Intralesional Injection Research Articles

Radiofrequency Combined with Intratumoral Immunotherapy: Preclinical Results and Safety in Metastatic Colorectal Carcinoma.

Radiofrequency ablation (RFA) of cancer induces an anti-tumor immunity, which is insufficient to prevent recurrences. In mice, RFA-intratumoral immunotherapy by granulocyte-macrophage colony-stimulating factor (GM-CSF) and Bacillus Calmette-Guerin resulted in complete metastases regression. Infectious risk in human needs replacement of live vaccines. Intratumoral purified protein derivatives (PPD) have never been tested in digestive cancers, and the safety of intratumoral immunotherapy after RFA has not yet been validated in human models. We investigated the therapeutic efficacy of combined radiofrequency ablation (RFA) and intratumoral immunotherapy (ITI) using an immune-muco-adherent thermogel (IMT) in a mouse model of metastatic colorectal cancer (CRC) and the safety of this approach in a pig model. Intratumoral stability of the immunogel was assessed using magnetic resonance imaging (MRI) and bioluminescent imaging. Seventy-four CT26 tumor-bearing female BALB/c mice were treated with RFA either alone or in combination with intratumoral IMT. Regression of distant metastasis and survival were monitored for 60 days. Six pigs that received liver radiofrequency and intralesional IMT injections were followed for 15 days. Experimental gel embolisms were treated using an intravascular approach. Pertinent rheology of IMT was confirmed in tumors, by the signal stability during 3 days in MRI and 7 days in bioluminescence imaging. In mice, the abscopal effect of RFA-intratumoral immunotherapy resulted in regression of distant lesions completed at day 16 vs. a volume of 350 ± 99.3 mm3 in the RFA group at day 25 and a 10-fold survival rate at 60 days. In pigs, injection of immunogel in the liver RFA area was safe after volume adjustment without clinical, hematological, and liver biology disorder. Flow cytometry showed an early increase in CD3 TCRγδ+T cells at D7 (p < 0.05) and a late decrease in CD29+-CD8 T cells at D15 (p < 0.05), reflecting the inflammation status changes. Systemic GM-CSF release was not detectable. Experimental caval and pulmonary thermogel embolisms were treated by percutaneous catheterism and cold serum infusion. RFA-intratumoral immunotherapy as efficient and safe mini-invasive interventional oncology is able to improve ablative treatment of colorectal liver metastases.

Therapeutic Effects of Intralesional Injection of Vitamin D3 in Treatment of Recalcitrant Warts: An Evaluator-Blinded Clinical Trial

Background: Viral warts are a prevalent infection that affects people all over the world. Unfortunately, there is no proven antiviral treatment for them. Recalcitrant warts are also difficult to resolve and deciding on a strategy for their treatment is challenging. Recently immunotherapy modalities have led to desired treatment outcomes in patients. This study investigated the efficacy of vitamin D injection (as an immunotherapeutic agent) in the treatment of recalcitrant warts. Methods: In this clinical trial study, 40 patients were divided into two groups: the first group (intervention group) received cryotherapy with an intralesional injection of vitamin D3 (0.1 cc of vitamin D3 (300000 IU/1mL) per lesion and a maximum of 0.5 cc per session), and the second group (control group) received just cryotherapy. In each treatment session, patients were evaluated for treatment responses and any side effects. Each patient received four treatment sessions at 2-week intervals. Results: After 4 treatment sessions, the rate of response in the intervention group and the group that received just cryotherapy was 95.33%±5.87 and 76.67%±25.14, respectively, and this difference was significant (P&lt;0.01). Furthermore, 57% (26 out of 45) of the lesions in the intervention group were completely resolved after 4 sessions, and the rest showed a moderate response to this treatment. Moreover, the minimum response rate was 80% in the intervention group and 30% in the control group. Conclusion: In recalcitrant skin warts, intralesional injection of vitamin D3 combined with cryotherapy significantly increased the treatment response and reduced the financial burden imposed on patients. The limitation of this trial was the small sample size of patients without a follow-up plan after completing the treatment sessions. Trial registration: The Iranian Registry of Clinical Trials registered this study (identifier: IRCT20200513047434N1).

Fractional CO2 laser Combined with TCA for the Treatment of Keloid Scars

Scarring is a complex phenomenon , Following an injury to the skin, whether voluntary or post-surgical, the healing process begins. This is a long physiological process designed to restore the integrity of the skin covering [1]. In certain circumstances, ad integrum restitution cannot be achieved, leading to pathological scarring. Risk factors can be local, depending on the topography of the lesion, or general, depending on age or genetic predisposition. We distinguish two types of pathological scars: hypertrophic and keloid [2]. Indeed, it has been confirmed that the latter are the cause of serious psychological problems, as they are not only aesthetically embarrassing, but also lead to an alteration in patients' quality of life and self-esteem [3]. The therapeutic arsenal is broad, and includes corticosteroids in intra-lesional and topical injections, pressotherapy, surgery, radiotherapy, cryotherapy, 5-fluorouracil (5-FU) and lasers [4]

Laser-Assisted Drug Delivery in the Treatment of Hypertrophic Scars and Keloids: A Systematic Review.

Hypertrophic scars and keloids are the results of an exaggerated healing process and are often associated with significant patient morbidity. Fractional ablative lasers create microchannels in the skin and penetrate into the substance of the scar, inducing a normal healing response in zones of created damage. Focal delivery of scar-modulating agents into the scar through these microchannels-a process termed laser-assisted drug delivery (LADD)-is a promising and developing treatment modality. In this systematic review, we aim to critically examine the evidence of LADD in the treatment of hypertrophic scars and keloids. The evidence suggests that LADD improves outcomes in hypertrophic scars and keloids. LADD is a more effective treatment modality than the topical application of agents in hypertrophic scars and equally effective as the intralesional injection of agents in keloids. There were few reports of adverse events. Evidence supports the use of LADD as an adjunct to non-surgical measures or a treatment modality to be used before more invasive measures such as surgical excision. However, the quality of evidence supporting this conclusion is inconsistent and lacks power. Additional studies are required to optimize dosages, laser settings, and agent choices for the treatment of these lesions.

In‐office serial intralesional steroid injection for subglottic stenosis: Case series of 14 patients with multiple etiologies

AbstractObjectiveSubglottic stenosis (SGS) is commonly treated with endoscopic dilations or tracheal resection. Since office‐based serial intralesional steroid injections (SILSI) were first reported in 2017, they have been established as an effective, less invasive treatment alternative or adjunct. The aim of this study is to add to the literature investigating the efficacy of office‐based SILSIs for idiopathic and post‐intubation SGS patients, specifically studying surgery‐free intervals (SFIs) and discussing our experience with SILSI treatment order and stenosis grade.MethodsThis study is a retrospective case series of 14 patients with subglottic stenosis treated with in‐office serial intralesional steroid injections as a primary or adjuvant treatment from 2018 to 2022 in an academic tertiary care center.ResultsOf seven patients with calculable SFI, a mean SFI increase of 481.28 days was observed following SILSI treatment (p = 0.042). Ten patients in our cohort presented with idiopathic or post‐intubation grade 2 SGS and were managed successfully with a combination of endoscopic dilation and SILSI. Two patients with post‐intubation grade 1 SGS were managed successfully with SILSI as their primary treatment. Two patients with post‐intubation grade 3 SGS required a tracheal resection and did not benefit from SILSI.ConclusionsWe have found that SFI significantly increased following SILSI initiation. Although statistical power was limited given the small sample size, our findings suggest that SILSI may be an effective primary treatment in low‐grade stenosis. SILSI as an adjuvant to endoscopic dilation may be most effective in intermediate‐grade stenosis. SILSI may not be effective in high‐grade stenosis patients who failed prior endoscopic treatment.

(133) Investigating Actinidin as a Potential Collagenase on Human Peyronie’s Disease Cells

Abstract Introduction Peyronie's Disease (PD) is characterized by a connective tissue disorder in the penile tunica albuginea and the formation of collagen-rich plaques, leading to penile curvature, painful erections, and erectile dysfunction. Intralesional Collagenase Clostridium histolyticum injections are no longer available in Canada, making treatment options for PD limited. Actinidin is a soluble enzyme that has the ability to hydrolyze various types of collagen and fibrinogen. We have previously reported the efficacy of actinidin on reducing collagen in in vitro human PD models. Objective To determine the dose-response efficacy and cytotoxicity of actinidin in reducing the intercellular bound collagen in human PD plaque models. Methods Fibroblast cells are isolated from human PD tissue (N ≥ 3) and 2D models are cultured. These cells were subjected to various treatment groups including media-only control and 5 concentrations of actinidin treatment ranging from 0.5 mg/ml to 30 mg/ml. The collagenase treatment was prepared from Hayward kiwi by isolating actinidin by filtration and pH adjustment. A dose-response curve was generated at different time points at various actinidin concentrations using an MTT assay. After 24 hours of treatment, collagen extraction was performed and quantified using a Soluble Collagen Quantification Assay Kit and a fluorescent microplate reader. The effects of the treatments on the extracellular matrix were further investigated by staining the cells with DAPI for the nucleus and Phalloidin-conjugated FITC for actin filaments. A twelve-hour timelapse was conducted using a fluorescent confocal microscope to capture FITC and DAPI fluorescein images. The total fluorescent area of each well was measured, and actin signals were normalized by the DAPI signals. Results The dose-response curve revealed that the lethal concentration affecting 50% of the cells after a 48-hour period is approximately 15-20 mg/ml. Treatment of 1 mg/mL actinidin significantly reduced cellular collagen of human PD fibroblasts compared to the control group (P &amp;lt; 0.001). The normalized stained β-actin signal was measured as the ratio between intracellular actin staining and nuclei count in each microscopic field. The high concentration actinidin treatment (30 mg/mL) exhibited a significantly higher normalized actin signal compared to other treatment groups (P &amp;lt; 0.0001). These findings suggest that actinidin may possess mechanisms that affect the plasma membrane integrity. Conclusions Our continuation of preliminary results demonstrates the ability of actinidin to break down PD cells by compromising extracellular collagen and the cellular membrane. High doses of actinidin cause cell destruction and we suggest that treatment should not exceed 10 mg/ml. Further studies will investigate the molecular mechanism of actinin in hydrolyzing collagen and to evaluate the effects on an animal model. Given the absence of durable FDA-approved treatments for PD in Canada, this novel option holds future treatment potential. Disclosure Yes, this is sponsored by industry/sponsor: KiwiEnzyme.com Ltd. Clarification: No industry support in study design or execution.

(119) Impact of Ethnicity on Clinical Outcomes of Intralesional CCH in Peyronie's Disease Patients Across Kaiser Permanente Southern California Database

Abstract Introduction Intralesional CCH injection is an effective treatment for Peyronie’s disease (PD) that utilizes collagenolytic enzymes to break down collagen plaque, thus reducing the penile deformity. The IMPRESS I and II clinical trials demonstrated efficacy of CCH in a predominant Caucasian population of men (95.8%). Little is known about treatment efficacy in the non-Caucasian population. Objective Using Kaiser Permanente’s ethnically diverse database, we sought to study the impact of race on CCH treatment outcomes. Methods This study examined the efficacy of intralesional CCH injection in a large healthcare system over 15 years. We defined treatment efficacy as percent change in penile curvature abnormality from baseline after a maximum of 4 treatment cycles. Impact of comorbidities on CCH efficacy was also examined. Patients with ventral curvature or initial curvature &amp;lt;30 ̊ or &amp;gt;90 ̊ were excluded from analysis. Standard statistical analysis was performed. Results 112 patients underwent CCH therapy and were included in this analysis. 46.4% of men completed all 4 cycles. Among men who received CCH, 66.1% were Caucasian, 22.3% Hispanic, and 9.8% African American. For co-morbidities, 87.5.% of men were not diabetic, while 22.3% of men had erectile dysfunction. The mean baseline pre-injection penile curvature was 51.63 degrees (range was 32-87 degrees). Caucasian men had the largest treatment response to CCH (45.6% decrease in penile curvature) compared to African American men (43.7%) and Hispanic men (40.5%), p = 0.9554. Non-diabetic men had a larger treatment response to CCH (44.9% decrease in curvature versus 39.3% in diabetics, p = 0.4726). Younger Men (age 18-44) also experienced a greater treatment response compared to other age groups (57.9% reduction in curvature, p = 0.171). There was a significant difference in number of cycles completed across different ethnicities (p = 0.0220). Hispanic men were significantly less likely to complete all 4 cycles of CCH compared to Caucasian and African American men (p=0.0004). Only 28.2% of Hispanic men completed all 4 treatment cycles. 48% of Hispanic patients report the need of language interpretation services during health appointments. Conclusions This is the largest post-market analysis of CCH treatment outcomes in a racially diverse PD population. Caucasian men had a greater treatment response after CCH injection possibly due to higher rate of completing all 4 treatment cycles. Nondiabetic men and younger men (aged 18 to 44) also had a greater treatment response after CCH injection. Hispanic men were significantly less likely to complete 4 cycles of injection therapy; possible explanations include language barriers. Future study is needed to determine if patient resources prepared in Spanish can improve treatment outcomes in Hispanic men with PD, and reduce these health care disparities observed in our study. Disclosure No.

(399) Reducing Out-of-Pocket Expenses for Peyronie’s Disease Therapy with a Novel Penile Traction Device

Abstract Introduction Penile traction therapy (PTT) has gained popularity as a nonsurgical approach to penile lengthening and curvature correction in those with Peyronie's disease (PD). PD is an acquired fibrotic plaque that develops within the tunica albuginea and causes penile curvature, which can have significant physical and mental health consequences. Due to the sensitive nature of this disease presentation and the large number of unidentified or misdiagnosed people, current prevalence estimations in the US are around 11%. PD therapies aim to correct penile curvature while also addressing erectile dysfunction and pain. Common PD therapies include oral medications, intralesional penile injections, surgery, and stretching techniques. When deciding which therapies to pursue, disease severity, costs, compliance, and patient access to facilities and trained providers must be considered. Of these therapies, PTT with a penile traction device (PTD), although uncovered by insurance, has proven to be one of the most cost-effective PD treatments. While an effective treatment in some men, PTDs cost hundreds of dollars out-of-pocket. Objective Our project aims to address the financial and practicality concerns of penile traction therapy by creating an affordable and comfortable PTD. Methods Our PTD offers precise, dial-adjustable tensioning and penile holding systems with contoured penile holding plates lined with silicone cushions for improved grip and comfort. Our PTD is 3D-printed using polylactic acid (PLA) and medical-grade silicone. To assess our efforts in improving comfort, we measured holding capacity under tension at increasing amounts of penile clamping. We compared our silicone-lined clamp to an all-plastic clamp: this test served as a surrogate for comfort. By improving its grip on the penis, patients can secure their penis with minimal clamping force, thereby improving comfort. Results Our literature search revealed that the average cost for PTDs recommended by urologists for patients with PD was approximately $883. Our PTD currently costs $6.38 to manufacture and assemble. We found a statistically significant (p=0.000276) increase in the tension-holding capacity of the silicone-lined clamp compared to that of the all-plastic clamp. This demonstrates that our silicone-lined clamp may exert less clamping force on the penis, thereby providing patients with the same stretching and a more comfortable grip. Conclusions Future directions include exploring urologists' perception of PTT for PD and their PTD recommendation patterns, refining our current PTD model, and clinically testing our device compared to those currently available. Disclosure No.

(112) Efficacy and Safety of Platelet-Rich Plasma Injections for Peyronie’s Disease: A Randomized Double-Blind Placebo-Controlled Cross-Over Study

Abstract Introduction Peyronie's Disease (PD) is currently treated with intralesional collagenase injection, the only FDA-approved medical therapy. Platelet-derived therapies, such as autologous platelet rich plasma (PRP), have shown potential in tissue regeneration. We are investigating the safety and efficacy of PRP in PD with an ongoing randomized, placebo-controlled, crossover study. Objective The objective of this study is to assess the safety and efficacy of autologous platelet-rich plasma (PRP) treatment in Peyronie's Disease (PD) through a randomized, placebo-controlled, crossover trial. Methods We analyzed data from an ongoing trial conducted between April 2021 and June 2023. Men with PD (write degrees/dorsal only etc) were randomly assigned to receive two 0.5 ml injections of PRP obtained using an autologous platelet separator (Arthrex Angel, Arthrex Inc.) or placebo directly into the dominant plaque, with a two-week interval between injections. Immediate post-procedure assessments included Visual Analogue Pain Scale, and follow-up evaluations focused on identifying complications. After three months, participants crossed over to the other treatment arm for two additional injections. Goniometer measurement assessments were performed prior to each crossover (NCT04512287). Related Samples Wilcoxon-Signed Rank test was used for dependent repeated groups, the serial measurements of degree of curvature at different time points for each patient within a specific group. Findings at p&amp;lt; 0.05 were considered statistically significant. Results The analysis includes data from 29 men who completed all injections and the 6-month follow-up. No minor or major adverse events, such as penile bruising, swelling, edema, allergy, or penile fracture, were reported. Regarding efficacy, we observed a significant reduction in curvature after six months compared to baseline. The pretreatment median curvature was 40.0 (IQR: 15), the median post-treatment curvature 30.0 (IQR: 30) (p=0.014). Furthermore, we did not observe worsening of curvature in subsequent evaluations. Conclusions Our findings from our ongoing clinical trial suggest that PRP treatment for Peyronie's Disease is safe, with minimal adverse events reported. The preliminary efficacy data indicates a significant reduction in curvature after 2 injections each of placebo and PRP treatment compared to baseline. Nevertheless, study completion is necessary prior to reporting true efficacy data comparing PRP vs placebo. Disclosure No.

(168) Downgrading Surgical Recommendations After Intralesional Injections of Collagenase Clostridium Histolyticum in Peyronie’s Disease Patients

Abstract Introduction After patients undergo intralesional injections of collagenase clostridium histolyticum (CCH) as a primary treatment for Peyronie’s disease (PD), they may have residual curvature and may opt for secondary treatment with surgery. On the other hand, the initial severity of curvature may be best addressed by plaque incision and grafting (PIG), but the surgeon may offer CCH with the intent that post-CCH curvature can be treated with a penile plication (PP) rather than a PIG. Objective Our study investigated the group of PD patients who had their surgical recommendations downgraded from a plaque incision and grafting (PIG) to penile plication (PP), a less complicated procedure, after receiving CCH. Methods Our retrospective, single institution chart review included patients from 2016 to 2022 who underwent surgery to treat PD. We then looked at patients who underwent CCH then PP, and compared those who were initially recommended PIG before CCH to those who were initially recommended PP. Functional penile length was also evaluated as the length of the erect penis, from the base of the pubis to the tip of the glans, in a straight line while disregarding any curvature. Results Our study included 53 men who underwent surgery for treatment of PD, with mean age 56.0 (SD 11.3) at presentation. Of the 24 patients who underwent CCH, their pre-CCH and post-CCH surgery recommendations were: PP then PP in 5 patients (21%), PIG then PP in 11 (46%), PIG then PIG in 8 (33%) (Figure 1). The PIG then PP recommended group had a pre-CCH primary curvature range of 30 to 64 degrees, and post-CCH range of 16 to 46 degrees (Table 1). These patients had no significant difference in operative duration, difficulty, functional penile length, or complications (Table 2). The PIG then PP recommended group had 5 patients (46%) who reported functional residual curves that were manage conservatively, which was not significantly different from the PP then PP recommended group (0 patients, 0%, p=0.08). Conclusions Intralesional injections of CCH helped to downgrade surgical recommendations from the more drastic PIG to the simpler PP in a subset of PD patients, without compromising operative difficulty or postoperative outcomes. This finding is encouraging given that PP can be performed in a shorter operative time, by less experienced surgeons, and with lower risk of postoperative sensation and erectile issues. Disclosure No.

The Effect of Botulinum Toxin (Masport) Injection Following Internal Urethrotomy of Bulbar Urethral Stricture: A Pilot Study.

The application of Botulinum toxin (Masport) in urology has a long history. We aimed to assess the effect of local Masport on improvement in patients with urethral stricture by reducing the recurrence of urethral stricture. This pilot study conducted was a double-blind randomized clinical trial with code IRCT20191222045852N1 on patients suffering from urethral stricture. Finally, 28 patients were allocated to intervention and control groups. Twelve patients received intralesional injection with Masport in addition to internal urethrotomy, while 16 patients underwent internal urethrotomy with normal saline. The Cox regression hazard model was used to evaluate the effect of treatment status on recurrence time adjusted for the age, length, and location of the stenosis, cause of the stenosis, and history of previous operations. The effect of treatment type was significant at the .05 level. The past medical history and cause of urethral stricture had a significant impact on relapse-free survival. Also, the improvement in the mean score of the EuroQol Visual Analogue Scale (EQ-VAS), International Prostate Symptom Score (IPSS), and Q-max in the group with Masport was significantly different from the group with normal saline. The internal urethrotomy with intralesional injection of Masport has a better survival prognosis than internal urethrotomy with normal saline group. Therefore, the authors suggest that, given this successful initial clinical trial, consideration be given to future studies involving the use of botox in the management of urethral strictures in conjunction with internal urethrotomy.

A novel neoadjuvant therapy for early-stage non-small cell lung cancer in a mouse model.

Lung cancer is the common malignancy with high mortality rate in the world. Even with curative resection for early-stage lung cancer patients, the rate of postoperative recurrence and metastasis is still high. Neoadjuvant nivolumab combined with chemotherapy leads to improved pathological complete response rate and event-free survival in resectable non-small cell lung cancer (NSCLC) patients. However, the neoadjuvant therapy is not only accompanied by grade 3 or above adverse events which resulting in the potential missing out on the window for curative surgery for the patients, but also has low efficacy especially in patients with low programmed death ligand 1 (PD-L1) expression. Hence, it is particularly important to explore innovative ways to inhibit tumour recurrence and metastasis. In the present study, we investigated whether neoadjuvant therapy with intralesional Rose Bengal (RB) elicited specific immune responses compared with control group, and then the lung cancer mouse model was used to evaluated the immunological mechanism. The secondary Lewis lung cancer cells (LLCs) tumour growth was significantly suppressed by RB intralesional injection into subcutaneous tumour; the formation rate of secondary tumours induced by the B16 melanoma cell injection was 100%. Intralesional RB neoadjuvant therapy before surgical resection exhibited effectively enhanced T central memory cells (Tcm) and T memory stem cells (Tscm) + naïve T cells (Tn) infiltration, elicited stronger cytotoxic T lymphocyte (CTL) responses against LLCs, and displayed markedly higher proportions of splenic lymphocytes that produce tumour necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ) upon restimulation in a lung cancer mouse model. Based on our preclinical data, neoadjuvant therapy with intralesional RB injection generated immune memory and prevented the recurrence and metastasis of tumour in a lung cancer mouse model, which provides a new strategy for neoadjuvant treatment of early-stage NSCLC.

Investigating Predictors of Decannulation Through Endoscopic Approach in Patients With Tracheostomy and Peristomal Subglottic Stenosis.

Peristomal subglottic stenosis (SGS) is a common sequela after tracheostomy, with severe cases precluding decannulation. Predictors of decannulation success in these patients following endoscopic intervention are not well studied. The aim of this study is to investigate predictors of successful decannulation and inform treatment decisions. This study is a retrospective case series of 22 adult patients presenting to the senior author with a tracheostomy and peristomal SGS precluding decannulation between 2018 and 2023. Department of Otolaryngology-Head & Neck Surgery, University of Arizona College of Medicine-Tucson. Patient demographics, relevant clinical factors, stenosis characteristics, and the number of endoscopic procedures performed were analyzed to identify predictors of successful decannulation. Endoscopic interventions were generally performed 3 months apart with CO2 laser debridement, balloon dilation, and intralesional injection of steroid, all done with a laser-safe endotracheal tube in place through the stoma. Out of the 22 patients in the study, 9 (40.9%) achieved decannulation, all through an endoscopic approach. Body mass index (BMI) and age were identified as significant negative predictors of decannulation success (P = .02; P = .05, respectively). Stenosis characteristics, such as the presence of tracheomalacia, excessive dynamic airway collapse, multilevel stenosis, posterior glottic stenosis, and anterior granulation tissue shelf did not significantly impact decannulation success. A 40.9% decannulation rate was achieved in our cohort. BMI and age were identified as negative predictors of decannulation success. Stenosis characteristics did not significantly affect decannulation outcomes. Further investigation is warranted to establish reliable predictors of decannulation.

Efficacy of Intralesion Injection of Combined 5-Flourouracil and Triamcinolone versus Triamcinalone alone in Keloids and Hypertrophic Scars: A Comparative Analysis

Objective: The treatment of keloids and hypertrophic scars is challenging and controversial. The therapeutic agents found in the literature include silicone sheets, compression garments, corticosteroid injections, 5-fluorouracil (5-FU), bleomycin and interferon, topical imiquimod, cryotherapy, radiation, and laser or light-based therapies. Triamcinolone acetonide (TCA), a corticosteroid, considered first line treatment for the prevention and treatment of keloids and hypertrophic scars. To compare the efficacy of triamcinolone acetonide alone and triamcinolone acetonide plus 5-florouracil for treating keloids and hypertrophic scars in burn patients.&#x0D; Methodology: In this study, the patients were divided into two groups A and B on the basis of treatment regimen, i.e. Group A (TCA alone) and Group B (5FU+TCA). The efficacy of both treatments was compared for improvement in Vancouver scar scale (VSS) and pruritus scale.&#x0D; Results: The mean VSS score pretreatment was calculated as 10.74±2.36 in Group A and 10.27±3.14 in Group B. Post-treatment, it was reduced to 5.58±1.04 in Group-A and 3.41±2.11 in Group-B. The comparison of efficacy shows an improvement of 65.80% in Group A and 75.07% in Group B; the p value was 0.047, showing a significant difference.&#x0D; Conclusion: Combination therapy of intra-lesion injection of triamcinolone acetonide and 5-florouracil has significantly higher efficacy as compared to triamcinolone acetonide alone for the treatment of keloids and hypertrophic scars, but necessary precautions have to be taken.

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.

The Application of I-Scan Imaging for Evaluating Benign Vocal Lesions

Current standard methods for evaluating benign vocal lesions, including white light laryngoscopy and video laryngostroboscopy, may struggle to identify smaller lesions. While histopathological results obtained from laryngeal microsurgery provide definitive results, their invasiveness can lead to scarring and impaired phonological outcomes. Intralesional steroid injection has recently gained acceptance, but it lacks pathological diagnostic capabilities. Therefore, there is a growing need for a simple examination that can enhance the diagnosis of benign vocal lesions. NBI, from Olympus Corporation, has shown promising outcomes in detecting and characterizing laryngeal lesions. The i-scan technology by PENTAX, while providing the ability to improve visual clarity during endoscopic procedures, has been addressed less in this field. Our study aims to further investigate the application of i-scan imaging in benign vocal lesions, enrolling patients diagnosed with vocal cysts, polyps, and nodules. We conducted i-scan imaging prior to office-based intralesional steroid injection, assessing the possibility of its providing additional diagnostic information for benign vocal lesions without additional burden.

Clinical and ultrasonographic evaluation of efficacy and safety of intralesional injection of autologous platelet-rich plasma in morphea: A comparative case series.

To evaluate the efficacy and safety of platelet-rich plasma to restore skin changes in morphea by ultrasound and Localized Scleroderma Cutaneous Assessment Tool. Nine morphea patients (21 lesions) were diagnosed clinically and by histopathology. Intradermal platelet-rich plasma was injected into morphea lesion once weekly for 12 sessions. The disease severity and damage were evaluated at baseline, after the last session (3 months later), and at 6 months follow-up using the LoSCAT and a high-resolution ultrasound. The healthy corresponding side was considered as a control. The Localized Scleroderma Cutaneous Assessment Tool score showed a significant improvement starting from 13 ± 7.28 up to 7.33 ± 6.82 after the therapeutic endpoint, reaching to 6.44 ± 7.09 after 6 months of follow-up with p value = 0.008 and 0.014, respectively. There was a significant positive correlation between the duration of the lesion and the improvement assessed by the ultrasound, with p value = 0.01. Regarding adverse effects, all patients reported having pain during platelet-rich plasma injection; transient edema of the face was reported by four patients (45%), and only two patients showed transient erythema. Autologous platelet-rich plasma is a safe technique with great aesthetic outcomes for filling up the contour defects and correcting both hyper and hypopigmentation, in addition to softening the indurated lesions.

DERMATOFIBROSARCOMA PROTUBERANS: THE EXPERIENCES OF DIAGNOSIS AND TREATMENT THROUGH A RARE CASE REPORT

Background: Dermatofibrosarcoma protuberans (DFSP) is classified as a soft tissue sarcoma, representing a rare form of skin cancer. Despite its rarity, DFSP is acknowledged as the most common skin sarcoma. The clinical features of DFSP are highly varied, making early-stage diagnosis challenging. Treatment initiated at an advanced stage significantly increases the risk of DFSP recurrence. Case Report: A 65-year-old female patient sought medical attention at our hospital due to a giant tumor on her central back. The lesion had initially appeared two years prior and had been initially misdiagnosed as keloids. Subsequently, the patient underwent intralesional steroid injections and surgery at a private clinic, but the lesion exhibited no improvement and relapsed within two months. Upon presenting to the National Hospital of Dermatology and Venereology, the patient displayed a brown-red raised tumor measuring approximately 8x4cm on her back. Given the suspicion of a cutaneous carcinoma, a biopsy was conducted. The histopathology and immunohistochemistry tests confirmed the diagnosis of DFSP. Consequently, the patient underwent wide excision of the lesion, including 3 cm of normal skin around it and deep into the fascia. No recurrence was recorded after one year of follow-up. Conclusion: DFSP, a rare form of skin carcinoma, can be challenging to differentiate from various other conditions, including keloids. In cases where conventional treatments such as intralesional triamcinolone acetonide injection show poor improvement for suspected keloids, DFSP should be considered and confirmed through histopathology and immunohistochemistry tests. Received 28 June 2023Revised 26 September 2023Accepted 29 November 2023

Practical management of hypertrophic scarring: the mayo clinic experience.

Hypertrophic scarring is a potential consequence of wound healing that causes functional and aesthetic disability. Common treatments include intralesional pharmacotherapy (e.g., triamcinolone), surgical excision, and energy-based laser devices. While numerous treatment methods have been described for hypertrophic scarring, an optimal treatment strategy has yet to be established given variability in clinical presentation. This study aims to identify patient- and provider-preferred treatment patterns. This is a single-center, retrospective study of adult patients that developed post-surgical hypertrophic scarring between 2007 and 2017. Specifically, trends in procedural management for hypertrophic scarring among this cohort were examined. A total of 442 procedures (intralesional steroid injection, surgical excision, laser-based treatment) were identified in 218 patients with a clinical diagnosis of hypertrophic scarring. Approximately 73% were female; 87% were Caucasian. The median age at first procedure was 45.6years (SD = 17.4). The most frequent anatomical locations for procedures were the trunk (n = 242; 54.8%), followed by head/neck (n = 86; 19.5%), upper extremities (n = 67; 15.2%), and lower extremities (n = 45; 10.2%). Procedural therapies included intralesional steroid injection (n = 221; 50%), surgical excision (n = 112; 25.3%) and laser (fractional non-ablative laser vs. pulsed dye laser; n = 109; 24.5%). Treatment modality varied by stage of treatment, scar anatomical location, and scar size. This single-center series of patients with hypertrophic scarring highlights a patient-centered management approach and offers clinical guidelines for provider-patient shared decision making.

Topical antimitotic treatments for plantar warts are more beneficial: A Bayesian network meta-analysis of randomized controlled trials.

Plantar warts are common infectious cutaneousgrowths causing severe physiological and psychological discomforts in patients and heaving global financial burdens. However, paucity of clear-cut guidelines for plantar warts, selecting appropriate treatments for plantar warts remains challenging. The objective of the study is to evaluate the efficacy and safety of common treatments for plantar warts. PubMed, EMbase, and The Cochrane Library were searched from inception to March 1, 2023 for randomized controlled trials (RCTs) of plantar warts. The primary outcome (complete response) and secondary outcome (recurrence and pain) were extracted and combined using Bayesian network meta-analysis (NMA) with random-effect and fixed-effect models. Totally, 33 RCTs were included in the systematic review and quantitative NMA. In NMA of complete response, topical application of 1% cantharidin, 20% podophylotoxin, 30% salicylic acid (CPS), microneedles plus bleomycin (MNB), and intralesional bleomycin injection (INB) were the only three treatments significantly superior to no treatment (NT) and CPS was of the highest possibility to be the top-ranked treatment (SUCRA=0.9363). However, traditional warts treatments, salicylic acid (SA) and cryotherapy were not superior to NT. The NMA has produced evidence for using CPS, MNB, and INB, which are all topical antimitotic treatments, to improve the management of plantar warts. The classic treatment modalities for plantar warts, including SA and cryotherapy, may play a less important role in the clinical practice of plantar warts.