRs < 0.50), abduction, forward flexion (Ff) and external rotation (Er) improved significantly (all FDRs = 1.00). Compared with conservative treatment, US-guided intervention for FS in the frozen stage is highly effective and of great clinical value.

Pain Management of Hallux Valgus Surgery Is Achieved by Cocktail Therapy.

Background Hallux valgus is a relatively common forefoot disease in clinical practice. The aim of our study was to assess the role of local cocktail drugs and postoperative pain after hallux valgus surgery. Methods A retrospective case-control study was conducted to analyze 75 moderate to severe hallux valgus patients from June 1, 2018 to December 1, 2019. All patients were divided into cocktail and control groups according to whether the cocktail therapy was used or not after the operation. The anesthesiologist did not provide analgesic treatment other than nerve block anesthesia and intravenous anesthesia, such as analgesic pumps. The operative region of the cocktail group received a mixture of 10 ml of 0.75% ropivacaine, 10 ml of flurbiprofen axetil injection, and 1 ml of compound betamethasone injection, whereas the control group received nothing in the surgical spot. We recorded patients' VAS scores preoperatively and at 6, 24 hours postoperatively; the length of hospital stay and the number of hospitalization expenses; the scores of Kolcaba comfort level; and the scores of Pittsburgh sleep quality. Result There was no significant difference in age or sex between the two groups. The VAS scores at 6 and 24 hours postoperatively were significantly lower in the cocktail group. The average length of hospital stay was 8.24 days in the control group and 3.73 days in the cocktail group. The average total hospitalization cost of the control group was ¥28285.16, and that of the cocktail group was ¥22366.31. In expenses of total hospitalization costs, the cocktail group was lower than the control group. Kolcaba's comfort various scores and the total score of the cocktail group were higher than the control group. The total score of PSQI and all dimensions in the experimental group were lower than those in the control group. Conclusion We found a significant difference in the results of postoperative pain management except for age, sex, and hospitalization expenses. After hallux valgus surgery, inject cocktail drugs around the first metatarsophalangeal joint did reduce postoperative pain level. Level of Evidence. Level III, case-control study.

Treatment of Keloids Using Plasma Skin Regeneration Combined with Radiation Therapy Under the Evaluation of Patient and Observer Scar Assessment Scale.

PurposeKeloids are caused by uncontrolled excessive proliferation of fibrous tissue. Multiple treatment strategies including steroid injection, surgical excision, laser therapy and radiation therapy have been reported. Few studies have evaluated the performance of plasma skin regeneration (PSR) in the treatment of keloid. This study aimed to evaluate the effectiveness of PSR combined with radiation therapy for keloids on different body parts.Patients and MethodsA total of 71 patients with 98 keloids were enrolled in this study. Keloids <4 mm thick underwent single-dose PSR, while keloids ≥4 mm thick were administered compound betamethasone injection beforehand. Radiation therapy was administered after 24 hours and again 7 days later after PSR. The outcome was evaluated using the patient and observer scar assessment scale at 12 months post-treatment.ResultsPatient-reported average scores for all keloids significantly decreased from 35.05±9.94 to 21.84±7.04 (p < 0.05). Keloids on face and neck, chest, and back responded better than those on shoulders and limbs. The recurrence rate was observed to be 15.3% (15 out of 98). Adverse effects were mild.ConclusionPSR combined with radiation therapy is an effective and safe strategy to treat keloids. Location could be a factor that affects curative effects.

Intra-articular injection of compound betamethasone and hyaluronic acid for the treatment of moderate-severe knee osteoarthritis:a randomized controlled trial

To compare clinical effects of compound betamethasone and compound betamethasone with hyaluronic acid in treating moderate-severe knee osteoarthritis (KOA). A prospective randomized controlled study was conducted in 116 patients with unilateral moderate-severe KOA patients from February 2017 to November 2017 and divided into observation group and control group, 58 patients in each group. In observation group, there were 15 males and 43 females aged from 45 to 80 years old with an average of (66.45±6.31) years old;according to Kellgren-Lawrence(K-L) classification, 42 patients were type Ⅲ and 16 patients were type Ⅳ;the courses of disease ranged from 4 to 8 years with an average of (5.25±2.21) years;the patients were treated by injecting 1 ml compound betamethasone into knee joint. In control group, there were 13 males and 45 females aged from 45 to 80 years old with an average of (64.89±6.41) years old;according to K-L classification, 43 patients were type Ⅲ and 15 patients were type Ⅳ;the courses of disease ranged from 4 to 10 years with an average of (5.41±2.35) years;the patients were treated by knee joint injection of 4 ml hyaluronic acid and 1 ml compound betamethasone. Visual analog scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC) were used to evaluate clinical effects before treatment and 1 week, 1, month, 3 and 6 months after treatment. Totally 55 patients in observation group were followed up for 6 months, and 3 patients were quit at 3 months after treatment for poor efficacy. Totally 56 patients in control group were followed up for 6 months, and 2 patients were withdrew from the follow-up on the first and third month respectively for poor efficacy. There were no statistical difference in VAS and WOMAC between two groups before treatment and different time points after treatment (P>0.05), and no significant difference in VAS and WOMAC before treatment and 6 months after treatment between two groups(P>0.05). For patients with moderate-severe KOA, there is no significant difference in therapeutic effect between compound betamethasone injection and compound betamethasone combined with hyaluronic acid injection, and long-term effect of two methods is not good.

Effects of synthetical methods in the treatment of keloid

Objective To evaluate comprehensive therapy in the treatment of keloid effect and the patients' satisfaction. Methods From 2002 to 2015, a total of 523 patients with comprehensive treatment, according to the treatment the patients were divided into group A (surgery combined radiotherapy group) and group B (operation with corticosteroid hormone therapy group), group C (corticosteroids in combination with radiotherapy group), and the therapeutic effect of patients with satisfaction was evaluate. Results Total effective rate of three groups of patients were 85.7%, 84.0%, 64.9%; the efficiency in group A was higher than that of group B and group C; there was statistically significant difference between group A and C (P 0.05). All the patients were follow up for one years and the adverse reaction in the three groups was slight and happened in the 2 month after cure. And the adverse reaction was all self-cure in the final follow up. Difference was statistically significant between three groups of patients' satisfaction, group B better than in group A and group C; there was no significant difference between group A and group B (P>0.05); the difference between group B and C group was statistically significant (P<0.05). Conclusions Three kinds of comprehensive therapy effect are obvious, among which surgical adjuvant radiotherapy effect is best, being worth to recommend for clinical use. Key words: Comprehensive therapy; Keloid; Surgical treatment; Radiation therapy; Compound betamethasone injection

Oral methotrexate combined with intralesional injection of compound betamethasone for the treatment of cutaneous Rosai⁃Dorfman disease: a case report

Oral methotrexate combined with intralesional injection of compound betamethasone for the treatment of cutaneous Rosai⁃Dorfman disease: a case report

Application of photodynamic therapy combined with compound betamethasone in treatment of hypertrophic scar

To investigate the effect of photodynamic therapy combined with compound betamethasone in the treatment of hypertrophic scar. 37 cases of keloid were divided into two groups, 19 cases in the treatment group, 18 cases in the control group. The patients in treatment group were treated with photodynamic therapy combined with compound betamethasone injection therapy. The patients in the control group were treated by compound betamethasone injection. The effect and recurrence rate were compared before and after treatment. The effective rate was 89.5% in the treatment group, 55. 6% in the control group, showing significant difference between the two groups (P = 0.029) The relapse rate in treatment group was significantly lower than that in the control group (P = 0.047) CONCLUSIONS: Photodynamic therapy combined with compound betamethasone has good effect and safety for the treatment of hypertrophic scar. The combined treatment can reduce the treatment period and side effects

Treatment of auricular keloids with surgery and intralesional injection of compound betamethasone

To investigate the treatment of auricular keloid with dinuclear surgery and intralesional injection of compound Betamethasone. From Jan. 2008 to Jan. 2012, a total of 186 cases of ear keloid were treated by surgery only (22 cases), or intralesional injection of compound Betamethasone (34 cases), or combined dinuclear surgery with compound Betamethasone (130 cases). All the patients were followed up for one year. SPSS 16.0 software was used for statistical processing and analysis, and GraphPad inspection method for inspection. The effective rate was 54.55% (12/ 22) in surgery group and 55.88% (19/34)in injection group. The recurrence was obvious in injection group during the follow-up period. The effective rate was as high as 96.92% (126/130) in combined group with recurrence in 4 cases, which was significantly higher than that in other 2 groups (P < 0. 01). Combined dinuclear surgery and compound Betamethasone injection has a good therapeutic effect on auricular keloids.

Effect of injection of ozone through lateral recess for treatment of radiculitis caused by lumbar disc herniation on blood glucose in patients with diabetes mellitus

Objective To evaluate the effect of injection of ozone (O3) through lateral recess for the treatment of radiculitis caused by lumbar disc herniation on the blood glucose in patients with diabetes mellitus.Methods Ninety-six patients with radiculitis caused by lumbar disc herniation involving 48 patients with diabetes mellitus and 48 patients without diabetes mellitus were enrolled in the study.The diabetic or non-diabetic patients were randomly divided into 2 groups ( n =24 each):non-diabetic patients-O3 group (group N-O3 ),non-diabetic patients-ghcocorticoid group (group N-GC),diabetic patients-O3 group (group D-O3 ),and diabetic patients-glucocorticoid group (group D-GC).In N-O3 and D-O3 groups,30 mg/L O3 10 ml was injected via the lateral recess.In N-GC and D-GC groups,compound betamethasone injection 3.5 mg was injected via the lateral recess.The blood glucose level was measured before treatment (T1),1 and 4 h after treatment (T3,4),and 1,3 and 7 days after treatment (T5-7).VAS score was recorded at T1,immediately after treatment (T2),and at T5-7.The patients' quality of life was measured using the Medical Outcomes Study 36-Item Short-Form Health Survey (MOS SF-36 Health Survey) questionnaire at T1,7.The therapeutic effect was evaluated at T7.The side effects were recorded.Results Compared with the baseline value at T1,VAS scores were significantly decreased after treatment,while the MOS SF-36 Health Survey questionnaire scores for physical functioning,bodily pain,role emotional,and mental health in all groups,for general health in group N-GC,and for vitality in groups D-O3 and N-O3 were significantly increased at T7,and the blood glucose level was significantly increased at T4 in groups N-GC and D-O3,and at T3-7 in group D-GC ( P ＜ 0.05).There was no significant change in the blood glucose level before and after treatment in group N-O3.The blood glucose level was significantly higher in group N-GC than in group N-O3,and in group D-GC than in group D-O3 ( P ＜ 0.05).There were no significant differences in the excellent and good rates and all the MOS SF-36 Health Survey questionnaire scores among all groups.No side effects were found in the study.Conclusion Injection of ozone through lateral recess for treatment of radiculitis caused by lumbar disc herniation exerts no influence on the blood glucose level in patients with diabetes mellitus. Key words: Ozone; Radiculopathy; Blood glucose; Diabetes mellitus; Lumbar vertebrae; Intervertebral disk displacement

Successful treatment of Kasabach–Merritt syndrome arising from kaposiform hemangioendothelioma by systemic corticosteroid therapy and surgery

Kasabach-Merritt syndrome is a rare type of vascular tumor with aggressive behavior in association with thrombocytopenia and consumptive coagulopathy. A standard guideline has not been established to date. A 7-day-old male infant with Kasabach-Merritt syndrome arising from kaposiform hemangioendothelioma was successfully treated with systemic corticosteroid and surgery. Systemic corticosteroid including methylprednisolone was injected intravenously followed by an intralesional injection of compound betamethasone. This approach brought about an excellent response after the first treatment which was maintained long enough to provide us with an opportunity to excise the tumor. Systemic corticosteroid and surgery may be considered an option for Kasabach-Merritt syndrome, although well-designed studies are needed to quantify the benefits and risks of this treatment.

Local use of a China-made compound betamethasone injection for the treatment of lichen simplex chronicus: a multi-center, randomized, parallel controlled clinical study

Objective To evaluate the safety and efficacy of single and local use of a China-made compound betamethasone injection in the treatment of lichen simplex chronicus. Methods A multi-center,randomized, parallel controlled study was conducted. Patients with lichen simplex chronicus were divided into test and control groups to receive a single dose of intralesional compound betamethasone injection made in China or Schering-Plough Labo N.V. Belgium. Patients were visited for the evaluation of efficacy and safety of the China-made injection at the beginning of the treatment (DO), on week 2 (D14) and 4 (D28) after the initiation of treatment. Results A total of 144 patients were enrolled, among which, 68 in the control group and 71 in the test group completed the trial. FAS analysis on week 4 revealed that the response rate and healing rate were 86.11% and 59.72% in the control group, respectively, 86.11% and 54.17% in the test group, respectively (χ2=0.00,0.45,respectively,both P>0.05).There was no severe adverse event in either group after the treatment, and only mild atrophoderma occurred in one patient in the control group, which was improved spontaneously within several weeks of follow-up. There was no statistically significant difference in the occurrence of side reactions between the two groups (P> 0.05). Conclusion The China-made compound betamethasone injection is effective and safe for the treatment of lichen simplex chronicus. Key words: Neurodermatitis; Compound betamethasone injection; Randomized controlled trials

Intralesional injection of two kinds of glucocorticosteroid for the treatment of active alopecia areata: a comparative study

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.

Clinical evaluation of compound betamethasone combined with anisodamine in treatment of eyebrow alopecia areata

Objective To observe the curative effect, safety and patient's satisfaction degree of combining compound betamethasone with anisodamine injection in the blocking treatment of eyebrow alopecia areata.Methods A total of 66 cases were randomly divined into two groups: patients were treated by compound betamethasone ( group A) and combining compound betamethasone with anisodamine ( group B). The drugs were injected from the middle of eyebrow alopecia areata to two sides by the standard of 0. 2 ml/cm2 in both groups one time a month. The curative effect of the all cases were observed at 1, 2 and 3 months after treatment. The safety of them were evaluated based on incidence rate of the side effect and their satisfactory degree were evaluated based on subjective reception 3 months after treatment. Results The effective rates in the group B were 58.82 %, 73.53 % and 88.23 % by turns at 1,2 and 3 months after treatment, and those in the group A were 31.25 %, 53.13 % and 71.88 %, respectively. The curative effect in the group B was better than that in the group A (P ＜ 0. 05), and the incidence rate of side effect in the group B was similar to that in the group A (P＞0.05) and the patient's satisfaction degree in group B was better than that in group A (P ＜0. 05) 3months after treatment. Conclusion The compound betamethasone combined with anisodamine injection in the treatment of eyebrow alopecia areata has superior curative efficacy, more safety and higher satisfactory degree in the patients. Key words: Compound betamethasone injection; Anisodamine injection; Eyebrow alopecia areata

The observation on keloid treated by compound betamethasone injection compare with triamcinolone acetonide injection

Objective To observe and compare the effect and side-effect of keloid treated by Compound Betamethasone injection and Triamcinolone Acetonide injection. Methods Group A was injected locally with compound Betamethasone to keliod every 4 weeks, totally 1～5 times according the status, Group B was injected locally with Triamcinolone Acetonide to keliod every 2 weeks, totally 1～5 times according the status. All the patients were visited followed 6monthes and 12monthes after treatment. Results Group A involved 116 patients (477 lesions), and the curative rate, effective rate, relapse rate of group A was 82.39%, 95.81%, 9.89% respectively. The side-effect occurred in 11.21% patients (include menstrual irregulation occurred in female was 5.97%). Group B involved 96 patients (389 lesions ), and the curative rate, effective rate, relapse rate was 75.32%, 88.43%, 13.86% respectively. The side-effect rate was 21.88% (include menstrual irregulation occurred in female was 19.64%).Conclusion Both are effective either by Compound Betamethasone or by Triamcinolone Acetonide to treat keloid, while the Compound Betamethasone is better, and has fewer influence on female menses, however the relapse rate is high. Key words: Compound betamethasone injection; Triamcinolone acetonide injection; Keloid