Intralesional Corticosteroid Therapy Research Articles

Corticosteroids and Immunosuppressants on Oral Lichen Planus’ Treatment

Dear Editor, Lichen planus (LP), a chronic inflammatory condition primarily targeting skin and mucous membranes, was first outlined by Wilson in 1869 and histologically by Dubreuilh in 1906 [1]. It predominantly affects women in their 4th and 5th decades [2]. Oral lichen planus (OLP) occurs mainly on the buccal mucosa, gingiva, and tongue, presenting in six types, with erosive ones causing eating discomfort. While 25% of LP cases manifest solely orally, some lesions can appear in areas like the anogenital region and esophagus [2]. OLP is postulated to be a T cell-mediated response to antigens, with potential ties to chronic liver diseases and higher prevalence in regions like Japan and Southern Europe [3]. Comorbidities like diabetes, hypertension, and stress may also contribute [4]. Dental materials can mimic OLP, and specific drugs, including NSAIDs and beta-blockers, might induce it in some individuals [5]. Asymptomatic OLP lesions generally need no treatment. For symptomatic forms, treatment targets symptom alleviation and lesion removal, primarily using topical corticosteroids. Resistant lesions may require intralesional or systemic corticosteroids, with alternatives like immunosuppressives, retinoids, antifungals, and metronidazole also being effective [6]. OLP has a premalignant nature with a 0.4-1.74% risk of turning malignant, typically from its atrophic or erosive form [7]. Treatment aims to alleviate pain, heal ulcers, minimize cancer risks, extend symptom-free periods, and uphold oral health. This report presents intralesional corticosteroid therapy for three patients with symptomatic OLP, presenting symptoms like pain and burning.

Electromyography Analysis of the Masseter Muscle's Activity in the Management of Oral Submucous Fibrosis.

Introduction Oral submucous fibrosis (OSMF) is a persistent, collagen metabolic disorder distinguished by the presence of fibrosis of the connective tissue stroma in the oral mucosa with a higher malignant potential rate for oral cancer. This study aimed to analyze the utility of electromyography (EMG) as the prognostic assessment tool in the management of OSMF with conventional intralesional corticosteroid therapy. Materials and methods This study included 20 OSMF cases of age range 20 to 80 years without systemic comorbidities to assess pre-treatment and post-treatment changes with intralesional corticosteroid therapy as an intervention and to determine if it could be assessed using electromyographic study. Clinical and histopathological grading of OSMF was done. The five clinical parameters were evaluated for measuring treatment prognosis. Among them, mouth opening, tongue protrusion, and burning sensation assessments were quantitative parameters, and palpable fibrotic bands and mucosa colour were qualitative parameters. As OSMF involves changes in muscle plane in moderately advanced and advanced cases, EMG was used as an assessment tool for measuring muscle activity. Among the muscles of mastication, the masseterand temporalis were selected for evaluation. Twenty age and gender-matched healthy controls were required for this study as there are no standardized normal values for amplitude and onset of activity in muscle analysis. The EMG activity of the right and left temporalis and masseter muscles were recorded using surface electrodes and were correlated with five clinical assessment parameters. Results In the right masseter, the rest amplitude of 1.6010 µV of the OSMFwas statistically significant (p-value: 0.050) when compared with 4.1275 µV of the control. The clench amplitude of 133.370 µV of the OSMFwas statistically significant (p-value: 0.062) when compared with 94.310 µV of the control. In the left masseter, the rest amplitude of 1.6695 µV of the OSMFwas statistically significant (p-value 0.066) when compared with 2.5735 µV of the control. In the left masseter, the onset of muscle action of 62.670 ms of the OSMFwas statistically significant (p-value: 0.017) when compared with 131.835 ms of the control. The clench amplitude differences in the right masseter of 133.370 µV pre-treatment, and 102.775 µV post-treatment were statistically significant (p-value: 0.007). The clench amplitude in the left masseter of 102.535 µV pre-treatment, and 92.090 µV post-treatment were statistically significant (p-value: 0.036). The correlation was seen between tongue protrusion and rest amplitude in the right masseter in OSMF (r = 0.376, p-value: 0.023). Conclusion There was a correlation between tongue protrusion and rest amplitude in the right masseter muscle in OSMF patients before treatment. In the right and left masseter, during rest, the amplitude of the OSMF group was lesser than that of the control group. During clench, in the right masseter, the amplitude of the OSMF group was higher than that of the control group. During clench in the left masseter, the onset of muscle action was lesser in the OSMF group than in the control group. After treatment, there was a reduction in clench amplitude in OSMF patients from their pretreatment values signifying muscle relaxation and a better onset of muscle action.

Corticosteroid Atrophy Plaque on the Scalp Treated with 5-Fluourouracil and Bleomycin Infusion in the MMP Technique

Alopecia areata (AA) is a disease with a great impact on quality of life of patients. Among several treatment modalities, intralesional injectable corticosteroid therapy is the first option, with corticosteroid-induced cutaneous atrophy as a common adverse event. We describe a case of plaque AA in the frontal region of the scalp that evolved with cutaneous atrophy induced by the application of intralesional corticosteroids but presented complete and sustained repilation after being treated with 5-Fluorouracil and Bleomycin using the technique of MMP (Microinfusion of Medicines into the Skin).

Vibration assisted analgesia during intralesional corticosteroid therapy for alopecia

Vibration assisted analgesia during intralesional corticosteroid therapy for alopecia

Effect of Epidermoid Cysts on the Efficacy of Intralesional Corticosteroid Therapy for Hypertrophic Scars and Keloids: A Prospective Pilot Study.

Patients with hypertrophic scars (HSs) or keloids occasionally have epidermoid cysts (ECs), and the effect of ECs on the effectiveness of intralesional corticosteroids (ILCs) treatment in these patients has not been reported. This study aims to evaluate the influence of ECs on the outcomes of ILCs treatment in patients with HSs or keloids. This prospective study included 572 patients with keloids ( n = 461) or HSs ( n = 111). Patients received intralesional triamcinolone acetonide injection (0.05 mL/injection) at a concentration of 40 mg/mL and every 28 days for 4 sessions, with a 1-year follow-up. A higher incidence of ECs was observed in keloid patients (16.92%) compared with HSs patients (7.21%). Keloid patients with ECs were older ( p = .008) and had a longer disease duration ( p = .0148), higher Vancouver scar scale (VSS) scores ( p = .04), and greater thickness ( p = .006). Keloid patients with ECs showed less improvement in VSS scores ( p < .0001) and thickness ( p < .0001) after ILCs treatment, with a higher recurrence rate ( p < .0001). The overall complication rate in keloid patients with ECs after ILCs treatment was 49.51%. Epidermoid cysts under keloids were associated with a poor response to ILCs therapy. Therefore, it is recommended to incorporate ultrasonography as a routine examination for keloid patients to aid in better decision making in clinical practice.

PLASMA CELL MUCOSITIS IN ORAL CAVITY: CASE REPORT

Plasma cell mucositis is a rare benign disease of unknown etiology, histologically characterized by plasmacyte infiltration in the upper aerodigestive tract submucosa. Affects mostly adults and may be associated with immunological disorders. Oral lesions may appear erythematous with papillomatosis, nodular, or granulomatous. A 21-year-old male patient with celiac disease was referred to the stomatology clinic for evaluation of an oral lesion. On physical examination, there is an ulcerated lesion on the left cheek mucosa, extending to the bottom of the sulcus and alveolar mucosa, with dimensions of approximately 4 to 5 cm in its longest axis, with a hardened consistency and painless on palpation, with the presence of bleeding to the touch. An incisional biopsy was performed, which revealed a chronic perineural and perivascular plasma cell inflammatory process, confirming the diagnosis of plasma cell mucositis. The patient underwent intralesional corticosteroid therapy with marked remission of the lesion. Plasma cell mucositis is a rare benign disease of unknown etiology, histologically characterized by plasmacyte infiltration in the upper aerodigestive tract submucosa. Affects mostly adults and may be associated with immunological disorders. Oral lesions may appear erythematous with papillomatosis, nodular, or granulomatous. A 21-year-old male patient with celiac disease was referred to the stomatology clinic for evaluation of an oral lesion. On physical examination, there is an ulcerated lesion on the left cheek mucosa, extending to the bottom of the sulcus and alveolar mucosa, with dimensions of approximately 4 to 5 cm in its longest axis, with a hardened consistency and painless on palpation, with the presence of bleeding to the touch. An incisional biopsy was performed, which revealed a chronic perineural and perivascular plasma cell inflammatory process, confirming the diagnosis of plasma cell mucositis. The patient underwent intralesional corticosteroid therapy with marked remission of the lesion.

RECURRENT LANGERHANS CELL HISTIOCYTOSIS IN JAWBONES: A CASE REPORT

Langerhans cell histiocytosis (LCH) is a rare disorder characterized by abnormal proliferation and infiltration of histiocytic cells. The jawbones are involved in about 20-30% of all skeletal cases. A 27-year-old female patient presented multiple lesions in the maxilla and mandible from 2012 to 2021. Radiographically, the lesions appear in a lytic form. An incisional biopsy was performed and confirmed the diagnosis of LCH, showing proliferation of large, round to oval mononuclear cells with an epithelioid shape, with eosinophilic cytoplasm and a grooved nucleus. The treatment consisted of intralesional corticosteroid therapy, a surgical approach, and chemotherapy. The last recurrence was diagnosed 5 months ago, and the patient is being prepared for another surgical treatment. Langerhans cell histiocytosis (LCH) is a rare disorder characterized by abnormal proliferation and infiltration of histiocytic cells. The jawbones are involved in about 20-30% of all skeletal cases. A 27-year-old female patient presented multiple lesions in the maxilla and mandible from 2012 to 2021. Radiographically, the lesions appear in a lytic form. An incisional biopsy was performed and confirmed the diagnosis of LCH, showing proliferation of large, round to oval mononuclear cells with an epithelioid shape, with eosinophilic cytoplasm and a grooved nucleus. The treatment consisted of intralesional corticosteroid therapy, a surgical approach, and chemotherapy. The last recurrence was diagnosed 5 months ago, and the patient is being prepared for another surgical treatment.

Aseptic Alopecic Nodule of the Scalp (NAAS) Simulating Hoffmann's Disease (HD), Efficacy of Intra-Lesional Corticotherapy: 03 Observations at the Bamako Dermatology Hospital (HDB)

The alopecic aseptic nodule of the scalp (NAAS) is a recently described entity known as a "pseudocyst of the scalp". It can be confused with dissecting folliculitis of the scalp (Hoffmann's disease) by certain clinical signs. We report three cases of NAAS mimicking MH with favourable evolution under doxycycline associated with intra-lesional corticotherapy. Case 1: A 36-year-old man presented with painful nodules of the scalp. Examination revealed two fluctuating subcutaneous nodules measuring 4 and 5 cm, both painful. The skin opposite the nodules was alopecic and not scarred. Case 2: A 28-year-old man presented with a scalp nodule that had been present for 3 months. Clinical examination revealed a fluctuating, painful subcutaneous nodule measuring 7cm, alopecic and non-scarring, with surrounding small patches of alopecia. In addition, inflammatory acne lesions were noted on the face. Case 3: A 33-year-old obese male smoker presented with a scalp nodule. Examination revealed a painful subcutaneous nodule measuring 3 cm, with smooth alopecic skin. Discussion: The pathophysiology of NAAS remains poorly understood, and a link with the spectrum of follicular occlusion pathologies has been suggested. Inflammatory acne was observed in two of our patients. The biopsy was non-specific; the pus came back sterile in all cases; after aspiration, the patients benefited from intra-lesional corticosteroid therapy associated with doxycycline 100mg/dr with a good evolution. Conclusion: Aseptic alopecic nodules of the scalp are clinically similar to folliculitis dissecans of the scalp. Certain clinical signs can help the practitioner to make the correct diagnosis in order to avoid aggressive treatment.

Current treatment modalities in granulomatous cheilitis.

Granulomatous cheilitis (GC) is a poorly understood disorder of the labial mucosa, which is a subtype under an umbrella term "orofacial granulomatosis." Several treatment modalities have been tried in the management of GC with suboptimal to optimal results. The objective of this article is to discuss various treatment modalities, whether medical or surgical, that have been tried for the management of GC with success. A comprehensive literature search was performed to screen articles related to the successful treatment of GC. Articles published in journals indexed in PubMed were searched along with those in Google Scholar. There was no availability of systematic review or meta-analysis on treatment of GC in the literature search. Recent data has been collected and consolidated from various case reports and case series to provide a concise overview of various treatments applied in GC. Various treatment modalities have been used in GC including glucocorticoids, antibiotics, immunomodulatory, and biological agents, surgical debulking, and laser therapy. No treatment modality has provided a predictable success. Intralesional corticosteroid therapy has been used more frequently either alone or in combination with other modalities.

Pembrolizumab-associated pyoderma gangrenosum in a patient with metastatic squamous cell carcinoma

Pyoderma gangrenosum (PG) is a rare, ulcerative neutrophilic dermatosis that has been reported in association with certain medications. Recognition of medications that trigger PG may help to better understand the pathogenesis of the condition and to provide earlier diagnosis and treatment for affected patients. Herein, we report a case of new-onset PG following initiation of the checkpoint inhibitor pembrolizumab for the treatment of metastatic cutaneous squamous cell carcinoma. Our case was resistant to intralesional corticosteroid therapy, but ultimately improved with systemic corticosteroids and cessation of pembrolizumab.

Management of ranula with a combination of intra-lesional corticosteroid therapy and micro-marsupialization- A case report

Management of ranula with a combination of intra-lesional corticosteroid therapy and micro-marsupialization- A case report - IDJSR- Print ISSN No: - 2394-708X Online ISSN No:- 2278-3784 Article DOI No:- 10.18231/j.idjsr.2020.023, International Dental Journal of Student's Research-Int Dent J Stud Res

Cicatrice pseudo-tumorale

Keloid scars are benign fibrous tumors that result from an abnormal response to trauma, their pathophysiology remains incompletely understood despite years of research. The predisposing factors are the young age of the patients (between 10 and 30 years), the subjects with pigmented skin, the localization (sternal, delto-pectoral, retro auricular and lobule, pubic and neck regions), skin tension, tissue hypoxia and depth of skin involvement. No treatment has shown constant efficacy in the treatment of keloid scars, we have at our disposal: press therapy, intra-lesional corticosteroid therapy, intra-keloid surgical suture excision, cryotherapy, brachytherapy and external radiotherapy at a dose of 15 to 20 Gy. We underline through this image (A) the interest of prevention by avoiding unnecessary surgical interventions in patients at risk, close monitoring of scars, and specialized care to avoid recurrence.

DENOSUMAB IN THE TREATMENT OF MAXILLARY CENTRAL GIANT CELL GRANULOMA: REPORT OF TWO NEW CASES

Central giant cell granulomas (CGCGs) are locally aggressive nonneoplastic lesions, which mainly affect the jaws of young patients. Microscopically, CGCGs are characterized by the proliferation of multinucleated giant cells in a fibrous and hemorrhagic stroma. Optimal treatment includes surgical and nonsurgical approaches. The latter encompass the use of subcutaneous denosumab due to its ability to inhibit osteoclast metabolism. Herein, we report 2 cases of aggressive CGCL treated with subcutaneous denosumab. Case 1: A 9-year-old girl with a maxillary CGCG causing nasal expansion and tooth displacement and mobility, which was recalcitrant to intralesional corticosteroid therapy, was treated with subcutaneous denosumab during 1 year (120 mg/mo), leading to complete calcification of the CGCG. Case 2: A 23-year-old woman with a diffuse maxillary enlargement diagnosed as CGCG by incisional biopsy was treated with subcutaneous denosumab for 5 months (120 mg/mo), leading to calcification of the CGCG, which was complementary managed with osteoplasty.

Oral Mucocele: Various treatment modalities

Mucoceles are common lesions of the oral cavity that result from an alteration in the minor salivary glands due to mucus accumulation and are broadly classified into extravasation and retention types. Rapid appearance, specific location, history of trauma, bluish color, and consistency help in the diagnosis. There are various treatment modalities which include conventional surgical removal, laser ablation, cryosurgery, sclerotherapy, micro-marsupialization, and intralesional injection of sclerosing agent or corticosteroid. Intralesional corticosteroid therapy and micro-marsupialization, though widely accepted treatment choices, the complete regression may not always be assured holding the importance of case selection and regular follow-ups for timely recognition of recurrences. This report highlights on the management of mucocele of lower lip in a 12-year-old female treated with different modalities: intralesional injection of corticosteroid, micro- marsupialization and surgical approach.

Quantification of bone gain in central giant cell granuloma of the jaws submitted to intralesional corticotherapy

ABSTRACT Introduction: The central giant cell granuloma (CGCG) is a bone alteration of unknown etiology that can affect the jaws and presents varied clinical behavior. Objective: To analyze radiographs from patients with CGCG submitted to intralesional corticosteroids, in order to quantify bone gain after treatment. Methods: Sixteen patients with the microscopic diagnosis of CGCG were selected from the Batista Memorial Hospital, in Fortaleza, Ceara, Brazil. Thirty-two radiographs (16 initial and 16 final) were evaluated by the mean pixel values of the affected region before and after the complete corticosteroid intralesional application protocol (six applications in biweekly intervals of triamcinolone hexacetonide). Results: Of the patients submitted to the study, 14 (87.5%) presented a mean increase in the values of pixels, understood as bone gain, in the radiographs after treatment with intralesional injections, and two (12.5%) did not present it. The comparison of the mean pixel values between the initial and final test sides showed p = 0.0027, which was statistically significant, confirming the increase in density in the studied regions. Conclusion: The tools for analysis of pixel values were useful in the quantification of bone gain in patients submitted to intralesional corticosteroid therapy, and these tools should be further explored and used during treatment as auxiliary methods in the evaluation of its efficacy.

Management of Infantile Periobital Hemangioma: a Prospective Study of a Single- Centre Experience from Saudi Arabia

Background: Although infantile hemangioma is a common benign childhood tumour, it is still a challenging entity in paediatric ophthalmology with many controversial lines of management. Management options include topical, intralesional or systemic steroids, surgical resection or even observation with no active intervention, as Hemangioma usually involutes after a period of growth. Aim: The current prospective study aimed to evaluate a single-centre experience in the management of infantile periorbital hemangioma in order to find a solution to the highly debated issue of the ideal management modality in this condition. Patients and Methods: A prospective study over a period of 4 years from January 2011 to December 2014 was carried out on infants diagnosed with periorbital hemangioma. The follow up period was one year from 2014 to 2015. All patients underwent a fine needle histopathological assessment before the start of treatment. All infants had one or more intralesional corticosteroid therapy, which was the first line of treatment in all cases. However, in 4 cases who did not show any improvement, systemic propranolol therapy was instituted. Results: Eighteen infants were enrolled in the study. There were 13 females and 5 males with the ratio of females to males being 2.6:1. In 11 infants, the tumor shrank within one week after the administration of intralesional glucocorticoids with the fading of tumor color. After one month of injection, the tumor was obviously involuted. The tumor became soft, flat and turned dark red. Two months after the injection, most of tumors continued to involute. Three of the tumors (17.7%), grew at the edge and required retreatment. Eleven patients underwent the treatment once, two patients twice, and one patient thrice. At the end of follow-up, tumors in 14 patients got almost completely involuted, with local telangiectasia left in 6 patients. In 3 patients, the tumor shrank, but did not completely involute. For effects evaluation, the treatment results were labeled as "markedly effective" in 12 cases and "effective" in 2 cases. Conclusions: Intralesional glucocorticoid therapy is a freely available, economic and effective therapy in the management of capillary periorbital hemangiomas, yet, in some cases of capillary hemangiomas, there is an indication for administering systemic propranolol therapy. The sample size is limited, yet, it may be the initial step in devising a road map for the management of infantile periorbital hemangiomas. It may also play a role in putting to rest a controversial topic in pediatric ophthalmology.

Extensive Aggressive Central Giant Cell Granuloma of the Mandible: Conservative Steroids Treatment in a Pediatric Patient

Central giant cell granuloma (CGCG) is a relatively rare intraosseous lesion, described by the World Health Organization as a localized proliferation consisting of fibrous tissue with hemorrhage deposits, the presence of osteoclast-like cells, and reactive bone formation. In this article, the authors present their experience in managing a wide, aggressive CGCG of the whole tooth-bearing mandible in a 9-year-old pediatric patient. The extension of the lesion and the age of the patient have presented a double challenge concerning treatment and outcome. If fact the main objective remains a correct therapeutic treatment, focused on healing the patient and avoiding recurrences, the clinician must be careful in preventing an excessive morbidity. The authors decided to treat the young patient with intralesional corticosteroid therapy, reserving surgery in case of non-response or for subsequent refinements. In this article is presented the authors’ conservative treatment protocol with intralesional corticosteroid injection and their results are compared with literature's data.

Linear Cutaneous Atrophy Development Due to Intralesional Corticosteroid Therapy: Case Report and Review of the Literature

Linear Cutaneous Atrophy Development Due to Intralesional Corticosteroid Therapy: Case Report and Review of the Literature

Nonsurgical Management of Oral Mucocele by Intralesional Corticosteroid Therapy.

Background. Oral mucocele is a common lesion resulting from an alteration of minor salivary glands due to mucus accumulation. Rapid appearance, specific location, history of trauma, bluish colour, and consistency help in the diagnosis. Conventional surgical removal is the treatment of choice but has several disadvantages like damage to adjacent ducts with further development of satellite lesions. Therefore, the present study was undertaken to evaluate the efficacy of intralesional corticosteroid injection (betamethasone) as a nonsurgical treatment procedure in oral mucoceles. Material and Method. A total of 20 cases (males and females, 10–30 years of age) with clinically diagnosed oral mucoceles were given 1 mL of betamethasone intralesionally. All the patients were examined after a period of 7, 14, and 21 days to evaluate the response of the lesion towards treatment and consequently given the 2nd, 3rd, 4th injections. If the lesion resolved after one or two injections, the treatment was discontinued. Results. Out of the 20 cases, 18 of them showed complete regression of the lesion whereas the remaining 2 cases showed decrease in size. All the patients received maximum of 4 consecutive shots in weekly interval. Conclusion. Intralesional corticosteroid therapy can be considered as the first choice in the treatment of oral mucoceles.

Central giant cell reparative granuloma of the Jaws

Central giant cell reparative granuloma (CGCRG) has been defined by The World Health Organization as a localized benign however sometimes aggressive osteolytic proliferation, consisting of fibrous tissue along with hemorrhage and hemosiderin deposits, with the presence of osteoclast-like giant cells and reactive bone formation.They are mostly localized in the maxilla and mandible , however lesions sourced from the orbit, paranasal sinuses, skull base, skull bones such as the temporal, sphenoid, ethmoid bones, and the small bones of the hands and feet have also been published.CGCRG often presents itself as a painless swelling of the face or mouth and it is divided into 2 groups according to its clinical findings, as aggressive and nonaggressive type.Nonaggressive lesions are slow-growing, mostly asymptomatic lesions which don't cause perforation of the cortical bone and root resorption. Aggressive lesions however are fast-growing; larger than 5 cm in size; cause pain and paraesthesia, root resorption and cortical perforation; and commonly show recurrence after surgery.The differential diagnosis for CGCRG includes other giant cell lesions such as the true giant cell tumor of the bone, aneurysmal bone cysts, and chondroblastoma.The traditional treatment for CGCRG is surgical abortion and this treatment is sufficient in 80% of the cases. Alternative methods to surgery are; intralesional corticosteroid therapy, calcitonin treatment, interferon alpha-2a, and imatinib treatment.