Intralesional Injection Research Articles

Effectiveness of Local Glucocorticoid Infiltration Versus Traditional Gauze Bandaging for the Treatment of Onychocryptosis: A Randomized Controlled Trial

Background/objectives: Local intralesional corticosteroid injections into the periungual fold are used to treat patients with onychocryptosis, but their short- or medium-term effects are unknown. The goal was to compare the efficacy of this treatment in stages IIa, IIb, and III of the condition with a common conservative method such as gauze bandaging. Methods: A two-arm randomized trial with 40 patients with stage IIa, IIb, and III onychocryptosis equally assigned into two treatment groups—control (spiculotomy and application of gauze bandaging) and experimental group (spiculotomy and infiltration of corticosteroid)—was performed. Anthropometric data, initial clinical status, pain, and inflammatory measures were collected before and at least one month after the intervention. Results: Pain reduction was higher in the experimental group (5.5 vs. 4.8 points) but with no significant differences (p = 0.306).Corticosteroids significantly reduced inflammation over gauze bandaging (1.9 vs. 1) with significant differences between them (p = 0.029). Conclusions: Corticosteroid infiltration was more effective than gauze bandaging application in reducing inflammation in patients with onychocryptosis, with similar effects on pain. These findings support the clinical importance of corticosteroid treatment for this condition, although a single infiltration may not be sufficient to prevent relapses.

The efficacy of cryotherapy compared to the other modalities for the management of palmoplantar warts: a systematic review and network meta-analysis

There are several treatment modalities for Palmoplantar Warts (PPW) introduced, but none have been proven to be significantly effective in all patients. The study aims to assess the efficacy and safety of cryotherapy compared to other modalities for PPW. Searches were conducted in Medline, Embase, Scopus, and CENTRAL databases, along with additional reference and citation tracking from included studies. Randomized Controlled Trials (RCTs) comparing various treatments for PPW were included. Two independent pairs extracted the data from the included studies. Outcomes assessed included cure rates, pain scores, recurrence rates, and adverse events. Network meta-analysis using Netmeta in R software was utilized, with treatments ranked by p-scores. A total of 27 RCTs that enrolled 2,539 participants were deemed eligible. As per p-scores, needling yielded the highest odd for the cure rate (p=1.00), followed by intralesional injection of the Measles, Mumps, and Rubella (MMR) vaccine (p=0.90). For the pain score, 76% topical monochloroacetic acid (p=0.13) showed the lowest mean pain score, while cryotherapy yielded the highest score (p=0.90). Furthermore, cryotherapy showed the highest odds for recurrence rate (p=0.75), followed by intralesional injection of Candida antigen (p=0.61). 0.05% intralesional bleomycin (p=0.93) was the highest agent for adverse events rate, followed by cryotherapy (p=0.61). Needling was the most effective in achieving a cure rate. Cryotherapy has the highest odds for pain score and recurrence rate, while 0.05% intralesional bleomycin has the highest adverse events profile.

Case report: A rare case of multifocal, combined lymphatic-venous malformation

Vascular malformations, including lymphatic-venous malformations (LVMs), are complex and can lead to significant morbidity. This case report details the management of a rare multifocal, combined LVM in a 3-month-old male, misdiagnosed as a right inguinal hernia prenatally. Postnatal imaging revealed multiloculated cystic masses extending from the mons pubis to the right groin, scrotum, and thigh. Doppler ultrasound and MRI demonstrated the extent of the masses, with the largest cyst measuring 4 × 4 × 2 cm. Initial surgical excision and debulking were performed; however, the lesion recurred 6 months later. Given the complexity and involvement of truncal vessels, complete excision was not feasible, and sclerotherapy with intralesional Bleomycin injections was initiated. After the first Bleomycin injection, a significant reduction in lesion size was observed. However, 6 months later, the lesion recurred and enlarged, necessitating a second Bleomycin injection. Subsequent follow-ups showed further reduction in lesion size. Unfortunately, 2 years later, the patient experienced diffuse cystic infiltration of the pelvis and right lower extremity due to treatment delays caused by the COVID-19 pandemic. Imaging at this stage revealed a cystic mass in the right pelvic cavity measuring 10 × 6 × 5 cm. Two additional sessions of Bleomycin injections were performed, resulting in a successful resolution of the cystic masses. Regular follow-ups have shown that the LVMs remain under control, with no symptoms and no concerns from the family. This case underscores the complexities involved in diagnosing and managing multifocal, combined LVMs. It suggests that Bleomycin sclerotherapy can be a valuable, minimally invasive alternative to more extensive surgical procedures, particularly when critical structures are involved. The patient’s condition has been successfully managed with a combination of surgical and sclerotherapy interventions, ultimately resulting in symptomatic relief and cosmetic improvement.

Comparison between Effects of Intralesional Platelet Rich Plasma and Corticosteroid Injection on Pain and Functional Outcome in Patients with Lateral Epicondylitis of Elbow

Background: A debilitating and painful elbow problem is lateral epicondylitis. Objective: In this study, pain and functional outcomes were examined in relation to intralesional platelet-rich plasma (PRP) and corticosteroid injections patients with lateral epicondylitis. Methodology: This randomized experimental study was done in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU) from March 2017 to February 2018. Thirty patients with diagnosed lateral epicondylitis, aged between 21- 60 years and had been ill for more than a month were enrolled and randomly assigned into two groups. In Group A received two doses of intralesional PRP injection, and Group B received two doses of intralesional corticosteroid injection. Pain and functional outcomes were evaluated by using a visual analog scale (VAS) for pain and a patient-rated tennis elbow assessment (PRTEE) questionnaire, respectively. In the lateral epicondylar region, intralesional PRP or corticosteroids were administered during the first (week 1=W1) and fourth (week 7=W7) treatment visits. Results: The findings revealed a statistically significant decline in pain over time, as well as improvements of functional outcomes in both groups as evidenced by significantly lower VAS scores and lower PRTEE scores up to 11 weeks post-injection. There was no discernible difference in progress between the two groups up until W1 to W9 scores, however at the eleventh week, group A showed greater improvement than group B (p<00.5). Conclusions: Intralesional PRP injection is a promising therapy option for lateral epicondylitis, offering sustained pain relief and improved functional outcomes over time compared to corticosteroid injection. Journal of Monno Medical College June, 2024; 10 (1):30-35

Long-term outcomes of intravenous corticosteroid pulse therapy for rapidly progressive alopecia areata: A single-center retrospective analysis of 106 cases and usefulness evaluation of a scoring system originally designed for half-year efficacy prediction for extended periods.

Intravenous corticosteroid pulse therapy (IVPT) has been preferentially conducted for rapidly progressive alopecia areata (RP-AA); however, the evaluation of long-term outcomes has been insufficient. In this study, 106 IVPT-treated RP-AA patients (36 males and 70 females) who were followed up for more than 1 year and up to 6.8 years were retrospectively analyzed. The mean observation period was 1137.8 ± 587.9 days (range 380-2490). The mean severity of alopecia tool (SALT) score before IVPT was 21.3 ± 23.4 but whole-scalp hair loss was observed in all cases after the intervention, suggesting that IVPT was performed soon after the onset. With additional interventions represented by intralesional triamcinolone acetonide injection with or without topical potent corticosteroid for those who insufficiently responded at 6 months after IVPT, 64.2%, 14.2%, and 21.7% of the patients respectively achieved good response (GR; SALT score ≤25), moderate response (MR; 25 < SALT score <75), and poor response (PR; 75 ≤ SALT score) 1 year after IVPT. On the final evaluation, the proportions of patients with GR, MR, and PR were 79 (74.5%), 7 (6.6%), and 20 (18.9%). Sixteen patients achieved and maintained full hair regrowth with IVPT alone until the end of observation. A previously reported scoring system for the short-term outcome prediction was shown to be useful for distinguishing the final-point GR responders from PR responders (P = 0.003). Of note, 21 patients were found to have some symptoms suggestive of the existence of preceding infectious diseases and tended to relapse. The revised scoring system adding the absence of preceding infectious diseases as one factor successfully predicted the occurrence of the relapse in our cohort (P = 0.002). Taken together, previously unreported real-world efficacy of IVPT to RP-AA was elucidated with the invention of a tool putatively enabling optimal long-term management.

Early activation of macrophage-2 with IL-4 in stromal vascular fraction increases VEGF levels and adipocyte count and maintains volume of fat graft in Wistar rats (Rattus norvegicus)

Several previous studies have demonstrated the benefits of early macrophage 2 activation fat grafts supplemented with macrophage culture. However, this approach is considered impractical in clinical settings because of intraperitoneal induction use. The aim of this study was to investigate the effect of early stromal vascular fraction (SVF) macrophage-2 activation with IL-4 on fat graft survival compared to SVF alone using an animal model for better fat graft viability. This experimental study included inguinal fat harvesting, isolated with collagenases to retrieve the SVF, and then injected with a combination of fat graft and SVF (0.3 mL) into the scalp region. The intervention group received an IL-4 intralesional injection on the third day, and the fat grafts were biopsied on days 7, 14, and 30. The primary outcomes were the final volume of the fat graft, vascular endothelial growth factor (VEGF) expression, and the adipocyte cell count using perilipin staining on immunohistochemistry examination. The group receiving IL-4 exhibited significantly higher VEGF on days 7, 14, and 30 (p=0.009, 0.009, and 0.021, respectively). Similarly, the IL-4 treatment significantly increased the perilipin concentration on days 7, 14, and 30 (p=0.008, 0.008, and 0.029, respectively). In this group, VEGF concentration was significantly increased on day 14 as compared to day 7 (p=0.009), while no significant difference was observed in the control group (p=0.090). Additionally, the IL-4 group displayed significantly less reduction of fat graft volume than the control group, as observed on days 7, 14, and 30 (p=0.009, 0.009, and 0.021, respectively). Overall, the study underscores the potential benefits of early M2 polarization in fat grafting, as well as providing practical advantages for improving fat graft volume retention.

Intralesional injection of mitomycin C following visual internal urethrotomy for recurrent urethral stricture: a randomized controlled study.

To assess the efficacy of Intralesional injection of mitomycin C (MMC) following visual internal urethrotomy (VIU) in the management of recurrent urethral stricture. Fifty male patients diagnosed with recurrent single bulbar urethral stricture measuring less than 1.5 cm previously treated with VIU were randomly allocated into two equal groups, (Group A) planned for VIU only and (Group B) planned for VIU with intralesional MMC injection using Botox injection needle. All patients were objectively evaluated pre- and post-operatively at 3, 6, and 12 months using uroflowmetry, post-void residual urine volume, and retrograde urethrography. Forty-five patients completed their follow-up in our study. Patients who underwent intralesional MMC injection showed significant improvement in uroflowmetry, post-voiding residual, and with a success rate (82.6% in Group B, compared to 50% in Group A with a highly statistically significant difference, p-value: <0.001). VIU with MMC was the only factor associated with a marked decrease in stricture recurrence (p = 0.02) as shown in the Multivariate Cox regression analysis. Intralesional injection of mitomycin C seems to be a safe and effective modality in reducing the recurrent stricture rate after VIU.

Case report: Intralesional secukinumab injection for pediatric nail psoriasis: does it have to be a positive outcome?

Recent studies have shown that local injection of secukinumab can achieve positive therapeutic effects when applied in the treatment of nail psoriasis. At present, there have been no other studies on the use of biological agents in the treatment of pediatric nail psoriasis. Three children were included in the study to evaluate the efficacy and safety of periungual injection and long-term injection of secukinumab in the treatment of nail psoriasis in children. It was found that local injection did not achieve a remarkable therapeutic effect. The nail lesions were improved continuously by subcutaneous injection once a month.

Efficacy of Nd:YAG Laser and Intralesional Triamcinolone Injection Combination Therapy in the Postoperative Management of Keloids.

Keloids, characterized by protruding scars that extend beyond the original skin damage site, cause significant emotional stress and reduced quality of life. Their exact pathogenesis remains unclear, with various hypotheses including growth factor imbalances and extracellular matrix changes. No single treatment is universally accepted, but multiple modalities like triamcinolone acetonide injection (TAC), laser therapies, and surgery are commonly used. This retrospective study involved East Asian patients who underwent keloid scar excision between March 2019 and June 2022. Patients were divided into two groups: one receiving only TAC injections and the other a combination of TAC and Nd:YAG laser therapy. The efficacy of treatments was evaluated using the modified Vancouver Scar Scale (mVSS) and the Patient and Observer Scar Assessment Scale (POSAS), with follow-ups at six and twelve months after operation. The study involved 111 patients. Both treatment groups showed significant improvements in mVSS and POSAS scores, but the combination therapy group demonstrated a statistically significant improvement in POSAS scores and lower recurrence rates at 12months compared to the TAC-only group. However, there was no significant difference in patient satisfaction between the groups. Dual therapy involving TAC injection and Nd:YAG laser treatment was more effective than TAC injection alone for managing keloid scars after surgery. This combination therapy showed better outcomes in preventing keloid recurrence and improving scar status at 12months after operation, along with significant improvements in patient-reported outcomes. 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 .

Possible Role of Platelet-Rich Plasma in the Treatment of Patients with Postherpetic Neuralgia: A Prospective, Single-Arm, Open-Label Clinical Study

Abstract Background: Currently, no treatment can fully and finally treat postherpetic neuralgia (PHN). Objectives: This study aimed to evaluate the possible efficacy of autologous intralesional platelet-rich plasma (PRP) injection in treating patients with PHN. Materials and Methods: A prospective, single-arm, open-label clinical study was conducted on 45 patients with PHN attending the Dermatology Outpatient Clinics of Sohag University Hospital, Egypt, between November 2019 and November 2021. Patients were subjected to full clinical general and dermatologic examinations. Patient’s assessment included; severity of pain through visual analogue scale (VAS), numerical rating scale (NRS), and verbal rating scale (VRS), in addition to Medical Outcomes Study 36 Item Short-Form (SF-36). Patients were treated by autologous PRP injection every 2 weeks for 2 months (4 sessions). Patients were evaluated before every session and 3- months after the last session. Results: There was a significantly decreased VAS, NRS, VRS, and SF-36 questionnaire values in the last session and three months after the last session. There was a highly significant moderate correlation between both scales (VAS and VRS) and patient’s age in years and who have aggravating factors. Likewise, there was a significant moderate positive correlation between scales (VAS and VRS) and the disease duration, medical co-morbidities, and associated myalgia. Limitations: These findings require further confirmations on more inclusive large-sized multicenter, randomized, placebo-controlled, clinical trials with longer follow-up. Conclusion: This clinical pilot study concluded that autologous intralesional PRP injection was an effective therapeutic option for patients with PHN.

7854 Ablation Aberration: A Case of Thyroid Dermopathy Exacerbation in a Filipino Male Following Radioactive Iodine Ablation and Total Thyroidectomy Improved by Weekly Intradermal Long-Acting Glucocorticoid Injection

Abstract Disclosure: K.T. Lim: None. O.C. Dampil: None. Ablation Aberration: A Case of Thyroid Dermopathy Exacerbation in a Filipino Male Following Radioactive Iodine Ablation and Total Thyroidectomy Improved by Weekly Intradermal Long-Acting Glucocorticoid Injection Introduction: Thyroid dermopathy (TD) represents an unusual extrathyroidal presentation of Graves' disease (GD), impacting about 0.5–4% of patients. RAI treatment for hyperthyroidism is known to progress Graves' ophthalmopathy. RAI-induced TD exacerbation, however, is rare in literature. Here, we present a case of worsening TD and ophthalmopathy in a Filipino patient with GD who underwent definitive therapy for persistent hyperthyroidism. Clinical Case: A 44-year-old man with GD had bilateral lower extremity indurated, mildly erythematous plaques for 4 years. Hyperthyroidism persisted despite methimazole compliance, so he underwent RAI ablation two years earlier, total thyroidectomy a year later, and has been on levothyroxine since. Despite definitive treatment, his extrathyroidal symptoms worsened. A punch biopsy of the skin lesions revealed upper and mid-lower dermis mucin deposition, with occasional spindle-shaped and stellate fibroblasts, and mast cells. These histopathologic findings were consistent with pretibial myxedema. We assessed his thyroid function and found he was euthyroid with normal TSH (3.1 μIU/mL; reference range 0.27-4.20) and an elevated TRAb (35.73 IU/L; reference range &amp;lt;1.75). Physical examination revealed thickened skin, cobblestone-like plaques, and non-pitting edema on the pretibial, ankle, and pedal areas. A 3.5-cm-diameter, circumscribed, orange-peel-textured, indurated plaque covered his left ankle. Fluocinolone acetonide 0.025% w/w ointment was initiated. After 3 weeks, his cutaneous symptoms improved by 35%, albeit his left ankle circumscribed plaque improved marginally. Triamcinolone acetonide 40 mg/mL was injected into this and other nodular lesions at 4mg (0.1 mL) per 1-cm-diameter circular region. Each dose was equally dispersed by multipoint intradermal injections using a 1 mL syringe with a 0.5”x 25G needle. A week after intralesional triamcinolone injection and continuous topical steroid application on the non-nodular lesions, a 70% improvement in cutaneous manifestations was observed (from baseline) with the plaques becoming thinner and softer. After three weekly intradermal steroid injections, the circumscribed plaque had flattened (with residual hyperpigmentation), and the other plaques and nonpitting edema dissipated. Conclusion: Our experience with this patient highlights a paradoxical TD exacerbation following RAI ablation and definitive surgery for persistent hyperthyroidism in GD. It also reveals that weekly administration of multiple subcutaneous injections of a long-acting glucocorticoid alleviates lesions where topical ointment does not. Presentation: 6/1/2024

Devices for treatment of nail psoriasis.

Nail psoriasis (NP) affects a significant proportion of cutaneous psoriasis patients, often leading to functional impairment and psychosocial distress. Despite available treatment options, challenges persist in achieving efficacy and with drug delivery, prompting investigation into novel therapeutic devices. A literature search was performed using the PubMed database for devices and lasers for NP on 17 October 2023 using the following search terms: device OR laser AND "nail psoriasis." Twenty-two articles were included describing treatment with pulsed dye laser, fractional carbon dioxide (CO<inf>2</inf>) laser, long-pulsed Nd:YAG laser, excimer laser, photodynamic therapy, intense pulsed light, and microneedling device. While some recent studies on use of therapeutic devices have shown promising results for NP treatment, current evidence supports an algorithmic approach including topical therapies, intralesional kenalog injections, and systemic therapies, depending on number of nails affected, presence of psoriatic arthritis, cutaneous psoriasis, comorbidities, and effect on quality of life. Laser therapy, although promising, requires further validation through extensive randomized trials before its inclusion in treatment regimens. These exploratory findings highlight emerging therapies that may expand the spectrum of options available. Use of lasers for NP treatment could provide dermatologists with a broader arsenal for customizing treatment plans that address individual patient needs, taking into account comfort, cost, and compliance to enhance overall patient outcomes.

Does Intralesional Steroid Injection Effectively Mitigate Vocal Fold Scarring in A Rabbit Model?

To assess the efficacy of intralesional steroid treatment in preventing vocal fold scarring following vocal fold surgery using a rabbit model. The research involved 42 male New Zealand white rabbits. Fourteen rabbits underwent vocal fold scar surgery using a 532nm laser and served as controls (control group). The remaining rabbits were divided into two groups of 14: one group received vocal fold scar surgery followed by dexamethasone injection (Dexa group) and the other received the same surgery followed by triamcinolone injection (Triam group). Four weeks after surgery, histological examinations and high-speed video analyses of vocal fold vibration were conducted. The maximum amplitude of vibration was the primary measure for assessing vocal fold function. In addition, real-time polymerase chain reaction (PCR) studies were undertaken to analyze scar regeneration and remodeling. The maximum amplitude differences were notably higher in the Dexa and Triam groups than in controls. Histologically, the collagen density (CD) ratios in both the Dexa and Triam groups were significantly reduced compared with controls. Real-time PCR analysis indicated marked elevations of Has-2 and Mmp-9 in the Dexa and Triam groups relative to controls. Intralesional steroid injections after vocal fold surgery are effective for reducing vocal fold scarring in a rabbit model. NA Laryngoscope, 2024.

Usefulness of intralesional contrast injection as a prebiopsy confirmation technique in a case of breast hemangioma

Hemangiomas are uncommon benign vascular lesions of breast. They have nonspecific imaging features and can be isoechoic or hypoechoic or of heterogeneous echotexture in ultrasound (USG). When isoechoic, it may be difficult to identify these lesions with confidence against a fatty background. Here, we report such a case of a high-density lesion detected in screening mammogram, which was not so obvious in USG. We used the technique of intralesional contrast injection into the probable USG correlate for confirmation, before proceeding with the biopsy and establishing the diagnosis of hemangioma. Thus, this simple prebiopsy confirmation technique helps in identifying the definitive USG correlate, thereby facilitating a USG-guided biopsy. This is very useful, especially in the peripheral healthcare centers where stereotactic facility may not be available. Another learning point from this case is that in case of superficially located lesions that are readily visible in mammogram but less conspicuous in USG, the possibility of hemangioma can be considered in the differentials. This observation has been mentioned in other case reports as well and reiterated in our case. However, due to the nonspecific imaging features and low incidence, it is difficult to make diagnosis of hemangioma without tissue sampling. The imaging features of breast hemangioma in mammogram and ultrasound are reviewed and described in this case report with an emphasis on the role of intralesional contrast injection in lesion localization.

Central Retinal Artery Occlusion Following Intralesional Triamcinolone Injection for IgG4-related Orbital Disease.

The risk of blindness associated with periocular and facial injections is well documented. Previous cases describing vision loss following a recent periocular or facial injection have emphasized the importance of facial "danger zones." To date, the literature suggests that nearly half of all cases of central retinal artery occlusion in the setting of a recent periocular or facial injection involve an injection in or around the nose. Here, the authors report the second known case of central retinal artery occlusion following a triamcinolone injection to the lacrimal gland. A 30-year-old female with a diagnosis of IgG4-related disease underwent lacrimal gland debulking with an intralesional steroid injection. She noted OD vision loss immediately after surgery, with posterior segment examination demonstrating retinal whitening with a cherry-red spot and intra-arterial yellow-white plaques. This case serves as a reminder to clinicians regarding the risk of iatrogenic embolism following triamcinolone injections around the face with special attention drawn to the lacrimal gland.

Effects of Intralesional Steroid Injection in Incision and Curettage of Chalazia

Effects of Intralesional Steroid Injection in Incision and Curettage of Chalazia

Losartan in Situ Forming Gel as a New Treatment for Hypertrophic Scars.

Hypertrophic scars are defined as visible lesions formed by excessive wound healing that cause cosmetic and, in some cases, functional challenges in patients. This study aimed to assess the efficacy of intralesional injections of losartan-loaded in situ forming gel and compare it with the common treatment (triamcinolone) in preventing scar formation. The formulation was prepared using a thermosensitive PLGA-PEG-PLGA triblock copolymer. Ear scar tissue in rabbits represented the hypertrophic scar, and the animals were treated with three treatments in three groups. Nine weeks following the single treatment, images of the scars were obtained and quantitatively analyzed using ImageJ and light microscopy was used to evaluate the fibroblast cell number, vascularization, inflammation and collagen deposition and fibrosis in H&E-stained sample tissue. According to the results based on the ImageJ and the Vancouver criteria, the losartan in situ forming gel (F-LG) indicated significantly higher improving effects on decreased vascularity and pigmentation in comparison with triamcinolone (F-TA) and placebo as a control (F-Ctl), although the effect F-LG was almost similar to F-TA on pliability and scar height, and they were better than the control. Histological findings showed F-LG and F-TA have less inflammatory and fibroblast cells compared to F-Ctl. Also, results indicated the dermal layers of the F-TA and F-LG groups' scar were thinner, and the deposition of collagens was reduced compared to the control. Consequently, F-LG was found to be an effective treatment in reducing scarring and promoting wound healing.No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Endoscopic Guided Dilations without Intralesional Corticosteroid Injections: Pediatric Crohn’s Patients Case Series

Background: The treatment for pediatric Crohn’s disease (CD) has shifted over the years from steroids and immunomodulators to biologics with the goal of histological and clinical remission. Endoscopic balloon dilation (EBD) has been utilized for stricturing disease, even in the pediatric population. EBD has been shown to be effective and minimally invasive, though historically, has been performed on patients with persistent mucosal inflammation. As such, intralesional corticosteroid (ILC) injections have been traditionally utilized during EBD. However, intralesional corticosteroid efficacy among pediatrics patients in deep endoscopic remission is unknown. Case Presentation: We report four patients that demonstrated at least initial successful dilations without intralesional steroid injections. Conclusions: The use of ILC injections during routine EBDs in pediatric patients should be further explored in randomized control trials.

A Three-Step Approach (MUC) for Umbilicoplasty: Creating a Deep Umbilical Depression in Lipoabdominoplasty.

Various methods of umbilicoplasty have been proposed to create an aesthetically pleasing umbilicus. However, following conventional lipoabdominoplasty, some patients, particularly those with a thin layer of abdominal fat, may exhibit a shallow navel. A modified umbilicoplasty with a three-step approach was performed between Jan 2019 and Mar 2023. The three-step procedure included multiple plications, umbilical stalk fixation, umbilical insertion and central gathering (MUC). Patients were followed up for at least 6months. Umbilical depth and complications were recorded. A total of 36patients were performed with MUC umbilicoplasty, with a mean age of 36.1years. Patients were satisfied with umbilical appearance. The average depth of the navel after MUC procedure was 1.8±0.3cm. A patient developed a hypertrophic scar in the umbilicus, which was treated with an intralesional injection of triamcinolone acetonide. No other complications were observed. The MUC approach to umbilicoplasty provides a deep umbilical depression with minimal scars. This three-step procedure is particularly beneficial for patients with a thin layer of abdominal fat. 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 .

Evaluating Treatment Modalities for Reducing Recurrence in Central Giant Cell Granuloma: A Narrative Review.

Treating central giant cell granuloma (CGCG) is challenging due to high recurrence rates and variable therapy responses. This study examines the efficacy of various treatments in reducing CGCG recurrence. A literature review explored outcomes of surgical excision, curettage, intralesional corticosteroid injection, and adjuvant therapy, considering factors like lesion location, size, and histological features. Aggressive surgical techniques such as en bloc resection were found to potentially lower recurrence rates compared to conservative approaches. However, treatment should be tailored to individual patient needs. Further research is needed to confirm these findings and improve treatment strategies. A concise literature review was conducted using PubMed, MEDLINE, and Google Scholar, focusing on papers published from 1986 to 2024. Search terms included "central giant cell granuloma", "recurrence", "treatment modalities", and "surgical excision". Studies reporting recurrence rates and treatment outcomes for CGCG were analyzed. Twenty-nine studies were reviewed, including six studies on surgical excision and curettage, eight studies on intralesional corticosteroid injections, six studies on calcitonin therapy, five studies on interferon-alpha therapy, and four studies on the therapy with denosumab. Analysis indicated that aggressive surgical treatments like en bloc resection were associated with lower recurrence rates compared to conservative methods. Predictors of recurrence included lesion size (>3 cm), location (mandible), and aggressive histopathological features. Aggressive surgical excision combined with nonsurgical methods may lower recurrence rates, while conservative techniques remain viable in some cases. Further prospective research is needed to validate these findings and enhance CGCG treatment options.