Intralesional Corticosteroid Injection Research Articles

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.

The Pathophysiology and Management of Pathologic Scarring-a Contemporary Review.

Significance: Pathologic scarring occurs secondary to imbalances in the cellular mechanisms of wound healing and affects millions of people annually. This review article aims to provide a concise overview of the pathophysiology and management of pathologic scarring for clinicians and scientists alike. Recent Advances: Contemporary research in the field has identified aberrations in transforming growth factor-β/small mothers against decapentaplegic (TGF-β/SMAD) signaling pathways as key drivers of pathologic scar formation; indeed, this pathway is targeted by many treatment modalities and translational investigations currently underway. Although intralesional injection of corticosteroids has been the gold standard in the treatment of pathologic scarring, studies show greater treatment efficacy with the use of combination injections such as triamcinolone/5-fluorouracil and triamcinolone/botulinum toxin. Adjunctive therapies including ablative fractional carbon dioxide/erbium-doped yttrium aluminum garnet and non-ablative pulsed-dye lasers, microneedling, and carboxytherapy have shown encouraging results in small cohort studies. Translational investigations involving the use of nanogels, RNA interference, and small molecules targeting TGF-β/SMAD pathways are also currently underway and hold promise for the future. Critical Issues: The heterogeneous nature of hypertrophic scars and keloids poses significant challenges in formulating standardized treatment and assessment protocols, thereby limiting the conclusions that can be drawn. Future Directions: Rigorous clinical trials into the individual and synergistic effects of these therapies would be ideal before any definitive conclusions or evidence-based treatment recommendations can be made. Owing to the heterogeneity of the pathology and patient population, well-conducted cohort studies may be the next best option.

Treatment Comparison for Medial Femoral Condyle Subchondral Cystic Lesions and Prognosis in Yearling Thoroughbred Racehorse Prospects.

Subchondral cystic lesions (SCL) in the medial femoral condyle are a usual finding in Thoroughbred survey and auction repository radiographs. Several treatments with different outcomes have been studied over the years to improve soundness and racing prognosis. Our objective was to report the racing prognosis in Thoroughbred yearlings intended for racing that were diagnosed with SCL in the medial femoral condyle and were treated using four current and different techniques: intralesional injection of corticosteroids, SCL debridement through the joint with a drill bit, translesional cortical screw placement, and absorbable hydroxyapatite implant placement. Data from 182 Thoroughbred yearlings treated for SCL in the medial femoral condyle were collected from 2014 to 2020. Limb affected, age at surgery, sex, and radiographic measurements of the SCL were recorded. Auction price and racing performance were collected for treated horses and compared to 154 maternal siblings free of medial femoral condyle SCL. Analyses were conducted to assess if racing prognosis was affected by SCL size, to detect differences in auction price and selected flat racing outcome parameters between cases and controls, and to compare racing prognosis between the studied treatments. Mares and lesions located in the right stifle were significantly overrepresented. The auction price of treated horses was significantly lower than that of their siblings. Horses treated for SCL had significantly lower chances to start in a race than controls (59% vs. 74% respectively). Wider SCL negatively affected the chances to start at least in one race, and negatively affected the earnings made in the 2-year-olds' racing year. Horses with SCL treated using a bioabsorbable implant had a significantly higher median in starts as 3-year-olds (seven starts) than horses that had the SCL debrided with a drill bit (three starts). In conclusion, Thoroughbred yearlings treated for a medial femoral condyle SCL had lower auction prices and decreased ability to start a race compared to siblings' wider cysts had worse prognosis to start a race and might affect earnings as 2-year-olds; and horses treated with bioabsorbable composite implant placement had more starts as 3-year-olds than with other techniques.

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.

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.

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.

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.

Ayurvedic Management of Chalazion (Utsangini): A Case Study

A chronic non- infective lipo- granulomatous inflammation of the blocked meibomian gland. An inflamed, blocked meibomian gland, typically on the upper eyelid, results in a chalazion (meibomian gland lipogranuloma). Ayurveda correlates it with Utsangini. Both Acharya’s Sushruta and Vagbhata provide an explanation of Utsangini under Vartmagatha Rogas. According to Sushruta, it comes under Tridoshaja / Sannipataj Sadhya Vyadhi. But even so, Vagbhata asserts that it is a Raktaja Sadhya Vyadhi.The overall prevalence of chalazion is 51% in adult .Both Shodhana and Shamana Chikitsa are mentioned in care of Utsangini. In modern medicine, the therapies include intralesional corticosteroid injection and surgical drainage are advised. In this study, a 22-year-old male patient with a right eye redness, watering of eye and painless swelling of the right upper eye lid with heaviness presented to the Eye OPD of the Dr. DY Patil College of Ayurved and Research Centre, Pimpri, Pune. Following the history and examination, chalazion was diagnosed. The patient received local treatment in kriya kalpa using Netra Parisheka therapy in addition to shamana chikitsa. As a result of the treatment remarkable improvement in all disease symptoms and signs was observed. So, the management of chalazion has been proven to be successful with Ayurvedic treatment.

Autologous Whole-Blood Versus Corticosteroid Local Injection in Treatment of Plantar Fasciitis: A Randomized Single Blind Placebo-Controlled Study.

Autologous whole-blood intralesional injection has attracted interest as a possible means of treatment for chronic plantar fasciitis. We contrasted its effectiveness with that of corticosteroids, which have a longer history of success in treating tendinopathies such as plantar fasciitis. In order to monitor the disease's progress naturally, we also compared them with a placebo. Sixty clinically diagnosed patients were taken up for intralesional injection of autologous whole blood (AWB), corticosteroid, and normal saline as placebo mixed with 2 mL of lignocaine after dividing them into three groups. Two doses were given and followed up in the third, sixth, and 12th weeks. The evaluation was done according to the visual analog scale (VAS) and the number of tablets of paracetamol (PCM) 500 mg consumed for the following period. When compared to the placebo group in the third, sixth, and 12th weeks, the corticosteroid group exhibited a significant improvement with a p<0.001 in the VAS score, whereas the autologous whole blood group showed no meaningful difference. When compared to the placebo group at the sixth and 12th weeks, the AWB group's VAS score showed a statistically significant difference with a p>0.001. At each follow-up, the placebo group consumed more analgesics than the corticosteroid group, with a p<0.001. Only in the third week of follow-up did AWB demonstrate a statistically significant difference in PCM consumption as compared to the corticosteroid group. Statistically significant improvement was seen in both the AWB group and corticosteroid group as compared to the placebo group. The corticosteroid group achieved earlier and superior relief of pain while AWB had a longer lasting effect. Therefore, study results indicate almost similar results in short-term studies.

Treatments and Prognosis for Subchondral Cystic Lesions in the Distal Extremities in Thoroughbred Prospect Racehorses.

Subchondral cystic lesions (SCLs) in equines and their treatments have been mainly studied in the medial femoral condyle of the femur. SCLs in the distal extremities affecting the fetlock or interphalangeal joints are frequent, but treatment or prognosis studies in horses are currently sparse. Our objective was to compare four treatments for SCLs in the distal extremities (intralesional injection of corticosteroids, transcortical drilling, cortical screw placement, and absorbable hydroxyapatite implant placement) and report the racing prognoses for affected thoroughbred yearlings. Data from 113 thoroughbred yearlings treated for SCLs in the distal extremities were collected from 2014 to 2020. Age at surgery, sex, bone affected, radiographic SCL measurements, SCL shape, and type of treatment were recorded. Sale data and racing performance were collected for the operated horses and for 109 maternal siblings that were free of SCLs. An analysis was conducted to assess if SCL size affected racing prognosis and to detect differences in sale value and selected racing parameters between the cases and controls. The outcomes for the different treatments, the different bones affected, and the SCL shape type were also analyzed. There was no difference in the ability to start in a race between the cases and controls (60.2% vs. 69.7%, respectively). The auction value of the treated horses was significantly lower than that of their siblings. The bone affected did not impact any of the racing variables studied, whereas the height of the SCLs negatively affected the number of wins and placed races. The type of treatment for the horses affected by SCLs did not have an impact on sale prices, ability to start a race, race starts, wins, and places, or age at the time of the first start. In conclusion, yearlings diagnosed with an SCL in the distal extremities had lower auction prices and decreased racing performances, with lower numbers of wins correlated with larger SCL heights compared to the siblings. Similar racing performance was found regardless of the treatment received.

The Effect of Intralesional Corticosteroid Injection in Management of De Quervain's Disease: A Study of 60 Patients in a Tertiary Care Hospital in Bangladesh

Background: The thickening of the extensor retinaculum, which normally keeps the tendon in place in the wrist, can lead to de Quervain's tenosynovitis. The problem can be treated surgically as well as by other means. Injection of corticosteroids is an excellent conservative therapy choice. Objective: To the effect of intralesional corticosteroid injection in management of De Quervain's disease Methods: This randomized clinical trial was conducted with 60 adult patients eithermale or female diagnosed as a case of De Quervain's disease (moderate to severe pain) attending outpatient department of Physical Medicine and Rehabilitation in DMCH for six months period. Intra lesional corticosteroid injections were given with 1cc syringe between the synovial sheath and the tendons, during the initial visit. The patients were advised to follow the ADL instructions for the affected hand as much as possible. Outcome was measured by Visual Analogue Scale (VAS) and Patient Rated Wrist Evaluation (PRWE) scale. Every patient was assessed every weekly for 6 weeks. Level of significance was assessed with the help of paired t-test and chi-square test where necessary. Results: Out of the 60 patients, 36.67% were between the ages of 41 and 45, and 28.33% were between the ages of 46 and 50, with a mean age of 41.775.43 years. The number of men to women was 1:7.6. More than half of the patients (53%) had the disease in their right hand, while 42% had it in their left hand and 5% had it in both. 83.33% of patients who got an intralesional injection of methyl prednisolone acetate felt less pain. Conclusion: Treatment of de Quervain's tenosynovitis with intravenous triamcinolone is effective without surgery. The right injection technique and long-term monitoring need additional focus.

Vitamin D in Keloids: An alternative to steroids?

Madam, Keloids are wound healing scars with well-demarcated overgrowth of fibrotic tissue, mainly involving excessive collagen proliferation produced by fibroblasts. They extend beyond the original injury site, and are associated with pain and pruritus (1,2). Few treatments available few for Keloids include occlusive dressings, compression therapy and intralesional corticosteroid injections (1). Triamcinolone acetate, a corticosteroid injection, is considered the first line treatment as it possesses anti-inflammatory and anti-mitotic activities, which reduce scar volume and prevent a recurrence. However, approximately 50percent of keloids are considered to be steroid resistant (3, 4). Moreover, as per literature, the usage of intralesional corticosteroid injections can cause several local and systemic adverse effects such as telangiectasias, skin necrosis, skin and subcutaneous fat atrophy, and Cushing’s syndrome (5) In light of the above, researchers are keen on finding other treatment modalities for treating these lesions, and among them Vitamin D, is being investigated. Vitamin D is a steroid hormone that normally plays a role in regulating serum calcium, inhibiting cellular proliferation and promoting cell differentiation and apoptotic activities. Transforming growth factor-beta (TGF-B), an inflammatory marker, has been implicated in the pathogenesis of keloids. TGF-B is believed to be inhibited with localised Vitamin D. Furthermore, Vitamin D deficiency plays a significant role in keloidogenesis, a process mediated by dysregulation of koebnerisin, an antimicrobial polypeptide (2). A study was conducted recently, where 40 adults, aged 18 to 60 years, were administered intralesional Vitamin D, on keloids sized atleast 5 cm, with sessions carried out every week for a maximum of 3-4 sessions. This study showed a highly significant reduction in the Vancouver Scar Scale, a scarring scoring system (1). However, further trials, specially comparative studies, are needed to effectively weigh in the efficacy of Vitamin D over steroids. Advantages of Vitamin D are evident and promising so far – it’s cost-friendly, and shows mild side effects such as burning, pain, swelling and tenderness that shortly disappears on its own.

CENTRAL GIANT CELL LESION IN THE MAXILLA TREATED WITH CORTICOSTEROID INFILTRATION

The etiopathogenesis of some non-neoplastic benign proliferative lesions remain uncertain. This is the case of giant cell lesions (CGCL), which, despite their benign and asymptomatic nature, may display aggressive behavior. Clinical and radiographic aspects may vary greatly, though histopathologically, few to many multinucleated giant cells, fibroblasts, ovoid mesenchymal cells, and loosely arranged stroma are often observed. This study aimed to present the satisfactory outcome of a CGCL in the maxilla treated exclusively with intralesional corticosteroid injections in a 30-year-old patient, who was admitted to our center with an asymptomatic swelling in the region of teeth 14 and 15 and displaying radiographic features of an odontogenic cyst. Even though surgery is the first-line treatment option, intralesional corticosteroid was an effective strategy to manage a relatively large lesion. The etiopathogenesis of some non-neoplastic benign proliferative lesions remain uncertain. This is the case of giant cell lesions (CGCL), which, despite their benign and asymptomatic nature, may display aggressive behavior. Clinical and radiographic aspects may vary greatly, though histopathologically, few to many multinucleated giant cells, fibroblasts, ovoid mesenchymal cells, and loosely arranged stroma are often observed. This study aimed to present the satisfactory outcome of a CGCL in the maxilla treated exclusively with intralesional corticosteroid injections in a 30-year-old patient, who was admitted to our center with an asymptomatic swelling in the region of teeth 14 and 15 and displaying radiographic features of an odontogenic cyst. Even though surgery is the first-line treatment option, intralesional corticosteroid was an effective strategy to manage a relatively large lesion.

Effect of Biologics on the Need for Procedural Interventions, Systemic Medications, and Healthcare Utilization in Patients with Hidradenitis Suppurativa: Real-World Data from the UNITE Registry.

Management of hidradenitis suppurativa (HS) often requires a combined medical/procedural approach. Biologics are frequently reserved for severe cases after irreversible tissue damage has occurred. We evaluated the association between consistent biologic use and the need for procedural interventions, systemic medications, and healthcare utilization. UNITE, a 4-year, global, prospective, observational, HS disease registry, documented the natural history, diagnostic/treatment patterns, and clinical outcomes of HS. Patients aged 12years or more, with active HS were enrolled between October 2013 and December 2015 and evaluated every 6months for 48months at 73 sites across 12 countries (data cutoff December 2019). Proportions of patients requiring different HS procedures, systemic medications, and healthcare utilization were assessed during the 6-month periods before, during, and after biologic initiation for 12weeks or more (i.e., consistent use). There were 63 instances of initiation of consistent biologic use (adalimumab [81%], infliximab [16%], and ustekinumab [3%]) in 57 patients. Patients' mean age was 40years, 58% were female, and 53%/47% had Hurley stageII/III disease, respectively. Fewer patients required surgical/procedural interventions and systemic medications for the 6-month period during/6-month period after biologic initiation versus the 6-month period before biologic initiation, including intralesional corticosteroid injections (22%/14% vs 24%), incision and drainage (I&D) by physician (10%/10% vs 17%), I&D by patient (10%/10% vs 14%), surgical excision (8%/10% vs 11%), deroofing (5%/2% vs 5%), systemic antibiotics (43%/41% vs 54%), and systemic immunosuppressants (10%/6% vs 13%). Fewer patients required hospital admission for HS (17%/13% vs 21%) or emergency department visits for HS (8%/8% vs 16%) during the 6-month periods in which consistent biologics use started and continued versus the 6-month period before consistent biologic use. Following initiation of consistent biologic use (12weeks or more), fewer patients required acute procedural interventions, systemic medications, and healthcare utilization, supporting the importance of early biologic initiation.

Arthroscopically guided lag screw fixation of subchondral bone cysts in the medial femoral condyle in Thoroughbred racehorses: description of technique and comparative results.

To describe an arthroscopically guided technique for lag screw placement across subchondral bone cyst (SBC)in the medial femoral condyle (MFC) and to compare postoperative racing performance with corticosteroid injection and cyst debridement. Retrospective cohort study. One hundred twenty-three horses with 134 MFC SBCs undergoing treatment at a single referral hospital in the UK between January, 2009, and December, 2020. Sex, age, limb affected, radiographic cyst dimensions, preoperative and postoperative lameness, surgical technique (lag screw placement, cyst debridement, intralesional corticosteroid injection), and, where applicable, screw positioning were recorded retrospectively. A ratio was calculated using measurements from preoperative and postoperative radiographs. Outcome was assessed by resolution or improvement in lameness, reduction in cyst size, and starting one race after treatment. Outcome data was compared between treatment groups. Twenty-six of 45 (57.8%) horses that underwent transcondylar screw placement raced postoperatively, at a median of 403 days between surgery and first postoperative race. There was no difference between treatment groups with regard to racing or preoperative and postoperative lameness. Cysts treated with transcondylar screw placement had a greater reduction in cyst size and a reduced period of convalescence in comparison with those that underwent debridement; the results were similar to those treated by intralesional corticosteroid injection. Postoperative racing rates were similar for all techniques. Convalescence was reduced for lag screw placement and corticosteroid injection compared to debridement. The arthroscopically guided technique results in radiographically consistent screw placement and cyst engagement and offers a viable alternative to other treatments.

Topical Anesthetic versus Lidocaine Mixture for Pain Relief During Keloid Treatment: A Prospective, Split Study.

The most common typical symptoms of keloids can be pain and itchiness. Intralesional corticosteroid administration is generally the first-line conservative treatment. Minimizing pain during intralesional corticosteroid injections into keloids should be aimed, as the treatment is often painful. There has yet to be a report on which local anesthetic technique is superior in keloid treatment between topical anesthetic versus lidocaine mixture injection. This was a single-center prospective study. The study included 100 patients with painful multiple/multifocal keloids aged 18 to 85 years and was performed between May 2021 and December 2022. Among multiple keloid lesions in a single patient, we assigned the keloids pretreated with topical cream application versus local injection. Then, subjects received 40mg of intralesional corticosteroid injections into the keloids with a 26G needle to treat keloids. Patients rated the pain intensity of each lesion pretreated with two different anesthetic techniques on an 11-point numeric rating scale. A separate direct question of "Which technique would you recommend if you had to be injected again?" was given. One-hundred patients with painful multiple/multifocal keloids were included in the study. Data on pain intensity numeric rating scale (NRS) revealed that injection techniques relieved the pain statistically significantly more than topical creams. ( P <0.001) 63% of the participants (n=63) preferred the injection technique, while 25% preferred topical anesthetics. In total, 12% of patients responded that there was no difference between the two techniques. When comparing with topical lidocaine/prilocaine (EMLA) cream, a 1:1 mixture of 1% lidocaine and epinephrine significantly alleviated pain during and after the corticosteroid injection.

Polyphenol-based targeted therapy for oral submucous fibrosis.

Oral submucous fibrosis (OSF) is a chronic, progressive, and precancerous condition mainly caused by chewing areca nut. Currently, OSF therapy includes intralesional injection of corticosteroids with limited therapeutic success in disease management. Therefore, a combined approach of in silico, in vitro and in vivo drug development can be helpful. Polyphenols are relatively safer than other synthetic counterparts. We used selected polyphenols to shortlist the most suitable compound by in silico tools. Based on the in silico results, epigallocatechin-3-gallate (EGCG), quercetin (QUR), resveratrol, and curcumin had higher affinity and stability with the selected protein targets, transforming growth factor beta-1 (TGF-β1), and lysyl oxidase (LOX). The efficacy of selected polyphenols was studied in primary buccal mucosal fibroblasts followed by in vivo areca nut extract induced rat OSF model. In in vitro studies, the induced fibroblast cells were treated with EGCG and QUR. EGCG was safer at higher concentrations and more efficient in reducing TGF-β1, collagen type-1A2 and type-3A1 mRNA expression than QUR. In vivo studies confirmed that the EGCG hydrogel was efficient in improving the disease conditions compared to the standard treatment betamethasone injection with significant reduction in TGF-β1 and collagen concentrations with increase in mouth opening. EGCG can be considered as a potential, safer and efficient phytomolecule for OSF therapy and its mucoadhesive topical formulation help in the improvement of patient compliance without any side effects. Highlights Potential polyphenols were shortlisted to treat oral submucous fibrosis (OSF) using in silico tools Epigallocatechin 3-gallate (EGCG) significantly reduced TGF-β1 and collagen both in vitro and in vivo EGCG hydrogel enhanced antioxidant defense, modulated inflammation by reducing TGF-β1 and improved mouth opening in OSF rat model.

Baricitinib for alopecia areata.

Alopecia areata is a disease in which an active immune response is triggered against the hair follicles, causing hair loss. The extent of this hair loss is proportional to the number of hair follicles attacked. Alopecia areata is classified into three types depending on the area of hair fall: alopecia areata, alopecia totalis, and alopecia universalis. Alopecia areata has an approximate worldwide prevalence of 1 in 1000 people1. The current, well-known treatment of alopecia areata is intralesional corticosteroid injections, with 60-70% of patients reporting some form of hair growth afterward, while other treatments include topical immunotherapy, Minoxidil, and Anthralin2. Similar treatment methods, along with hair transplants and platelet-rich plasma (PRP) therapy, are used in Pakistan, which has been effective to some extent in controlling or stopping the progression of the condition3. Baracitinib, which has already been approved for rheumatoid arthritis and atopic dermatitis, is a Janus kinase (JAK) inhibitor that blocks the proteins known as JAK enzymes, which are involved in immune signalling and inflammation. It is unclear as to how the immune system of the body causes alopecia areata. A possible mechanism is by sending out signals that interrupt the events of hair growth. Baracitinib stops the communication among the immune cells responsible for causing hair loss which ultimately inhibits the signals mentioned above and lessens the response to injury, resulting in hair regrowth4. Thus, it can be thought of as a potential treatment for severe alopecia areata. Recently, in June 2022, FDA approved baricitinib as the first systematic treatment for alopecia areata after two clinical trials were conducted by Brett King et al. The trial showed promising results regarding the use of barticinib as after 36 weeks of exposure, oral baricitinib outperformed placebo in terms of promoting hair growth in patients with severe alopecia areata. The proportion of participants that achieved at least 80% scalp hair coverage at 36 weeks was estimated to be 38.8% with 4-mg baricitinib, 22.8% with 2-mg baricitinib, and 6.2% with placebo in trial 1 and 35.9%, 19.4%, and 3.3%, respectively, in trial 25. ---Continue

Comparison of the Effect of Intralesional Injection of Corticosteroid and Platelet-rich Plasma in Patients with de Quervain’s Tenosynovitis

Background: De Querveins’ tenosynovitis affects the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons in the first dorsal compartment of the wrist. Corticosteroid injection is the mainstay of treatment for those patients who do not respond to conservative management. Platelet-rich plasma (PRP) is a currently used strategy in the clinical practice to provide a regenerative stimulus for tendon healing. Objective: To evaluate the effects of Platelet-rich plasma in the treatment of DQVD in comparison with corticosteroid (CS) injection. Materials and Methods: The present randomized clinical trial had been conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka. A total of 100 patients with pain and swelling over the radial aspect of the wrist with positive Finkelstein test were randomly allocated into three groups: group A (received platelet-rich plasma injection), group B (received corticosteroid injection) and group C (received conservative management). The severity of pain and functional status of the wrist joint were recorded according to VAS and Mayo’s wrist score both pre-procedurally on day 0 and post-procedurally at the end of 1st, 3rd and 6th month. Results: The mean age of the participants in group A, B and C were 45.6 (±10.4), 46.9 (±11.3) and 42.4 (±6.3) years respectively. In all groups, majority of the study participants were female and housewives. No significant statistical difference was observed among the groups regarding VAS scores and Mayo’s Wrist Scores at baseline. At the end of 6 months, the reduction of pain in group A was significantly lower than group B (p&lt;0.001). Again, at the end of 6 months, the improvement of Mayo’s Wrist Scores in group A group was significantly higher than group B (p&lt;0.001). In group A, 77.8% reduction of pain score was achieved while in group B, 68.4%reduction of pain score was achieved after 6 month of treatment (p&lt;0.001). Conclusions: Platelet-rich plasma provides better functional outcome than corticosteroid in the treatment of de Quervain tenosynovitis. Bangladesh Medical Res Counc Bull 2023; 49(1): 32-38

Treatment of Frontal Fibrosing Alopecia

Introduction. Frontal fibrosing alopecia (FFA) is known as a lymphocytic primary cicatricial alopecia. The main characteristic of FFA is progressive frontotemporal hairline recession. The pathogenesis of FFA is not completely understood. Destructing the stem cells of the epithelial hair follicles causes permanent hair loss and seems to be the main cause of FFA. Studies have reported significantly decreased quality of life in patients with hair loss. On the other hand, late diagnosis and treatment of FFA can decrease the success rate of the treatment. In this regard, different topical and systemic therapies have been developed to resolve the symptoms; however, only a partial response to treatment is usually achieved. We conducted a systematic review of the literature to identify the effectiveness of the available treatment modalities used for FFA patients and the related outcomes. Methods. On April 2022, we made a wide systematic computer-assisted search of PubMed and Google Scholar databases, using “frontal fibrosing alopecia” and “treatment” keywords. We scanned 1,514 articles. All the studies concerning a therapeutic regimen for FFA were included. After removing duplicate studies, 50 studies containing the therapeutic regimen of 1,478 FFA patients were included in this review. Results. The 5-alpha-reductase inhibitors (oral finasteride/dutasteride) were the most used medications (usually prescribed as a combination therapy with other medications). Topical corticosteroids were the second commonly used medication for the treatment of FFA. Systemic corticosteroids seem to be ineffective in improving FFA progression. Oral isotretinoin (or alitretinoin) had the most promising effect on improving facial papules of FFA patients with a 92% rate of facial papule improvement. Conclusion. In our review, intralesional corticosteroid injection and 5-alpha-reductase inhibitors (finasteride/dutasteride) were reported as the most effective treatment modalities. Oral isotretinoin (or alitretinoin) is considered as the most promising treatment for improving facial papules in the context of FFA. However, it had minimal effects on hair regrowth or stabilization of hairline recession in FFA patients.