Intralesional Corticosteroids Research Articles

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).

Comparison of pain relief among patients with chronic plantar fasciitis treated with intralesional platelet-rich plasma injection versus corticosteroid injection in a tertiary care centre in Kerala - a prospective study

Background: Aim of the study was to compare pain relief and functional outcome and between intralesional autologous platelet rich plasma injection (PRP) versus corticosteroid injection in the treatment of plantar, and fasciitis by using visual analogue score and American Orthopaedic Foot and Ankle Society (AOFAS) score. Methods: The sample size for the study was 30 patients attending Dr. Somervell Memorial CSI Medical College. Patients were divided into two groups (PRP versus steroid) of 15 each. The study follows a prospective observational design with follow up at 2 weeks, 2 months and 3 months post procedure. The functional outcome of patients in each group was assessed using the visual analog scale and AOFAS score. Results: Post-procedure, a significant decrease in VAS score was seen in patients treated with PRP injection (8.73 to 2.27) than those treated with Steroid injection (8.8 to 3.53). Also, there was a significant improvement in the AOFAS score from 72.73 to 88.67 while for those patients treated with steroid injection, the AOFAS score was comparatively low (65.87 to 82.2). Conclusions: Plantar fasciitis is a prevalent condition in our community, and many treatment options typically offer only temporary relief from symptoms. Intralesional PRP injection emerges as a dependable treatment method that fosters the healing process of the affected fascia, resulting in improved functional outcomes. Our study indicates that a singular administration of platelet-rich plasma injection for plantar fasciitis yields substantial pain relief compared to the local steroid injection.

Characterization of orofacial features in sclerodermatous chronic graft-versus-host disease.

Chronic graft-versus-host disease (cGVHD) is a leading cause of morbidity and mortality following allogeneic hematopoietic cell transplantation (alloHCT). The sclerodermatous form of cGVHD can be particularly debilitating; however, orofacial sclerodermatous involvement remains poorly described. To characterize orofacial features of sclerodermatous cGVHD in a single center cohort of patients who underwent alloHCT. Retrospective data were collected from electronic medical records and analyzed descriptively. There were 39 patients who received alloHCT between 1993 and 2017 and developed orofacial sclerodermatous cGVHD. Concomitant cutaneous sclerodermatous cGVHD was common (n = 20, 51%). Orofacial sclerodermatous cGVHD features included fibrous bands of the buccal mucosa (n = 23, 59%), limited mouth opening (n = 19, 54%), perioral fibrosis (n = 8, 21%), and focal gingival recession (n = 4, 10%). Oral mucosal fibrosis was observed at the site of active or resolved chronic lichenoid inflammation in 30 patients, with all but two also presenting with a history of ulcerations. Management included jaw stretching exercises (n = 10; 6 stable/improved), surgery (n = 3; 2 improved), and intralesional corticosteroid injections (n = 2; 2 improved). Orofacial involvement with sclerodermatous cGVHD can present with multiple manifestations including fibrous banding, limited mouth opening, perioral fibrosis, and focal gingival recession. Surgical and non-surgical management strategies may improve clinical function and reduce morbidity.

Real-World Assessment of Disease Characteristics and Clinical Outcomes in Alopecia Areata in a Global Noninterventional Observational Cohort (ADAAGIO)

Background: A range of medications with varying efficacy are used to treat alopecia areata (AA). There remains limited evidence on prevailing treatments, disease characteristics, and clinical outcomes of patients with AA in routine practice, particularly for those with extensive hair loss. This study sought to address this evidence gap.
 Methods: This was a retrospective chart review study spanning the United Kingdom, France, Spain, and Germany. Adult and adolescent patients with ≥50% scalp hair loss were included. The study index date was defined as date of de novo or progression to ≥50% scalp hair loss and patients were required to have ≥6 months of postindex follow-up (i.e., index date to last clinic visit); index dates ranged 2015-2019. Analyses were descriptive and reported patient demographics, baseline clinical characteristics, and Dermatologic Life Quality Index (DLQI) score. The primary clinical endpoint was absolute Severity of Alopecia Tool (SALT) score and was assessed longitudinally based on post-index visits in which SALT was recorded. Sustained SALT ≤20 was also assessed via Kaplan-Meier methods to evaluate time to achieving SALT ≤20 without subsequent regression within 6 months to SALT >30.
 Results: A total of 741 patients were included. Median age at AA diagnosis was 27 years and 52.6% were female. Mean (SD) baseline SALT score at index was 63.5 (15.6), with 80.2% having patchy AA and 19.8% having alopecia totalis or universalis. Among patients with DLQI measured at index, mean (SD) DLQI score was 19.2 (7.2) with 84.5% reporting either a large (DLQI 11-20) or extremely large (DLQI 21-30) impact of AA. Topical corticosteroids were the most common treatment observed post-index, with 55.6% receiving ≥1 course with a median cumulative exposure of 4 months. Intralesional corticosteroids (22.5%), systemic immunosuppressants (22.0%), and oral (17.3%) or topical (19.4%) minoxidil were also common. Among patients with SALT measured at 12 months post-index, there was a mean (SD) absolute SALT reduction of -44.6% (37.3%) from baseline. However, at 12 months post-index, most patients (90.1%) failed to achieve SALT ≤20 that was sustained for ≥6 months.
 Conclusions: Although patients in this study experienced a substantial absolute SALT score reduction, few patients achieved and subsequentially sustained the more clinically meaningful SALT threshold of ≤20. These findings highlight the potential suboptimal effectiveness of the varied treatments applied in this population.

Vibration assisted analgesia during intralesional corticosteroid therapy for alopecia

Vibration assisted analgesia during intralesional corticosteroid therapy for alopecia

Clinical and Molecular Insights into Hypertrophic Scars and Keloids: A Literature Review

Background: Hypertrophic scars and keloids represent two distinct forms of abnormal wound healing, characterized by excessive fibrous tissue formation. Despite their prevalence, the pathophysiological mechanisms underlying their development and persistence remain incompletely understood. This literature review synthesizes current clinical and molecular insights into hypertrophic scars and keloids, aiming to highlight differences in their etiology, pathogenesis, and therapeutic responses. Methods: A comprehensive review of the literature was conducted, focusing on articles that provided significant insights into the clinical manifestations, genetic predispositions, molecular pathways, and treatment strategies related to hypertrophic scars and keloids. Experimental studies and clinical trials were included to encompass a wide range of data sources. Results: Hypertrophic scars are confined to the original wound boundary and may regress over time, whereas keloids extend beyond the wound margins and do not regress. Clinically, hypertrophic scars and keloids differ in their appearance, texture, and predilection sites. At the molecular level, these differences are underscored by distinct profiles of cytokine expression, growth factor activity, and extracellular matrix composition. Genetic studies have identified several predisposing factors, including specific gene mutations and polymorphisms. Treatment strategies vary; however, intralesional corticosteroids remain the first-line treatment for both conditions. Emerging therapies targeting specific molecular pathways offer potential for improved outcomes. Conclusion: Hypertrophic scars and keloids are complex conditions with distinct clinical and molecular characteristics. Understanding these differences is crucial for developing targeted and effective therapies. Future research should focus on unraveling the genetic basis of these conditions and exploring novel therapeutic targets. Enhanced knowledge of the pathogenic mechanisms will facilitate the advancement of personalized medicine approaches in the management of hypertrophic scars and keloids.

Cost benefit analysis of intralesional injections in keloids using Luer lock and non-locking syringes

Background: For keloid scarring, intralesional corticosteroid injections continue to be the most often utilised first therapeutic option. This is a common procedure done on an outpatient basis by surgeons and orthopaedists. Luer lock syringes which lock the needle with syringe prevent any leakage or spillage of drug while pushing it near the keloid compared to normal syringes. Methods: We intend to do a cost benefit analysis based on the retrospective data of intralesional steroid injections done by the authors (AP and SK) in their private practice. Results: The time between 2021 to 2022, 200 injection data was retrieved, 100 each using non locking syringes and Luer lock syringes. The spillage rate with non-Luer lock syringes was 14%. Conclusions: We found that luer lock syringes prove to be cost effective after giving more than 200 injections in keloids than non-locking syringes.

Clinical efficacy of intense pulsed light combined with low-dose intralesional corticosteroids in treating noninfectious granulomas after mesotherapy: A case series analysis.

Mesotherapy is a popular cosmetic procedure for localized delivery of substances. However, due to the lack of standardized processes, there are potential risks of adverse reactions. Granulomas formation is one of the chronic reactions which impose significant physical and mental burdens on patients. The aim of this analysis is to evaluate the safety and feasibility of combining intense pulsed light (IPL) with intralesional corticosteroids for treating noninfectious granulomas after mesotherapy. This retrospective observational case series included patients who suffer from noninfectious granulomas after mesotherapy and received combination of IPL and intralesional corticosteroids treatment between October 2021 and December 2022 at Peking University Shenzhen Hospital, Shenzhen, China. The process and effect were analyzed and summarized. Among the seven patients, five expressed extreme satisfaction with the efficacy, while two was slightly satisfied. The physicians believed that all patients had shown significant improvement. No adverse reactions or recurrences were observed during follow-up. Based on this analysis, the application of the combined treatment in patients suffering from noninfectious granuloma due to mesotherapy demonstrates good clinical efficacy and safety, making it worth considering as a treatment option.

Guidelines of care for the management of acne vulgaris

Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9years or older. The objective of this study was to provide evidence-based recommendations for the management of acne. A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. Analysis is based on the best available evidence at the time of the systematic review. These guidelines provide evidence-based recommendations for the management of acne vulgaris.

Cystic folliculosebaceous hamartoma: an unusual histopathological entity: a case report

The skin covers our body and exhibits a complex structure that is adapted to the different body areas. The scalp skin is distinctive, and the histopathological alterations in its diseases also present distinctive features. We present the clinical case of a 28 year old female patient, with no significant medical history. She reported a nodular tumor on the left parietal region of the scalp, which had been present for 10 years and showed slow growth. The patient had no major discomfort other than an occasional discharge of scant whitish material upon applying pressure. Intralesional corticosteroids were administered but had no effect. Over the following year, the discomfort increased, leading to the decision to remove it. The anatomopathological study found dilated follicular hairy structures in the dermis filled with keratin and debris, surrounded by multiple sebaceous glands that flow there, all surrounded by a characteristic mesenchymal cells population, diagnosing a folliculosebaceous cystic hamartoma.

Very Early Pulsed Dye Laser Intervention for Optimal Cosmetic Outcome in Post-Thyroidectomy Scars.

Early intervention of surgical scars with a pulsed dye laser is known to effectively prevent pathologic scars. Despite multiple reports on the effectiveness of the treatment, very few studies have demonstrated its appropriate initiation timing. In this study, our objective was to determine the optimal timing for initiating laser treatment following thyroidectomy. This study retrospectively analyzed 91 patients undergoing pulsed dye laser treatment post-thyroidectomy, grouping them by treatment initiation timing. The patients underwent treatment at intervals of 3-4 weeks with at least five sessions. Those with a high pliability score were injected with intralesional corticosteroids. The Antera 3D® skin imaging analyzer was used to assess biophysical parameters. The total Vancouver Scar Scale score significantly reduced after treatment in all groups. The Vancouver Scar Scale score reduction rate was significantly higher after treatment in the group for which the treatment was initiated within 3 weeks of surgery. The pigmentation and erythema score analyzed by Antera 3D® was also lower in this group. Early intervention using a pulsed dye laser within 3 weeks of thyroidectomy can substantially inhibit pathological scar development, providing physicians with a guide for optimal treatment commencement.

Profibrotic Subsets of SPP1+ Macrophages and POSTN+ Fibroblasts Contribute to Fibrotic Scarring in Acne Keloidalis

Acne keloidalis (AK) is a primary scarring alopecia characterized by longstanding inflammation in the scalp causing keloid-like scar formation and hair loss. Histologically, AK is characterized by mixed leukocytic infiltrates in the acute stage followed by a granulomatous reaction and extensive fibrosis in the later stages. To further explore its pathogenesis, bulk RNA-sequencing, single-cell RNA-sequencing, and spatial transcriptomics were applied to occipital scalp biopsy specimens of lesional and adjacent non-lesional skin in patients with clinically active disease. Unbiased clustering revealed 19 distinct cell populations, including two notable populations, POSTN+ fibroblasts with enriched extracellular matrix signatures and SPP1+ myeloid cells with a M2 macrophage phenotype. Cell communication analyses indicated that fibroblasts and myeloid cells communicated by SPP1 signaling networks in lesional skin. A reverse transcriptomics in-silico approach identified corticosteroids as possessing the capability to reverse the gene expression signatures of SPP1+ myeloid cells and POSTN+ fibroblasts. Intralesional corticosteroid injection greatly reduced SPP1 and POSTN gene expression, as well as AK disease activity. Spatial transcriptomics and immunofluorescence staining verified micro-anatomic specificity of SPP1+ myeloid cells and POSTN+ fibroblasts with disease activity. In summary, the communication between POSTN+ fibroblasts and SPP1+ myeloid cells by SPP1 axis may contribute to the pathogenesis of AK.

Effects of Stem Cell Therapy on Keloid Treatment: A Literature Review

Fibroblasts that produce excess collagen and growth factors play a role in the pathogenesis of keloid formation. In general, keloids are treated with intralesional corticosteroids alone or with a combination of other modalities, but the recurrence rate is still relatively high, so alternative treatments such as stem cells are being investigated, one of which is Mesenchymal Stem Cells (MSC), which have proven to be useful in healing keloids. Therefore, this literature review aims to discuss the effects of stem cell therapy in the treatment of keloids. In this literature review, 36 journals were used that discussed stem cell therapy in the treatment of keloids taken from various journal sources, namely Google Scholar, Pubmed, Medline, Ebsco, Hindawi, and Cochrane which were published within the last 10 years. According to the source, MSC is divided into 2 types, namely Adipose Mesenchymal Stem Cells (AMSC) and Bone Marrow Mesenchymal Stem Cells (BMMSC). In several studies, AMSC is known to reduce the expression of TGF-β1, COL-1, and COL-2 proteins, and has been shown to inhibit the proliferation of fibroblasts in keloid patients. Whereas in the BMMSC study that was applied with Hydroxybutyl chitosan (HBC) and Arg-Gly-Asp (RGD) hydrogels for 7 days, it was shown to significantly reduce nodular collagen fibers (p<0.05). Keloids occur due to excessive production of collagen and are influenced by various factors such as age, gender, skin color, and genetics. Stem cell therapy, such as MSC, has been proven in various studies to be an alternative treatment for keloids

Management of Indralupta (Alopecia Areata) - A Case Study

Indralupta is one of the Urdhwajatrugata Vyadhi characterized by the patchy hair loss over hair-bearing skin that includes scalp and beard. According to Sushruta Acharya, Indralupta is due to the vitiated pitta in association with vitiated Vata causing the falling of hairs from the scalp and vitiated Rakta and Kapha block the orifices of the hair follicles which restricts the growth of new hair. Alopecia areata is autoimmune disease presented as nonscarring, circumscribed, smooth patch of hair loss, management is by the intralesional and topical corticosteroids. Shodhana (Raktamokshana) and Shamana Chikitsa is advised for the Indralupta in ayurveda classics. In this present case study 17 years old male patient is treated with Pracchanna Karma (Raktamokshana) followed by Maricha Lepa along with internal medicine. The therapy has shown a remarkable improvement in the signs of Indralupta. The patient obtained considerable relief from the symptoms through the therapy. The treatment proved to be easy, economical, highly effective with in short duration.

Needle-Free Jet Injector-Assisted Triamcinolone Treatment of Keloids and Hypertrophic Scars is Effective and Well Tolerated in Children.

Keloids and hypertrophic scars can cause severe pain, pruritus, and psychological distress. Conventional intralesional corticosteroid treatment with needle injections remains challenging, especially in children with needle phobia. We aimed to evaluate the effectiveness, tolerability, and patient satisfaction of intralesional treatment with triamcinolone acetonide using a needle-free electronic pneumatic jet injector in children with keloids and hypertrophic scars. A retrospective study was performed in children with keloids and hypertrophic scars who received intralesional triamcinolone acetonide treatments using an electronic pneumatic jet injector. Effectiveness was evaluated using the Patient and Observer Scar Assessment Scale and Global Aesthetic Improvement Score at follow-up versus baseline. Tolerability was assessed with reported adverse effects and injection-related pain using a visual analog scale. Satisfaction questionnaires were used to evaluate treatment-related patient satisfaction. Six female patients and five male patients aged 5-17 years, with a total of >118 keloids or hypertrophic scars were included. Electronic pneumatic jet injector treatment led to a significant reduction in the total Patient and Observer Scar Assessment Scale observer and patient scores compared with baseline, with a median reduction of 28.9% and 23.8%, respectively (p = 0.005; p = 0.009). Median visual analog scale pain scores for electronic pneumatic jet injector treatment were significantly lower compared with needle injections, 3.0 versus 7.0, respectively (p = 0.027). No severe adverse effects were reported. Overall, 6 patients were 'satisfied' and five patients were 'very satisfied' with the treatment. Electronic pneumatic jet injector-assisted intralesional triamcinolone acetonide is an effective and well-tolerated treatment for keloids and hypertrophic scars in children. It should be considered as an alternative non-traumatic delivery method, especially in children with needle phobia or severe pain during previous needle injections.

A description of alopecia areata in European patients based on real-world survey data: physician-reported characterization of severity and associated treatment utilization.

Alopecia areata (AA), an autoimmune disease -affecting the hair of the scalp, face, and/or body, can entail substantial psychological and physical burden for patients. There is currently no international agreement on how to treat AA and the approach may vary across countries. This study investigated the management of AA in clinical practice. Data from a point-in-time survey conducted in France, Germany, Italy, Spain, and the United Kingdom, between October 2021-June 2022, were analysed for adults with mild, moderate, and severe AA, based on physician assessment. Dermatologists were surveyed about factors used to assess disease severity, physician-reported treatment goals, and treatment patterns for AA, including the use of wigs. In total, 239 dermatologists reported on 2,083 patients. Physicians' severity assessment and treatment goals were predominantly driven by scalp hair loss. Topical and intralesional corticosteroids were the most prescribed treatments for mild and moderate AA. Conventional immunosuppressants, oral Janus kinase inhibitors, and topical immunotherapy use generally increased with AA severity and therapy line. Wig use was greatest for severe AA. The primary reasons for the last treatment change in the moderate and severe groups were worsening of condition, lack of initial efficacy, and loss of response, and for mild group were improvement in condition, lack of initial efficacy, and worsening of condition. Findings were generally similar across countries. This analysis provides insights into the management of AA in five European countries and confirms the need for more effective therapies, especially for patients with severe AA.

A Case of Angiolymphoid Hyperplasia with Eosinophilia Treated with Combination Therapy of Topical and Intralesional Corticosteroids

Angiolymphoid hyperplasia with eosinophilia is an uncommon, benign vasoproliferative disorder that can present with single or multiple pink to red-brown dome shaped papules, predominantly on the head and neck. The most common reported symptoms include, but are not limited to, pruritus, bleeding and pain. Currently, there is no definitive treatment for this condition, with numerous therapeutic modalities described in the literature. The most effective and commonly used treatment is excision but can be more invasive and still has a high failure rate (40.3%). Despite the high failure rates associated with topical, systemic and Intralesional corticosteroids, we were able to show significant improvement with the combination of topical and Intralesional corticosteroids. This form of therapy is considerably cheaper and non-invasive compared to alternative therapies. Given the high recurrence and lack of definitive treatments, more research is needed for a better understanding of pathophysiology and identification of effective therapies.

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.

Efficacy and Safety of Combination 308-nm Excimer Laser and Intralesional Corticosteroid versus Intralesional Corticosteroid Monotherapy in the Treatment of Frontal Fibrosing Alopecia: A Pilot Study

Frontal fibrosing alopecia (FFA) is a slowly progressive cicatricial alopecia that can result in permanent hair loss, so early diagnosis and treatment is crucial. However and of concern, a standard treatment regimen for FFA has not yet been established. In an attempt to remedy this gap, we conducted this study to investigate the efficacy and safety of combined 308-nm excimer laser with intralesional corticosteroid (ILC) compared to ILC alone to treat FFA. The results of our study revealed that the combination of 308-nm excimer laser and ILC was not superior to ILC alone for treating FFA. Moreover, side effects, including erythema and postinflammatory hyperpigmentation, were reported in both groups.

Treatments for alopecia areata: a network meta-analysis.

Treatments for alopecia areata: a network meta-analysis.