Intralesional Injection Therapy Research Articles

Myofibroblasts reside in the middle dermis of the keloids but do not predict the response to injection therapies: a double-blinded, randomized, controlled trial.

Keloids form as a pathological response to skin wound healing, and their etiopathology is poorly understood. Myofibroblasts, which are cells transformed from normal fibroblasts, are believed to contribute to pathological scar formation in wounds. We carried out a double-blinded randomized controlled trial (RCT) comparing the efficacy of intralesional 5-fluorouracil (5-FU) and triamcinolone (TAC) injections in treating keloids. A total of 43 patients with 50 keloids were treated with either intralesional TAC or 5-FU injections, and their clinical response was evaluated. Biopsies were collected before, during, and after injection therapy from the active border of a keloid. To understand the role of myofibroblasts in keloids, we conducted an immunohistochemical analysis to identify myofibroblasts [α-smooth muscle actin (αSMA)] from the biopsies. We first defined the three histologically distinct regions-superficial, middle, and deep dermis-in each keloid. We then demonstrated that myofibroblasts almost exclusively exist in the middle dermis of the keloids as 80% of the cells in the middle dermis were αSMA positive. However, both the percentage of myofibroblasts as well as the area covered by them was substantially lower in the superficial and deep dermis than in the middle dermis of the keloids. Myofibroblasts do not predict the clinical response to intralesional injection therapies. There is no difference in the myofibroblast numbers in keloids or in the induced change in myofibroblasts between the responders and non-responders after treatment. This study demonstrates that myofibroblasts reside almost exclusively in the middle dermis layer of the keloids, but their numbers do not predict the clinical response to intralesional injection therapies in the RCT.

Clinical Features and the Outcome Evaluations of Keloid and Hypertrophic Scar Treatment with Triamcinolone Injection in Mekong Delta, Vietnam - A Cross-Sectional Study.

Excessive scarring is a common problem that can have significant cosmetic and psychological consequences for patients. Intralesional injection therapy, such as the use of triamcinolone, has emerged as an effective treatment option for hypertrophic scars. The objective of this study was to describe the morphological features of hypertrophic scars, categorize them, and evaluate the efficacy of triamcinolone injection therapy in treating these scars. A cross-sectional descriptive study of 80 patients with hypertrophic scars treated with triamcinolone intralesional injection at Can Tho University of Medicine and Pharmacy Hospital from 5/2018 to 5/2021. There were 80 patients in all, with a male/female ratio of 1/1.05 and a median age of 15-35. There were 129 scars in all, with scar age >1 year accounting for 83%, keloid scars accounting for 64%, and hypertrophic scars accounting for the remaining 36%. Scars are most commonly seen on the trunk, accounting for 53.5% of all scars, particularly on the anterior chest wall. When the source of scars was discovered, trauma and acne accounted for 24% and 23%, respectively, while the rest were predominantly spontaneous scars, accounting for 49%. Scarring and discomfort of mild to moderate severity were common clinical symptoms; scars larger than 5cm in size had more symptoms than scars smaller than 5cm. Prior to the therapy, the mean Vancouver Score Scale-VSS was 6.55±2.13. After 24 weeks of the therapy, 96.7% of patients had entirely improved itching symptoms, 75% had completely improved pain, and 25% still had minimal pain. After therapy, the mean Vancouver Score Scale-VSS was 2.55±1.81 (p<0.05). At week 24, 3.75% of patients experienced skin shrinkage, 3.75% experienced depigmentation, and 13.75% experienced vasodilation. Triamcinolone intralesional injection should be utilized as a first-line therapy for hypertrophic scarring.

Evaluation of the efficacy of intralesional triamcinolone injection therapy in patients with granulomatous mastitis: a comparative study with oral methylprednisolone

Aims: This study aims to compare the efficacy of oral steroid therapy with the combination of topical and intralesional steroid (TILS) therapy in patients with granulomatous mastitis (GM).&#x0D; Methods: This is a single-center retrospective longitudinal study. Women with a diagnosis of GM who applied to Medipol Universty Pendik Hospital General Surgery Clinic between January 2020 and April 2022 were included in the study. Participants received TILS or peroral steroid (POS) treatment in sequential order, and each patient received only one of the treatment options. Participants were evaluated by physical examination, USG, and radiography before and after treatment to assess lesion size, side, number of foci, skin characteristics, and the presence of pain. The clinical and radiological findings were compared betwen the groups at the end of the 6-month follow-up and the participants were followed up for the next 12 months to demonstrate the efficacy. &#x0D; Results: A total of 52 women participated in the study, with 26 in the POS group and 26 in the TILS group. The mean age was 33.33+6.94 years and similar between the two groups (p=0.831). Three patients (11.53%) in the TILS group and 7 patients (26.92%) in the POS group were nonresponders to treatment (p=0.159). Given the nonresponders, GM lesions persisted in one patient (3.84%) in the TILS group and 3 patients (11.53%) in the POS group at the end of the study (p=0.610). At the end of the 12-month follow-up, five patients (19.2%) in the TILS group and 20 patients (76.9%) in the POS group who achieved a complete remission at the posttreatment 6 months experienced disease recurrence (p

Early outcome of surgery, triamcinolone and silicone gel combination therapy for earlobe keloid: our local experience

Background: Earlobe keloids cause facial disfigurement, physical, emotional and psychological burden to patients, while posing an intriguing treatment challenge to the plastic surgeon. Different options of combination therapy have been used in the treatment of earlobe keloids with varied success rates. Methods: This interventional prospective hospital-based study was carried out in Irrua Specialist Teaching Hospital, Irrua, Edo State, over a 15-month period (October 2017 to December 2018). Forty-two patients with earlobe keloids who met the inclusion criteria were serially recruited into the study. Forty-eight earlobe keloids in 41 patients had the intralesional excision biopsy, intralesional triamcinolone injection and silicone gel combination therapy. A modified Sharquie et al’s scar grading system was applied pre-intervention to record the baseline scores and post-intervention to evaluate the patients’ rate of response. Post treatment complications were identified, and the patients were followed up for six months. Results: Most of the patients with earlobe keloids fell in the age group 21-30 years and the male-female ratio was 1:19.5. Multiple earlobe piercing had significant association with the development of earlobe keloids. 95.8% of treated lesions had complete response to therapy. Two (4.2%) patients had dyschromia following treatment. Conclusions: The triple therapy combination of intralesional excision biopsy, postoperative intralesional triamcinolone injection and topical silicone gel application is a readily available, safe and efficacious treatment modality for earlobe keloids. Thus, it can be used as a first-line treatment modality.

(375) Can Tamoxifen and a PDE5 inhibitor slow the progression of Peyronie’s Disease?

Abstract Introduction The available treatments for Peyronie’s Disease as recommended by international guidelines are either surgery or intralesional injection therapy. In recently cell and rat studies it has been shown that using a phosophdiesterase type 5 inhibitor (PDE5i) and a selective oestrogen receptor modulator (Tamoxifen) inhibited myofibroblast transformation and extracellular matrix production. Objective The aim of this study is to compare the combination of tamoxifen and a PDE5i versus no treatment or other oral medications in the progression of early Peyronie’s Disease. Methods This is a retrospective study of all patients with early Peyronie’s Disease, defined as less than 6 months duration or persistent pain presenting over a 3-year period. Patients were given Tamoxifen 20mg twice daily + Tadalafil 5mg daily for 2 months. The control group either received no treatment or simple oral medication such as Vitamin E. Data retrieved included demographics, duration of disease, change in curvature and pain, as well as further treatment modalities. Assessment of curvature was with photos or an artificial erection test. Data was analysed using the Mann-Whitney Test. Results A total of 147 patients were recruited with early Peyronie’s Disease, 102 patients given the active drug combination (median age 49, range 24-71) and 45 controls (median age 55, range 27-76). The results in each group are presented in Table 1. Overall, the patients on Tamoxifen and Tadalafil showed more improvement and less deterioration which was statistically significant (p=0.009) Conclusions The combination of Tamoxifen and Tadalafil has been shown to prevent the progression of Peyronie’s Disease in vitro and in this study in patients with early disease. Future prospective studies are warranted to confirm this finding. Disclosure No

Adjuvant therapies of acne: review of literatures

Acne is a chronic inflammatory disorder affecting pilosebaceous unit with various clinical manifestation from comedone, papule, pustule, to nodule and cyst. Choice of treatment is based on acne severity. Prolong antibiotic use along with restriction of isotretinoin use in Indonesia can be a challenge in managing acne. A lot of treatment options from topical agent, systemic medication, comedone extraction, intralesional corticosteroid injection, chemical peeling, light and laser-based therapy, as well as diet modification can be used as an adjuvant to improve acne. Review of literatures was performed to present recent evidence toward the effectivity of adjuvant therapy as a part of acne management.

EFEKTIVITAS INJEKSI INTRALESI BEBERAPA JENIS OBAT PADA TERAPI ORAL LICHEN PLANUS : TINJAUAN SISTEMATIK

Introduction: Oral lichen planus (OLP) is a chronic inflammatory disease with unknown etiology. The immune system plays a role in this disease, a sub-epithelial band infiltration is dominated by T lymphocytes and macrophages is visible histopathologically. Stress, genetics, diet, drugs, dental plaque, systemic disease, and poor oral hygiene are thought to trigger OLP. Treatment of this disease usually uses topical corticosteroids in the form of an ointment, mouthwash, spray or paste or systemic corticosteroids, but in some patient there are unwanted side effects of systemic and topical corticosteroids such as moon face and hirsutism. Intralesional corticosteroid injections are topical therapy and can be used to reduce these side effects. The purpose of this systematic review is to provide information on the effectiveness and types of drugs used in the treatment of OLP by intralesional injection. Methods: A literature search was conducted using electronic databases including PubMed and Google Scholar. Only articles in English and Indonesian are included, with keywords intralesional injection, oral lichen planus, and therapy. Cohort study, randomized controlled trial, and research between 2010 and 2020. Results: A total of 1,179 articles were obtained according to the keywords, but after eliminating duplication and screening based on abstracts, 8 articles were obtained, with 4 types of drugs being used for intralesional injection therapy in OLP, namely Triamcinolone acetonide, Bacillus Calmette Guerin-Polysaccharide Nucleic Acid (BCG-PSN), bethametasone and bevacizumab. Conclusion: Intralesional injection with Triamcinolone acetonide, betamethasone, BCG-PSN, and bevacizumab drugs is effective in treating oral lichen planus.

An outbreak of devastating facial stigmata caused by a single unlicensed aesthetic practitioner

Background The practice of medicine by uncertified personnel is a common concern in public healthcare. Although the introduction of the Korean National Health Insurance Service has significantly reduced the number of these cases, the problem persists in the field of aesthetics. Herein, we report an outbreak of devastating facial stigmata in patients treated with illegal cosmetic procedures.Methods During 1 week in November 2021, five patients presented to Bucheon St. Mary’s Hospital for the management of identical patterns of severe facial scarring. Each patient had been treated for “skin rejuvenation” by a single unlicensed practitioner. Months of needling therapy by the practitioner, aimed at resolving the problem, only aggravated the scarring. The victims visited our hospital after the practitioner ceased to answer their calls. The patients had similar presentations with multiple prominent scars on both cheeks. Ectropion of the right lower eyelid due to scar contracture was observed in one patient.Results Five monthly treatments with intralesional triamcinolone injection and laser therapy were performed. Despite thorough management, the patients were left with improved but distinctive stigmata on their faces.Conclusions Cases of illegal aesthetic procedures are difficult to prosecute because the patients have implicitly agreed to the procedure. Therefore, active legislative measures should be adopted to prevent further victimization. Public education on the dangers of illegal aesthetic practices is also necessary.

Intralesional collagenase Clostridium histolyticum for acute phase Peyronie's disease: a single-center, retrospective cohort study.

BackgroundPeyronie’s disease (PD) can be subdivided into acute and chronic phases. Intralesional collagenase Clostridium histolyticum has been shown to improve curvature in the chronic phase. Initial clinical trials excluded patients in the acute phase from treatment. Recent studies show comparable results among men in the acute phase. The definition of acute phase varies among existing studies, but it is generally understood to last 12–18 months and is accompanied by penile pain and progression of deformity. We sought to evaluate the safety and efficacy of intralesional collagenase injection therapy during the acute phase of PD using multiple definitions of the acute phase.MethodsAll men receiving intralesional collagenase for PD from October 2015 through December 2020 at a single academic institution were retrospectively assessed for patient demographics and comorbidities, pre- and post-treatment curvature, and adverse events. Two definitions of acute phase were used: (I) acute phase duration ≤6 months, chronic phase duration >6 months; and (II) acute phase duration ≤12 months with penile pain, chronic phase duration >12 or no penile pain.ResultsOf 330 patients identified, 229 underwent intralesional collagenase treatment with pre- and post-treatment erect penile goniometry. 65 (28%) met criteria for definition 1 of acute phase, 37 (16%) met criteria for definition 2, and 76 (33%) met criteria for either. Percent change in penile curvature was not significantly different between acute and chronic phases using definition 1 (16.0% vs. 16.6%, P=0.89), definition 2 (19.9% vs. 15.7%, P=0.43), or either (16.5% vs. 16.3%, P=0.96). The rates of development of bruising, swelling, hematoma, or corporal rupture were not significantly different between the acute and chronic phases under either definition (all P>0.05).ConclusionsThis single-center, retrospective cohort analysis suggests that intralesional collagenase is both safe and effective for the treatment of men with acute phase PD. Limitations exist inherent to retrospective review, since many men did not return for post-treatment goniometry, possibly skewing our cohort toward incomplete responders. Prospective, randomized studies will be required to confirm these findings.

To study the effectiveness of intralesional verapamil in resolution of plaque of peyronie’s disease

The prospective study was conducted to study the role of intralesional verapamil in resolution of plaque of peyronies disease. Verapamil's effectiveness is predicated on its ability to affect fibroblast function on multiple levels, including cell proliferation, extracellular matrix protein synthesis and secretion, and collagen breakdown. Calcium antagonists may thus have the potential to reduce, halt, or even reverse plaque formation and Peyronie's disease progression. According to the intralesional verapamil injection therapy, the majority of men with Peyronie's disease who receive treatment experience long-term pain relief, curvature reduction, and enhanced sexual performance. Intralesional verapamil injection therapy resulted in reduction of pain in 92% cases, reduction of plaque size in 80% cases, reduction of penile curvature in 75% cases and improvement in erectile dysfunction in 60% cases.

Peyronie's Disease - Outcomes of collagenase clostridium histolyticum injection: A systematic review

ABSTRACT Introduction Peyronie's Disease (PD) is a condition characterized by abnormal and excessive wound repair causing fibrous plaquing of the tunica albuginea. Intralesional (IL) therapies are for patients who prefer to avoid surgical intervention and associated adverse complications. Currently, among available IL injection therapies (Collagenase Clostridium histolyticum (CCh) (Xiaflex, Endo Pharmaceuticals, Dublin, Ireland), verapamil, IFN-a-2b, OnabotulinumtoxinA (Botox) (AbbVie, Chicago, Illinois), Hyaluronic acid). The only FDA approved intralesional treatment option is CCh, which recently expanded its indications for atypical PD. Objective This study aims to review recent literature pertaining to CCh and other intralesional therapies in treatment of PD. Methods A systematic search of literature using exclusively PubMed was performed. There were no specific inclusion or exclusion criteria, however a preference was placed on recent and high impact articles. The review represents many types of studies including randomized control trials, meta-analyses, as well as phase 2 and 3 clinical trials. The use of CCh was compared to other IL therapies and evaluated for efficacy. This included Lastly, CCh use in atypical Peyronie's Disease was assessed for rate of success and complication. Results Recent literature supports the notion that CCh is the most superior IL treatment for typical and atypical PD patients. The capstone CCh study was the IMPRESS trial that showed a 34% reduction in curvature with a mean -17.0 ± 14.8 angle reduction with IL CCh, while men in the placebo saw an average 18.2% decrease in penile bend with a mean -9.3 ± 13.6 degree of change per person (p&amp;lt;0.0001). A shortened protocol for IL CCh treatment offered a 31.4% reduction in curvature while decreasing cost and office visits, potentially increasing patient compliance. Lastly, the literature shows CCh is used most commonly in atypical cases with about 64.8% of patients being treated with CCh – this is probably because of the high efficacy and superb safety profile that it offers. The most serious complications associated with CCh including urethral injury, corporal rupture and penile fracture are rare in all types of PD. Conclusion Since the approval of CCh by the FDA in 2013, it has been a staple in the treatment of PD, and here we report the continued success and superiority of this therapy. CCh is an effective, minimally invasive therapeutic option in most PD populations, however recent changes have made CCh unavailable for commercial use out of the United States, thus impacting many patients who have previous benefited from it. Disclosure Work supported by industry: no.

The Effect of Collagenase Clostridium Histolyticum Injection on the Treatment Patterns of Peyronie's Disease: An Analysis of Large Health Care System Over 15-year Period

ABSTRACT Introduction Penile plication or excision with grafting has traditionally been the only effective treatment for stable Peyronie's disease (PD) without concurrent erectile dysfunction. Intralesional collagenase clostridium histolyticum (CCH) was approved by the U.S. Food and Drug Administration(FDA) in 2013 for patients with stable disease with curvature between 30 and 90°. The effect of CCH injection therapy on the diagnosis and treatment patterns of PD is unknown. Objective We studied the effect of FDA approval of CCH on the management of PD in a population-based analysis. We analyzed the effect of the advent of CCH on rates of prescribing of oral treatments, including vitamin E, colchicine, and pentoxifylline along with surgical intervention. We also studied the effect of injection therapy on the rate of new diagnosis of PD in a population-based analysis. Methods The Kaiser Permanente Southern California database, which provides comprehensive data on all Kaiser Permanente patients in 15 medical centers in the Southern California region was reviewed. Patients undergoing a penile prosthetic surgery for concurrent erectile dysfunction were excluded. PD patients were identified using ICD-9 code and ICD-10 code. Injection therapy was determined using CPT codes, as well as the use of CCH based on the pharmacy database. Surgical therapy (either penile plication or excision with grafting) was identified using CPT codes. The use of oral medication treatment (e.g., vitamin E, colchicine, and pentoxifylline) was ascertained using both the outpatient and inpatient pharmacy database. Main Outcome Measure This study first presented the annual incident rates of PD from 2004 to 2020 among Kaiser members ages 18 or older, and, among eligible PD patients, the annual rates of receiving CCH injection therapy, surgical therapy, and oral medication treatment. Descriptive statistics and multivariable logistic regression modeling were used to assess factors influencing the choice of intralesional injection vs surgical therapy. Results From 2004 to 2020, 11,706 patients presented for PD management (average incident rate, 52.8 per 100,000 eligible members). Median age was 58 years and 54.5% were Caucasian. Over the study period, the incident rate (per 1,000 eligible patients) of surgical management declined on average by 0.37 each year (p &amp;lt; 0.001) while there was an increase of 0.43 for injection therapy (p &amp;lt; 0.001). Following the FDA's approval of CCH in 2013, the average incident rate (per 1,000 eligible patients) for surgical therapy in 2014-2020 declined by 2.8 (p &amp;lt; 0.001) compared to that in 2004-2013, whereas it significantly increased by 5.1 (p &amp;lt; 0.001) for injection therapy. Average rates of prescribing of oral colchicine and vitamin E significantly decreased from 2016-2020 compared to 2004-2015 (p&amp;lt;0.001), while average rates of prescribing pentoxifylline significantly increased (p&amp;lt;0.001). Patients presenting in the post-CCH era were approximately two times significantly more likely to receive injection therapy (OR: 2.08; P &amp;lt; 0.001 CI: 1.47 to 2.94). On multivariable modeling, patients more likely to receive injection therapy as primary treatment for PD were ages 45-54 (OR: 2.77; P = 0.002; CI: 1.34 to 5.73). Conclusions Since the Introduction: of CCH, there has been a significant change in the management pattern for PD (decrease in surgical therapy, and increase in intralesional injections). Since the recent publication of AUA Guidelines on PD in 2015, there has been a significant decrease in non-evidence supported oral medication prescriptions. Disclosure No

Several problems worthy of attention in non-surgical treatment of scar

Pathologically, scars are divided into physiological scars and pathological scars, and the latter mainly include hyperplastic scars and keloids. Scar treatment includes surgical treatment and non-surgical treatment, with the pathological scars as the major targets in treatment. Until now, there is no treatment with ideal therapeutic effect. Therefore, new therapeutic methods for pathological scars are still being explored at home and abroad. In recent years, some non-surgical therapeutic methods for scars that have received widespread attention have emerged. In this article, several problems worthy of attention including intralesional injection therapy, photoelectric therapy, and rehabilitation robots were discussed.

Single-cell Transcriptomics Uncover a Novel Role of Myeloid Cells and T-lymphocytes in the Fibrotic Microenvironment in Peyronie’s Disease

BackgroundPeyronie’s disease (PD) is an acquired fibrotic disease affecting the penile tunica albuginea that can lead to curvature and deformities, shortening, and erectile dysfunction. Although immunological mechanisms have been suggested for the pathophysiology of PD, these have not been investigated using single-cell transcriptomics. ObjectiveTo investigate the immunological signature of plaques from PD patients using immunohistochemistry (IHC) and single-cell RNA sequencing (scRNA-Seq). Design, setting, and participantsTunica albuginea biopsy was performed in patients undergoing penile surgery for either PD (n = 12) or plication or penile cancer (control, n = 6). The inclusion criteria for PD patients were stable chronic disease (≥12 mo in duration) and no previous penile surgery or intralesional injection therapy. Outcome measurements and statistical analysisIHC was performed on surgical samples from ten patients with PD and five control subjects. An additional two PD and one control sample were used for scRNA-Seq (droplet-based; 10X Genomics). Cell clusters were visualised using heatmaps and t-distributed stochastic neighbour embedding plots (BioTuring v2.7.5). Results and limitationsIHC revealed the presence of myeloid dendritic cells (DCs; CD68+, TLR4+, CD206+), cytotoxic T lymphocytes (CTLs; CD3+, CD8+), and B lymphocytes (CD20+) in PD plaques, which were absent in controls. scRNA-Seq yielded results for 3312 PD and 5658 control cells. Cell clusters contained fibroblasts (COL1A2+), myofibroblasts (COL1A2+, ACTA2+), smooth muscle cells (ACTA2+, DES+), endothelial cells (VWF+), myeloid cells (CD14+), T lymphocytes (CD3D+), and neutrophils (ALPL+). Myeloid cell subclustering showed infiltration of monocyte-derived cells; control tissue contained classical DCs and resident macrophages. Lymphocyte subclustering revealed mucosal-associated invariant T (MAIT) cells and CTLs in PD. Differential gene expression suggests an increase in inflammatory and immune responses in chronic PD. The study is limited by the small scRNA-seq sample size (n = 3) for IHC, mitigated by a larger cohort of historic paraffin-embedded samples (n = 15), which showed largely parallel findings. Owing to tissue stiffness and extracellular matrix adhesion, our single-cell yield was lower for PD than for the control sample. ConclusionsOur data suggest that even in the chronic PD stage (painless and stable curvature) there is a sustained inflammatory reaction. While vascularisation and collagen production are elevated, the inflammation is driven by specialised monocyte-derived CTL and MAIT cells. These findings could uncover new avenues for medical treatment of PD. Patient summaryWe looked at the role of the immune system in patients suffering from Peyronie’s disease, a condition causing shortening and curvature of the penis. We found that even in a stable, chronic stage of the disease, there is activation of the immune system. Our results suggest that there is potential for novel treatments for this condition.

A comparative study between intralesional platelet rich plasma injection and extracorporeal shockwave therapy for the treatment of plantar fasciitis

PurposePlantar Fasciitis is a widely prevalent condition and is extremely disabling if it remains unresolved. Despite many available treatment modalities, the management of recalcitrant cases is still a dilemma. We conducted this study to evaluate and compare the role of two novel modalities: Intralesional PRP (Platelet Rich Plasma) injection and Extra Corporeal Shockwave Therapy (ESWT) for the management of this condition. Methods60 patients with a clinical diagnosis of recalcitrant plantar fasciitis were randomized into 2 groups; PRP Group (n = 30) and ESWT Group (n = 30). In PRP group patients received 3 intralesional injections of PRP and in ESWT group 3 sessions of Extra Corporeal Shockwave Therapy were administered. The Primary outcome measures were Visual Analogue Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, Roles and Maudsley Index and Heel Tenderness Index (HTI). The secondary outcome measures were complications. The patients were followed up for a period of 6 months and evaluated for various scores. ResultsAt 6 months follow-up, significant results were found only on VAS score for both groups (p-value <0.05). However, both modalities resulted in significant clinical improvement with no complications reported. No statistically significant differences were reported between the two test groups. ConclusionsBoth autologous PRP and ESWT can become extremely useful modalities for management of recalcitrant cases of plantar fasciitis with no known adverse effects.

Comparison of Botulinum Toxin A, Corticosteroid, and Anesthetic Injection for Plantar Fasciitis.

Plantar fasciitis is the most common cause of heel pain, and injection therapies are part of the treatment modalities. This study aimed to compare 2 intralesional injection therapies for plantar fasciitis: corticosteroid and botulinum toxin A, compared with a third control group using a local anesthetic. The clinical evolution, as well as changes in the thickness of the plantar fascia and ankle dorsiflexion, was evaluated. A randomized, controlled, double-blind trial design was used. Patients were divided into 3 groups: group 1, anesthetic only; group 2, corticosteroid; and group 3, botulinum toxin A (BoNT-A). We used an ultrasonographic evaluation to measure the plantar fascia thickness. The results were evaluated using the Maryland Foot Score and a 10-cm visual analog scale. Clinical scores were recorded at the beginning of the study, at 2 weeks, and at 1, 3, and 6 months. We evaluated 78 patients for study eligibility. The 3 intervention groups were homogeneous. All patients showed better clinical outcomes compared with their initial evaluations, without differences between groups at the end of follow-up. The thickness of plantar fascia diminished at the final evaluation, and ankle dorsiflexion was better compared with the initial values without difference between treatment groups. Considering all the evaluated outcomes, no significant differences between treatment groups were observed. The pain relief and functional improvement obtained with the different treatments was maintained during the 6-month follow-up. Level I, therapeutic study.

Intralesional vitamin D3 versus new topical photodynamic therapy in recalcitrant palmoplanter warts Randomized comparative controlled study.

Recalcitrant palmoplanter warts represent a therapeutic challenge. Side effects of local destructive methods necessitates the need for other less morbid modalities. Recently immunotherapy as well as light based devices and lasers have emerged as therapeutic approaches. To compare between the safety and efficacy of intralesional vitamin D3 injection and photodynamic therapy (PDT) using eosin in treatment of recalcitrant palmoplanter warts. Prospective, randomized, controlled comparative study. Fifty -six patients with recalcitrant palmoplanter warts were randomly divided into 3 groups. Group A was injected with intralesional vitamin D3. Group B was subjected to PDT using eosin loaded in trasferosomes as a photosensitizer. Group C is the control group. Clinical improvement was assessed by photographic records and dermoscopic assessment, at baseline, before each session and after completion of treatment. Patients were followed up for 6 months after cure to detect recurrence. Group A and B showed complete clearance in 88.89 % and 86.36 % respectively compared to 18.75 % in the control group. These results were statistically significant (P value<0.001). No side effects were reported except for pain during injection in group A. In the current study, both vitamin D3 and PDT using Eosin are safe, highly effective and well tolerated modalities in treatment of viral warts.

Comparative study of intralesional injection of triamcinolone versus placental extract in cases of oral submucous fibrosis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Oral submucous fibrosis (OSMF) is a common premalignant condition caused by chewing arecanut, betel quid and gutkha with tobacco. One of the important therapeutic modalities is intralesional injection therapy. The most commonly used intralesional agents are placental extract, corticosteroids and hyaluronidase.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Patients of OSMF (30) were randomly allocated and 15 patients were given 1 ml placental extract submucosally in each retromolar trigon weekly for 8 weeks and 15 patients were injected with 40 mg/ml of triamcinolone submucosally on each side weekly for 8 weeks. The mouth opening was measured as the inter-incisor distance by Vernier calliper at maximal active mouth opening by patient at initial visit and every follow up visit and recorded. Treatment outcome was evaluated on the basis of improvement in trismus, oral mucosal pattern and reduction in burning sensation. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 30 patients, 27 were males and 3 females. 16 patients (53.33%) were in the age group of 21-30 years. Most of patients in our study had complain of reduced mouth opening and inability to take spicy food which is 93.33% of cases followed by burning sensation in mouth 90%, oral ulceration 83.33%, dryness of mouth 30%, difficulty/pain in swallowing 13.33% and halitosis 2%. 60% of patients mouth opening was improved &amp;gt;10 mm with triamcinolone while in placental extract 26.6%. Symptomatic relief were obtained more with injection placental extract.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Triamcinolone injection has more improvement in mouth opening compared to placental extract. It was observed that injection placental extract gives good symptomatic relief in the major symptoms like burning sensation in mouth, inability to take spicy food, oral ulceration compared to injection triamcinolone.&lt;/p&gt;

Intralesional Injection Therapy and Atypical Peyronie's Disease: A Systematic Review.

Peyronie's disease (PD) is an inflammatory disorder of the tunica albuginea causing fibrotic changes including abnormal penile curvature, pain, and erectile dysfunction. Approximately 10% of PD patients will have atypical features including ventral plaques, hourglass deformities, unilateral indentations, severely shortened penile length, and multiplanar curvatures. Currently, the only intralesional treatment approved by the United States Food and Drug Administration is considered off-label for atypical PD. Furthermore, treatment of atypical PD, especially ventral plaques, is met with hesitation, in part due to potential urethral injury. To systematically review the available literature for the safety and efficacy of intralesional injections for atypical PD. A thorough literature search of the PubMed database was performed on manuscripts published between 1982 and 2020. Keywords included atypical Peyronie's disease, ventral plaque, hourglass deformity, and injection. 15 articles met the criteria for evaluation. Overall, 1,357 patients with PD were treated with intralesional therapy, of which 250 patients were considered to have an atypical presentation. 162 (648%) of the patients were treated with intralesional collagenase Clostridium histolyticum, 49 (19.6%) with verapamil, 29 (11.6%) with interferon alfa-2b, 5 (2.0%) with hyaluronic acid, and another 5 (2.0%) with onabotulinumtoxinA. There was only 1 reported severe adverse event (penile fracture), which was surgically repaired. There were no reports of urethral injury. Intralesional injection treatment may be a safe alternative option for atypical PD. There is a greatneed for future research to closely monitor the role of intralesional therapy in this cohort. Choi EJ, Xu P, El-Khatib FM, etal. Intralesional Injection Therapy and Atypical Peyronie's Disease: A Systematic Review. Sex Med Rev 2021;9:434-444.

Intralesional Steroid Injection Therapy for Esophageal Anastomotic Stricture Following Esophageal Atresia Repair.

The role of intralesional steroid injection (ISI) in the treatment of anastomotic stricture in patients with esophageal atresia remains unclear. The aim of this study was to evaluate the efficacy and safety of ISI. A total of 158 patients with esophageal atresia with at least 1 ISI for the treatment of esophageal anastomotic stricture between 2010 and 2017 were identified. The change in stricture diameter (ΔD) was compared between procedures with dilation alone (ISI-) and dilation with steroid injection (ISI+). A total of 1055 balloon dilations were performed (452 ISI+). The median ΔD was significantly greater in the ISI+ group: 1 mm (interquartile range [IQR] 0, 3) versus 0 mm (IQR -1, 1.5) (P < 0.0001). The ISI+ group had greater percentage of improved diameter (P < 0.0001) and lesser percentages of unchanged and decreased diameters at subsequent endoscopy (P = 0.0009, P = 0.003). Multivariable logistic regression confirmed the significance of ISI on increasing the likelihood of improved stricture diameter with an adjusted odds ratio of 3.24 (95% confidence interval: 2.15-4.88) (P < 0.001). The ΔD for the first 3 ISI+ procedures was greater than the ΔD for subsequent ISI+ procedures: 1 mm (IQR 0, 3) versus 0.5 mm (IQR-1.25, 2) (P = 0.001). There was no difference in perforation incidence between ISI+ and ISI- groups (P = 0.82). ISI with dilation was well tolerated and improved anastomotic stricture diameter more than dilation alone. The benefit of ISI over dilation alone was limited to the first 3 ISI procedures.