Intralesional Steroid Therapy Research Articles

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).
 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. 
 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

Our Experience at Tertiary Medical College: Comparative Study Between Surgical Deroofing with Buttoning Technique and Posterior Cartilage Window with Pressure Gauze Dressing Technique in Patients with Pseudocyst of Pinna.

Our Experience at Tertiary Medical College: Comparative Study Between Surgical Deroofing with Buttoning Technique and Posterior Cartilage Window with Pressure Gauze Dressing Technique in Patients with Pseudocyst of Pinna.

Effectiveness of QR678 and QR678 Neo® with intralesional corticosteroid vs. intralesional corticosteroid alone in the treatment of alopecia areata -A randomized, comparative, prospective study.

Alopecia areata (AA) is an inflammatory disorder, marked by chronic, persistent, and patchy loss of hair. At present intralesional/topical corticosteroids, Minoxidil solution, and topical immune-therapies are used for treatment. Though all these have side effects and high rate of relapse. As QR678Neo® is proved to be effective in hair regrowth in male and female pattern hair loss, the aim of the study is to compare the efficacy of QR678Neo® with intralesional steroid therapy vs. intralesional steroid alone in the treatment of AA of scalp in men and women. A total of 20 participants in age group of 20-50years with nonscarring patchy hair loss were chosen for the study. Patients were arbitrarily divided into two groups (Group A-intralesional steroid with placebo and Group B-intralesional steroid with QR678Neo® ). All the participants were evaluated at baseline, 3months and 6months with standard global photography, dermoscopic assessment, and self-evaluation questionnaire at the end of study. Marked improvement was seen in the global assessment score after 6months (mean- 6.6 SALT) as compared to baseline (38.5 SALT score) in group B. There was significant reduction of black dots, yellow dots, broken hairs, and tapered hair at 6months on video dermoscopic examination in group B. Also, higher satisfaction was experienced with the treatment in group B patients. QR678Neo® in combination with intralesional steroids therapy proved to be significantly beneficial, efficient, and can be considered as safer treatment option for alopecia areata.

Inflammatory Myofibroblastic Tumor of the Larynx: Report of a Case

PurposeInflammatory myofibroblastic tumor (IMT) is a rare tumor composed of mesenchymal myofibroblastic spindle cells enveloped by an inflammatory infiltrate. Historically, this tumor sparked debate regarding whether it was a true malignancy with metastatic potential or merely a locally destructive physiologic inflammatory response. Few reports of IMT exist in the recent literature, with the majority of cases occurring in the pediatric population and favoring the lungs. Here we present an exceedingly rare case of IMT involving the larynx of a 22-year-old female. ResultsA hemorrhagic and solid mass of the right true membranous vocal fold was excised and sent for histopathological assessment. Features of the surgical specimens were diagnostic for IMT. Intralesional steroid therapy was selected for additional treatment. Panendoscopy facilitated surveillance for any additional or recurrent lesions, of which there were none. At 11 months post-excision, follow-up MRI revealed symmetric vocal cords without evidence of any masses. ConclusionsAlthough rare, laryngeal IMT should be considered in any patient presenting with hoarseness due to a vocal fold mass. Based on the successful treatment of our patient, we suggest that our approach of surgical excision followed by intralesional corticosteroid injection may be an efficacious treatment approach for this rare tumor. However, more research is warranted to elucidate the most effective, safe, and cost-effective treatment approach.

Digital Myxoid Cysts: Correlation of Initial and Long-Term Response to Steroid Injections

Digital mucous cysts (DMCs) are benign myxoid pseudocysts that develop on the distal interphalangeal joint's lateral or dorsal aspects. Management consists either of a surgical approach, conservative therapy, or simple follow-up. To correlate the initial and long-term response with clinical and ultrasound parameters in DMCs treated with intralesional steroids as first-line therapy. A single-center prospective open-label study recruited 15 patients affected by DMCs, who had been treated with a cycle of up to 3 steroid injections at a 6 to 9 week time interval. At the first follow-up visit, 53.3% of patients were cleared of DMCs, achieving a complete response, whereas 46.7% experienced a >30% decrease in their DMC volume, and were considered partial responders. After 1 year of follow-up, the cure rate decreased to 40%, and the recrudescence rate was 27.3%. Clinical and sonographic characteristics that positively correlated with a maintained complete response at follow-up were as follows: young age, absence of osteophytes, low volume, complete clearance at T1, and short disease duration (p < .05). Intralesional steroid therapy is an easy approach for DMC, with minimal side effects; identifying predictive hallmarks is useful to offer a straightforward surgical treatment to patients who have nonresponder characteristics.

Giant subcutaneous granuloma annulare

Subcutaneous granuloma annulare is an uncommon, benign self-limiting cutaneous disease, almost exclusively seen in young children. We report a case of 31-year-old male patient, presented with asymptomatic firm plaques over the left lateral malleoli and dorsum of the feet. Histopathological examination was done to confirm the diagnosis and the lesions responded well to monthly doses of the combination of rifampicin, ofloxacin, minocycline (ROM) therapy and intralesional steroid therapy. This case is reported for its unusual presentation of very large plaque in an adult male and its resolution after combined ROM and intralesional steroid therapy.

Cutaneous Plasmacytosis: A Pitfall For B and Plasma Cell Neoplasms

Abstract Introduction/Objective Cutaneous plasmacytosis (CP) is an uncommon condition typically affecting Asian males in the 3rd to 5th decades. It is thought to be a reactive process that classically presents with asymptomatic, red-brown, plaques and nodules on the face and neck. It has been associated with polyclonal hypergammaglobulinemia and systemic involvement. Histologically it is characterized by dense superficial and deep dermal infiltrates of mature plasma cells with polyclonal differentiation on in-situ hybridization (ISH). The differential diagnosis includes neoplastic plasma cell processes, characteristically with monoclonal plasma cell infiltrate, and mature B cell neoplasms with polyclonal plasma cell differentiation. Methods We report a case of a 69 year old Caucasian male who presented with asymptomatic, enlarging red-brown nodules on bilateral nasal ala. Histologic examination revealed dense, superficial plasma cell infiltrate, concerning for a plasma cell neoplasm. CD138 and Kappa/Lambda ISH demonstrated plasma cell polyclonality. Further workup ruled out infectious or systemic involvement and a plasma cell dyscrasia was ruled out by Hematology/Oncology. Results These findings supported the diagnosis of CP. Treatment with intralesional steroids showed initial improvement with regrowth of the nodules. To date, treatment with topical steroids and CO2 laser ablation are being considered. Conclusion CP is reported as type of pseudolymphoma, which is described as a reactive lymphoproliferation that histopathologically and/or clinically imitates cutaneous lymphoma. The pathogenesis is unknown, however, there are studies suggesting an association with increased interleukin-6, which is involved in the differentiation of B cells to mature plasma cells. The majority of patients with CP have a favorable prognosis. There has been variable success with both topical and intralesional treatment to include, cyclophosphamide, topical tacrolimus, prednisone, intralesional steroid therapy, topical psoralens combined with ultraviolet A exposure, and other chemotherapies. Familiarity with this rare entity is imperative to prevent misdiagnosis and overtreatment.

Keloid and Hypertrophic Scar Formation, Prevention, and Management: Standard Review of Abnormal Scarring in Orthopaedic Surgery.

Keloid and hypertrophic scar formation after orthopaedic surgical closure is a complex issue. The nature and location of procedures maximize wound tension, leave foreign bodies, and diminish dermal supply, all potentiating keloid formation. There is little discussion regarding the pathophysiology and management of this recurrent problem in orthopaedic literature. Keloid formation is a fibroproliferative disorder resulting in extensive production of extracellular matrix and collagen, but prevention and treatment is poorly understood. Patient and surgical factors contributing to the development of this condition are discussed. The treatments include both medical and surgical therapies that work at a biologic level and attempt to produce a cosmetic and complication-free management strategy. Medical options that have been investigated include combinations of intralesional steroid therapy, laser therapy, and biologics. Preventive surgical closure and excision remain mainstays of treatment. Radiation therapy has also been used in refractory cases with mixed results. Despite medical therapies and surgical excision aimed at treating the resulting scar, recurrence rate is very high for all modalities that have been studied to this point. Future work is being done to better understand the pathophysiology leading to keloid and hypertrophic scar formation in an effort to find preventive methods as compared to treatment strategies.

Intralesional steroid and ultrasound therapy in patients with carpal tunnel syndrome

The study aimed to compare the effects of intralesional steroid injection and ultrasound therapy for the treatment of carpal tunnel syndrome. A total 130 patients divided into 2 groups: a) One group (n=65) received intralesional corticosteroid injection along with wrist splint, exercise, naproxen sodium 500 mg tablet and omeprazole 20 mg capsule twice daily for 2 weeks; b) Another group received (n=65) ultrasound therapy (10 min/day, 3 days/week for 4 weeks) along with Wrist splint for 4 weeks, exercises for 4 weeks, naproxen sodium 500 mg tablet and omeprazole 20 mg capsule twice daily for 2 weeks. The patients were followed-up 2 weekly for 4 weeks. The visual analogue score, symptom severity scores and functional status scores were significantly improved within each group at week 2 (p&lt;0.05) and week 4 (p&lt;0.05) except for the symptom severity score at (p&gt;0.05). The improvement in symptom severity scores and functional status scores in the intralesional steroid group was more than in the ultrasound therapy group after 4 weeks.

Intralesional triamcinolone acetonide therapy for inflammatory oral ulcers

The aim of this study was to report on the clinical indications and treatment outcomes of intralesional steroid therapy (IST) for oral ulcerative conditions in an oral medicine practice. This was a retrospective single-center study of patients with oral ulcerative conditions treated with IST. Demographic data, clinical diagnosis of the oral condition, size of the ulcer, and pain were abstracted from patients' electronic medical records. Ninety-three patients (51 females [54.8%]) were treated for persistent traumatic oral ulcers (n = 38 [40.8%]), ulcers in oral chronic graft-versus-host disease (n = 23 [24.7%]), oral lichen planus (n = 19 [20.4%]), and other conditions (14%). Complete resolution was achieved in 81.7% of patients in a median of 96 days (range 10-357 days), with 80% fully healed in a median of 84 days (range 10-140 days). Overall, patients received a median of 2 injections (range 1-5 injections) and a median dose of 12 mg per injection (range 2-36 mg). Nearly half the patients were also treated with concomitant topical steroid therapy. After the first injection, the median pain score reduced from 5 (range 1-10) to 1 (range 0-10; P < .001) and the median size of ulcers reduced from 1 cm (range 0.1-5 cm) to 0.3 cm (range 0-2 cm; P < .001). IST may be an effective treatment for inflammatory and immune-mediated oral ulcers.

Postmenopausal lichen planopilaris also known as fibrosing frontotemporal alopecia Kossard : An evidence-oriented practical guide to treatment from the University of the Saarland, Hair Research Center of the Dr.Rolf M.Schwiete Foundation

Postmenopausal lichen planopilaris (PLPP), also known as fibrosing frontotemporal alopecia Kossard (FFAK), is anot uncommon inflammatory scalp disease affecting approximately 5% of patients at specialized hair centers. The overall incidence of sporadic occurrence is believed to be just under 1% in the older, predominantly female, general population. Since the disease is often undiagnosed, it is statistically likely to be underrepresented. It especially occurs in postmenopausal women who are in the 6th and 7th decade of life (90%), but also in about 10% of premenopausal women, and in men it is documented only in isolated cases. The result is apermanent scarring hair loss accentuated at the front hairline with backward movement towards the neck mostly accompanied by atypical loss of the eyebrows. The disease therefore often leads to significant mental distress and social anxiety in those affected. This is the basis for acompelling need to develop evidence-based therapeutic concepts. While numerous retrospective case series have characterized the phenomenology of FFAK very well, to date there are no randomized controlled trials on evidence-based therapy. Here, we present the Homburger Evidence-Oriented Therapy Algorithm, which is oriented along the available case series evidence: It may (1)serve as atherapy guide for practice and (2)can be used as abasis for working out reliable data based on study evidence. The article contains detailed practical information on photo documentation, biopsy and histological processing up to the practical implementation of, for example, intralesional steroid therapy as well as information on selection criteria for suitable systemic therapies.

Intralesional steroid induced hypopigmentation- a case report

&lt;p class="abstract"&gt;Ganglions are tense, smooth, fluctuant, cystic transilluminant swellings commonly &lt;span lang="EN-IN"&gt;found on the dorsum of the wrist, at the scapholunate articulation. Treatment modalities include aspiration, intralesional corticosteroids, surgical excision, etc. Hypopigmentation is one of the adverse effects associated with intralesional steroid therapy&lt;/span&gt;. &lt;span lang="EN-IN"&gt;Here, we report &lt;/span&gt;&lt;span lang="EN-IN"&gt;a 21 years old male patient who came with an asymptomatic whitish patch on the left wrist after receiving triaminolone 40 mg injection at the same site for a ganglion.&lt;/span&gt;&lt;span lang="EN-IN"&gt;Case is being reported so as to create awareness of this benign condition amongst the treating physicians or surgeons.&lt;/span&gt;&lt;/p&gt;

Surgical Management of a Case of Bilateral Auricular Keloids in an Adolescent Girl

The Keloid is a fibroproliferative anomaly of the cutaneous connective tissue secondary to dysregulation in the skin healing and repair process, occurring in susceptible individuals. It is characterized by excessive collagen and glycoprotein deposition in the dermis following any local irritation, inflammation, burn, incision or injury, thereby leading to a cosmetically unaesthetic, aberrant and exuberant scar formation extending well beyond the boundaries of the original wound. It usually presents as firm nodules, often pruritic and painful, which do not regress spontaneously. The condition presents quite a therapeutic challenge owing to its unpredictably aggressive nature, frequent invasion of adjacent normal dermis, occasional appearance of satellite lesions in nearby non-traumatized tissue and a remarkable tendency for recurrence following removal. Various combinations of Pressure therapy, intralesional steroid therapy and surgery have shown promising results in the treatment of auricular keloids. We report on a young Indian female, aged 19 years, who developed bilateral auricular keloids subsequent to earlobe piercing, which was successfully managed by careful and atraumatic surgical excision alone.

Use of Lycopene in the Management of Oral Submucous Fibrosis:A Clinical Study

Background: Oral Submucous Fibrosis is a potentially malignant disorder well known for its chronic and resistant nature. The conservative drug treatment that is currently available for this disorder is clearly inadequate. Objective: The study was done to evaluate the efficacy of oral lycopene therapy when used in combination with conventional intralesional steroid therapy in the management of oral submucous fibrosis. Methods: Thirty patients with oral submucous fibrosis (grade III and IV) were included and randomly divided into 2 groups consisting of 15 each: Group A (oral lycopene with biweekly intralesional steroids and hyaluronidase), Group B (biweekly intralesional steroids and hyaluronidase alone). Mouth opening and burning sensation were recorded from baseline to 6 weeks. Cases were followed up to 3 and 6 months. Results: We observed a complete relief of burning sensation in all patients of both the groups, There was significant increase in mouth opening among both groups. The patients in the group B had increased moth opening than the group A patients.The results were statistically significant. Conclusion: Lycopene in combination with intralesional steroids and Hyaluronidase, is highly efficacious in improving the mouth opening and reducing other symptoms in patients with Oral Submucous Fibrosis. No side effects were reported with its usage.

Hypersensitivity reaction to vegan tattoo ink and successful treatment with intralesional and topical steroid therapy

Hypersensitivity reaction to vegan tattoo ink and successful treatment with intralesional and topical steroid therapy

An atypical response following intraoral intralesional steroid therapy

AbstractManagement of graft‐versus‐host disease (GVHD) involves a combination of systemic and local immunomodulatory therapies. Intralesional steroid therapy (IST) can be effective in treating refractory oral ulcerations. Complications of intraoral IST have not been reported. A 61‐year‐old male was admitted on day +157 status‐post reduced intensity allogeneic haematopoietic cell transplantation for chronic lymphocytic leukaemia and myelodysplastic syndrome with a new onset of erythrodermatous skin rash and oral mucosal lichenoid changes with multiple ulcerations and associated severe odynophagia. Platelet count and coagulation values were within normal limits. A diagnosis of overlap GVHD syndrome was made and treatment was initiated with methylprednisolone 2 mg/kg, extracorporeal photopheresis and budesonide oral rinses (3 mg/5 mL). Despite progressive overall improvement, there were two residual painful ulcers of the buccal mucosa bilaterally and IST was initiated in the morning of day +181. By that evening, the patient developed prominent right sided swelling and ecchymosis extending from the inferior aspect of the temporal area to the posterior and inferior borders of the mandible, and extending anteriorly to the lip, with significant dysphagia. Computed tomography scan demonstrated diffuse haemorrhage and inflammation consistent with haematoma. Improvement was noted within 3 days with gradual resolution over the next week. This case highlights that haematoma formation is an unpredictable and potentially life‐threatening complication of IST. While the precise aetiology in this case is unclear, underlying bleeding risk and immune dysregulation may be contributing factors. Clinicians should be aware that if significant swelling develops following IST, patients should be directed to an emergency department for evaluation and monitoring.

Efficacy and safety of intralesional corticosteroid application for hemangiomas

There are different modalities for management of infantile hemangiomas (IHs). In this report, our aim is to evaluate whether intralesional corticosteroid treatment is associated with systemic side effects and whether this is an effective treatment modality for IH. Six children treated with intralesional corticosteroids for problematic hemangiomas were included in the study. Clinical characteristics, response to treatment, weight, height, blood pressure, morning serum cortisol, and adrenocorticotropic hormone levels were recorded. Each child received intralesional triamcinolone at a dose of 2 mg/kg for 2-5 injections at monthly intervals. Subjects were followed for 1 year. All patients had adrenal suppression following the second or third triamcinolone injections. Five patients demonstrated partial response and one demonstrated no response. Intralesional steroid injection may effectively induce the resolution of hemangiomas, but all the patients in our group had adrenal suppression after treatment. The use of intralesional steroid therapy is not a superior treatment option for hemangiomas. It also has side effects comparable to systemic steroids.

Earlobe Keloids: A Pilot Study of the Efficacy of Keloidectomy with Core Fillet Flap and Adjuvant Intralesional Corticosteroids

Management of earlobe keloids is challenging because they are often resistant to treatment. The literature reports different treatment modalities with variable responses. Surgical excision with core fillet flap in combination with adjuvant intralesional steroid injection has not been thoroughly explored for keloid treatment, in spite of its positive therapeutic and cosmetic outcome. To evaluate the clinical efficacy of keloidectomy with core fillet flap and adjuvant intralesional steroid injection in treating earlobe keloids. Between 2004 and 2012, 21 earlobe keloids were treated using keloidectomy with core fillet flap and given intraoperative intralesional steroid injections. Follow-up was scheduled 2weeks after the procedure and then monthly to administer intralesional steroid injections and to assess response, postoperative complications, recurrence, and objective and subjective satisfaction. The clinical outcome efficacy was 87.6%. Mean follow-up was 21.9months. Immediate recurrence was 9.5%, with few complications encountered. Subjectively, 82.3% of the patients were highly satisfied. Keloidectomy with core fillet flap and adjuvant intralesional steroid therapy is an effective modality for the clinical management of earlobe keloids. This approach should be considered for the treatment of this difficult condition.

Effect of Oral Fluticasone on Refractory Peptic Esophageal Stricture - A New Therapeutic Method for Refractory Peptic Esophageal Stricture

Purpose: Esophageal dilation is a safe and effective initial therapeutic option for the treatment of benign strictures of the esophagus. Intralesional steroid therapy, electrosurgical incision, or stent placement can be used for specific patients with refractory benign esophageal stricture. However, in some patients with refractory esophageal stricture, these therapeutic modalities may not be effective. The purpose of this study is to evaluate oral fluticasone inhaler as a therapeutic modality for management of refractory peptic esophageal stricture. Methods: Patients with refractory peptic esophageal stricture (after eosinophilic esophagitis were ruled out) were enrolled in this study. As EGD with intralesional steroid injection must be performed at intervals, we prescribed patients oral inhalation therapy with fluticasone for use between dilations and compared its effect with that of intralesional steroid injection on frequency of esophageal dilation. To avoid any possible bias, oral steroid inhaler was given alternatively at each session of esophageal dilation and intralesional steroid injection, as showed in this flow diagram: A__B__A__B__A__B__A___B__. (A: esophageal dilation + intralesional lesion steroid injection; B: esophageal dilation + intralesional lesion steroid injection + oral steroid inhaler). We analyzed the data from the first 6 sessions. Results: With dilation only, patients required subsequent dilation about once a month. When intralesional steroid injection was performed in addition to dilation, patients required dilations about every 2 months. Use of inhaled oral steroids significantly decreased the frequency of esophageal dilations (see Table). There were no side effects with the use of fluticasone during this period.Table: [54] Days elapsed between esophageal dilationsConclusion: Oral steroid inhaler therapy is more effective than intralesional steroid injection in augmenting the effect of esophageal dilation in patients with refractory peptic esophageal stricture. To our knowledge, this is the first report of using orally inhaled steroid in treatment of refractory peptic esophageal stricture. A multiple center study is needed to investigate this novel observation further.

Clinical experience with complications of hand rejuvenation

Prominent signs of ageing of the hands have recently been treated with permanent or longer-lasting injectable dermal fillers. However, few previous studies have described the long-term complications of such hand rejuvenation. The purpose of our report was to share our experience of 15 cases with long-term complications following hand rejuvenation using various medical fillers. We performed a retrospective review of the management of 15 patients who presented with complications from the injection of synthetic fillers for hand rejuvenation at a tertiary medical centre over a period of 10 years from March 2002 to January 2011. Injected materials included polymethylmethacrylate (PMMA) microsphere filler, calcium hydroxyapatite filler, hyaluronic acid filler, poly-l-lactic acid (PLLA) filler and other medical fillers. Of the total study sample of 15 patients, nine underwent surgical excision, six patients with a history of PMMA or PLLA filler injection received intralesional steroid therapy and three patients with a history of hyaluronic acid filler injection received injection therapy using hyaluronidase. Hand rejuvenation complications can be successfully treated according to our proposed algorithm.