Intralesional Steroid Research Articles

P100 Dermoscopy and clinicohistopathological profile of lichen planopilaris restricted to the face: a case series of six unusual cases

Abstract Lichen planopilaris (LPP) is an autoimmune cicatricial alopecia that usually affects the scalp. LPP confined to the face is rare and the information on its dermoscopy is limited. We present the dermoscopy and clinicohistopathological profile of six patients, all but one of whom were men aged 32–60 years. A 12-year-old girl was the youngest patient in our series, as well as in the literature to the best of our knowledge. All patients presented with varying degrees of hyperpigmented atrophic patches and scarring alopecia restricted to the face. Two had a linear morphology, which is usually the most common presentation of facial LPP. In our series, the chin was the most frequently affected site, followed by the cheek and upper lips; the forehead was the least frequently involved. None of the patients had lesions elsewhere on the body, including the scalp. The duration of the lesions ranged from 1 to 6 months. All cases showed a brown-to-violaceous background and/or mild blotchy erythema, significantly reduced hair follicles, cicatricial alopecia and variable scaling and/or peripilar cast, brown dots, pigment pseudonetwork, pigment clumps and whitish scar-like areas on dermoscopy. Histopathology predominantly showed perifollicular inflammatory infiltrate, basal layer vacuolar degeneration and pigment incontinence, focal areas of perifollicular fibrosis corresponding to the erythema and peripilar cast, brown dots and pigment clumps, and scar-like areas. The men all described regular shaving, almost daily. The girl and two men described having a regular mustard oil massage over the face, which might have irritated and damaged the facial skin. The possibility of continuous microtrauma due to shaving and mustard oil application acting as a trigger leading to development of facial LPP cannot be ruled out. All patients received hydroxychloroquine, potent topical corticosteroids, intralesional steroids and/or oral steroids. Patient 3 was lost to follow-up; the rest are under regular follow-up with a favourable—albeit suboptimal—response. This case series highlights a rare presentation of LPP restricted to the face, with only a few similar cases with dermoscopy reported in the literature. Its diagnosis requires a high degree of suspicion in any case presenting with scarring alopecia and atrophic patches over the face. The treatment is difficult and aims to halt disease progression and/or hair regrowth if detected and treated early, preventing significant morbidity and anxiety in the patient.

BI24 Cutaneous pseudolymphoma secondary to pembrolizumab

Abstract A 35-year-old man presented with a 7-week history of itchy, nontender, indurated erythematous plaques and nodules on his forehead and upper back, with no discriminatory clinical features. He was systemically well. Three months previously, he had completed a 12-month course of adjuvant pembrolizumab for stage IIIC melanoma. The primary melanoma had been excised from his left cheek, with involvement of left parotid and supraclavicular lymph nodes, treated with clearance via superficial parotidectomy and left neck dissection. Clinical and imaging surveillance revealed no evidence of melanoma recurrence. Incisional biopsies of the lesions on his back and forehead both demonstrated a superficial and deep dermal perivascular and periadnexal infiltrate of small- and medium-sized lymphoid cells. There was no epidermotropism and B- and T-cell clonality studies were negative. Morphological appearance and immunophenotype favoured a CD4+-reactive lymphoid process in keeping with cutaneous pseudolymphoma (CPL), secondary to pembrolizumab. The conspicuous forehead lesion was unresponsive to clobetasol propionate under occlusion. A single course of intralesional triamcinolone acetonide 10 mg mL–1 resulted in significant improvement within days, with subsequent complete resolution. The lesion on the back resolved spontaneously. Drug-induced CPL describes an adverse cutaneous drug reaction mimicking B- or T-cell lymphomas clinically and/or histologically. It has been described with anticonvulsants, antidepressants and biologic agents, often with resolution on cessation of the responsible drug (Etesami I, Kalantari Y, Tavakolpour S et al. Drug-induced cutaneous pseudolymphoma: a systematic review of the literature. Australas J Dermatol 2023; 64:41–9). It has been proposed that the drugs affect immune surveillance, leading to an abnormal cutaneous lymphocyte response. A case report (Ayoubi N, Haque A, Vera N et al. Ipilimumab/nivolumab-induced pseudolymphoma in a patient with malignant melanoma. J Cutan Pathol 2020; 47:390–3) has described drug-induced CPL secondary to ipilimumab and nivolumab in a 38-year-old man presenting with erythematous plaques on the hands and face, similar to the presentation of our patient, which responded to prednisolone. As with the other adverse effects of immunotherapy, it is likely that CPL in this cohort is due to an iatrogenic immune dysregulation leading to T-cell overactivity. We present the first reported case of CPL secondary to pembrolizumab and highlight the successful use of intralesional steroid as a treatment option. It is important to recognize CPL as an adverse cutaneous effect of immunotherapy and be aware that it can present after completing treatment due to an ongoing immune response.

P60 Intralesional steroids vs. liquid nitrogen cryotherapy vs. 595 nm pulsed dye laser in the management of chest keloids: a comparative study

Abstract Chest keloids often result in cosmetic disfigurement, contractures, pruritus and pain. Inflammatory truncal acne often triggers chest keloid. Management is often challenging as they are relatively resistant to treatment and recurrence rates are high. The objective of the study was to compare the clinical efficacy and safety of intralesional triamcinolone acetonide (40 mg mL−1) vs. liquid nitrogen cryotherapy vs. 595 nm pulsed dye laser in the management of chest keloids. We conducted a comparative prospective study in a total of 42 patients with chest keloids from July 2021 to July 2022. These patients were randomly divided into three treatment groups via the envelope method. The Vancouver Scar Scale (VSS) was used to assess the clinical efficacy of the treatment modality. Patients were scored at the initiation of therapy and every 4 weeks until 16 weeks. Seven patients were lost to follow-up (response rate 83%). Treatment arms consisted of intralesional triamcinolone acetonide (n = 10), liquid nitrogen cryotherapy (n = 11) and pulsed dye laser (n = 14). There was a near-equal sex distribution of chest keloids (male-to-female ratio 1.21 : 1), with 15 patients (35.7%) having additional keloids in other body parts. The mean (SD) age of patients with chest keloids was 27.2 (13.6) years with a common incidence in those aged 20–30 years. Comparison of mean VSS as baseline and at 16 weeks revealed a statistically significant decrease in the score in all three treatment arms (P < 0.05). Comparison between the three different treatment arms revealed pulsed dye laser to be the most effective modality in decreasing VSS at the 16-week follow-up (Anova followed by post hoc analysis with Tukey’s test). With regard to the adverse clinical event profile, acneiform eruptions were reported following steroid injections, blistering and depigmentation were reported following liquid nitrogen cryotherapy, and blistering was reported following pulsed dye laser therapy. Thus, the pulsed dye laser (595 nm) appears to be a safe and efficacious treatment modality in the management of chest keloids.

Combining intralesional steroid injection with oral steroids in patients with idiopathic granulomatous mastitis.

Idiopathic granulomatous mastitis (IGM) is a chronic inflammatory breast disease. Currently, there is no international standard for steroid use in IGM, particularly for intralesional steroid injections. This study aimed to determine whether patients with IGM who received oral steroids could benefit from intralesional steroid injection. We analyzed 62 patients with IGM whose main clinical presentation was mastitis masses and who received preoperative steroid therapy. Group A (n = 34) received combined steroid treatment: oral steroids (starting dose, 0.25 mg/kg/d; tapered off) and intralesional steroid injection (20 mg per session). Group B (n = 28) received oral steroids only (starting dose, 0.5 mg/kg/d; tapered off). Both groups underwent lumpectomy at the end of steroid treatment. We analyzed the preoperative treatment time, preoperative mass maximum diameter reduction rate, side effects, postoperative satisfaction, and rate of IGM recurrence. The mean age of the 62 participants was 33.6 ± 2.3 (range, 26-46) years, and all had unilateral disease. We found that oral steroids combined with intralesional steroid injection yielded better therapeutic effects than did oral steroids alone. The median maximum diameter reduction of the breast mass was 52.06% in group A and 30.00% in group B (P = .002). Moreover, the use of intralesional steroids reduced the duration of oral steroid use; the median durations of preoperative steroid therapy were 4 and 7 weeks in groups A and B, respectively (P < .001). Group A patients were more satisfied (P = .035) with the postoperative results, including postoperative appearance and function. No statistically significant between-group differences were noted regarding side effects and recurrence rates. Preoperative administration of oral steroids combined with intralesional steroid injection yielded better therapeutic effects than did oral steroids alone and may be an effective future treatment for IGM.

A Clinicopathological Study of OSMF to Evaluate the Response After Treatment with Intralesional Steroid Versus Intralesional Steroid Plus Hyaluronidase.

Oral submucous fibrosis (OSMF) is a chronic debilitating and a well-recognized potentially malignant condition of the oral cavity, sometimes involving oropharynx associated with trismus and burning sensation. Apart from medical management and counselling, local injection of hyaluronidase mixed with triamcinolone acetonide has been used at our centre for the last 20 years with satisfactory clinical results and without any significant side effects. The problem with the treatment was that the doses and duration of treatment has not been standardized. Therefore, in this study, authors aim to evaluate and compare the efficacy of Triamcinolone alone versus Triamcinolone acetonide plus Hyaluronidase at weekly interval and improvement in Clinical and Histopathological staging of disease after 6 weeks of treatment. This study was conducted in Department of Otorhinolaryngology & Head Neck Surgery, with a total sample of 80 participants divided into two Groups, group A received Inj. Triamcinolone acetonide and group B received Inj. Triamcinolone Acetonide and Hyaluronidase 1500 IU at weekly interval. Pre-treatment and post-treatment clinical and histopathological profile of the patients were recorded and analyzed using SPSS 16 software. According to pre-treatment status, the proportion of clinical grades I, II and III were found in proportion 12.5%, 18.8% and 15.0% respectively. No significant difference was found in proportion of various grades between the groups (p = 0.388). At post treatment, the grading was reduced with changed proportion of grades I, II and III cases as 33.8%, 41.3% and 7.5% respectively. There was no significant difference in proportion of various grades between the groups (p = 0.681). Further, the intragroup comparison showed significant improvement Pre to post in group A (p = 0.002), Group B (p < 0.001) and overall, as well (p < 0.001). The inj. Triamcinolone acetonide and Inj. Hyaluronidase showed a better improvement on post treatment histopathological grading although the difference between the two groups was not significant statistically.

Cost-Effectiveness of Steroids for Prolonging the Surgery-Free Interval in Subglottic Stenosis.

Repeat endoscopic dilation (ED) in the operating room for subglottic stenosis (SGS) remains an economic burden to patients. The cost-effectiveness (CE) of adjuvant serial intralesional steroid injections (SILSI) to prolong the surgery-free interval (SFI) in SGS patients requiring ED has yet to be studied. Details of the cost of SILSI and ED were received from our tertiary academic center. SFI, cost of intervention, and the effect of SILSI on prolonging SFI were collected from a systematic review by Luke et al. SGS etiologies in the review included idiopathic, iatrogenic, or autoimmune. A break-even analysis, comparing the cost of SILSI alone with the cost of repeat ED, was performed to determine if SILSI injections were cost-effective in prolonging the SFI. Average extension of the SFI with SILSI was an additional 219.3 days compared to ED alone based on a systematic review of the literature. 41/55 (74.5%) cases did not require further ED once in-office SILSI management began. SILSI administered in a 4-dose series in 3-to-7-week intervals (~$7,564.00) is CE if the reported recurrence rate of SGS requiring ED (~$39,429.00) has an absolute risk reduction (ARR) of at least 19.18% with the use of SILSI. Based on the literature, SILSI prevents ~3 out of every 4 cases of SGS at sufficient follow-up from undergoing repeat ED, resulting in an ARR of ~75%. SILSI is economically reasonable if it prolongs the SFI of at least one case of recurrence out of 5. SILSI, therefore, can be CE in extending the interval for surgical ED. NA Laryngoscope, 133:3436-3442, 2023.

Efficacy and Safety of Detachable Microneedle Patch Containing Triamcinolone Acetonide in the Treatment of Inflammatory Acne.

Detachable microneedles (DMNs) are dissolvable microneedles that detach from the base during administration. The use of DMNs-containing steroids for acne has never been investigated. Thirty-five patients with facial inflammatory acne were evaluated for acne treatment efficacy and safety of DMNs and DMNs containing triamcinolone acetonide (TA) via a 28-day randomized, double-blind, controlled trial. Four inflammatory acne lesions were selected from each participant and randomly treated with a single application of 700 µm DMNs containing 262.02 ± 15.62 µg TA (700DMNTA), 1000 µm DMNs containing 160.00 ± 34.92 µg TA (1000DMNTA), 700 µm DMN without TA (700DMN), and a control. Efficacy was measured by assessing physical grading, diameter, volume, erythema index, and melanin index. Safety was evaluated by assessing reports of adverse effects from patients and physicians. All three treatment groups achieved resolution of inflammatory acne significantly faster than the control group, with median times for resolution of 4.6, 5.25, 6.7, and 8.1 days in the 1000DMNTA, 700DMNTA, 700DMN, and control, respectively. When compared to the control group, the diameters and post-acne erythema of inflammatory acne were significantly reduced in the treatment groups. The 1000DMNTA decreased acne size and erythema more than other treatments. DMNTA also tended to decrease acne size and erythema more than DMN with no TA, but there was no statistically significant difference. All participants preferred DMN over conventional intralesional steroid injection due to less pain and self-application. No adverse effect was observed. DMNTA is a safe, effective alternative treatment for inflammatory acne and significantly reduces post-acne erythema.

TREATMENT OF KELOIDS AND HYPERTROPHIC SCARS BY COMBINED CRYOTHERAPY AND INTRALESIONAL TRIAMCINOLONE

Objectives: To evaluate the outcomes of combining cryotherapy and intralesional triamcinolone in the treatment of keloids and hypertrophic scars. Methods: 60 patients (31 males and 29 females) with 266 keloids and 34 hypertrophic scars were enrolled and divided equally into 2 groups. Group 1 were treated with cryotherapy in combination with intralesional triamcinolone 20 mg/ml (treated group) and group 2 (control group) were treated with intralesional triamcinolone alone 20mg/ml. The duration of treatment for both groups was 12 weeks with 4 sessions. The assessment of therapeutic responses was made at baseline, after 4, 8, 12 and 16 weeks. Results: After treatment, in terms of thickness, the keloids and hypertrophic scars responded significantly better to combined cryotherapy and triamcinolone than triamcinolone alone (p &lt; 0.05): 1.3% had excellent improvement, 46.4% had good improvement and 41.2% had moderate improvement and 11.1% had little improvement. Meanwhile, in control group, the percentage for each degree of improvement were 1.4%, 16.7%, 55.6% and 26.4%, respectively. Ultrasound revealed an average reduction of scar height in treated group (2.4 ± 1.3 mm), which was higher than the result in control group (1.8 ± 0.4 mm) (p &lt; 0.05). Side effects in treated group including pain, blister, hypopigmentation, longer healing time, acne, and troublesome with menstrual cycles were sometimes were reported. No significant side effects were reported in both groups. Conclusion: Combining cryotherapy with injection of intralesional steroids appeared to be superior in comparision with intralesional steroids alone in treatment of keloids and hypertrophic scars without severe side effects.

Role of Erbium YAG laser in management of scar at donor site of split thickness skin grafting

A variety of revision treatments available for managing different types of scars, including laser therapy, chemical peeling, cryotherapy, dermabrasion, soft tissue augmentation, intralesional steroid injection, and surgical excision. Rhytides, dyschromias, and specific kinds of scars are among the epidermal and dermal lesions that are successfully treated using erbium YAG lasers. In this study, the use of the Erbium YAG laser to treat scars at the site of skin grafting is highlighted.

Investigation of Adverse Reactions in Tattooed Skin through Histological and Chemical Analysis

Background: Just as the number of tattooed people has increased in recent years, so has the number of adverse reactions in tattooed skin. Tattoo colourants contain numerous, partly unidentified substances, which have the potential to provoke adverse skin reactions like allergies or granulomatous reactions. Identification of the triggering substances is often difficult or even impossible. Methods: Ten patients with typical adverse reactions in tattooed skin were enrolled in the study. Skin punch biopsies were taken and the paraffin-embedded specimens were analysed by standard haematoxylin and eosin and anti-CD3 stainings. Tattoo colourants provided by patients and punch biopsies of patients were analysed with different chromatography and mass spectrometry methods and X-ray fluorescence. Blood samples of 2 patients were screened for angiotensin-converting enzyme (ACE) and soluble interleukin-2 receptor (sIL-2R). Results: Histology showed variable skin reactions such as eosinophilic infiltrate, granulomatous reactions, or pseudolymphoma. CD3+ T lymphocytes dominated the dermal cellular infiltrate. Most patients had adverse skin reactions in red tattoos (n = 7), followed by white tattoos (n = 2). The red tattooed skin areas predominantly contained Pigment Red (P.R.) 170, but also P.R. 266, Pigment Orange (P.O.) 13, P.O. 16, and Pigment Blue (P.B.) 15. The white colourant of 1 patient contained rutile titanium dioxide but also other metals like nickel and chromium and methyl dehydroabietate – known as the main ingredient of colophonium. None of the 2 patients showed increased levels of ACE and sIL-2R related to sarcoidosis. Seven of the study participants showed partial or complete remission after treatment with topical steroids, intralesional steroids, or topical tacrolimus. Conclusions: The combination of the methods presented might be a rational approach to identify the substances that trigger adverse reactions in tattoos. Such an approach might help make tattoo colourants safer in the future if such trigger substances could be omitted.

A Case of Subcutaneous Sarcoidosis Treated With Intralesional Kenalog

Abstract Sarcoidosis is a granulomatous disorder that is characterized by the development of noncaseating granulomas affecting multiple organ systems, most commonly the lungs and lymph nodes of the body. Aside from these organ systems, sarcoidosis can also affect the skin, eyes, central nervous system, liver, heart, kidneys, and musculoskeletal system. We present a patient with subcutaneous sarcoidosis, also known as Darier-Roussy disease, without extracutaneous findings. Patients may benefit from topical or intralesional steroids for localized involvement to decrease the size of the nodules while avoiding the adverse effects of systemic medications.

A CASE REPORT- ORAL SUBMUCOUS FIBROSIS

The condition known as oral submucous fibrosis (OSMF), which is mostly brought on by the chewing of areca nuts, manifests as a burning sensation, paleness of the oral mucosa, a palpable fibrous band, and restricted mouth opening. The stages of OSMF, which are based on clinical and pathological grading, determine the appropriate course of treatment. For trismus alleviation and repair surgery for any malignant transformation, patients with OSMF need treatment. A 58-year-old woman who had a limited mouth opening and complained about pain as well as a burning sensation when eating was seen. The patient had oral physiotherapy in addition to intralesional steroids (Dexamethasone 4 mg and Hyaluronidase 1500 I.U.). The effects of chewing areca nuts and their propensity to cause cancer have been explained to the patient

Restylane: What we know

AbstractRestylane is a hyaluronic acid‐based facial and hand dermal filler line used for cutaneous augmentation and fold‐crease reduction approved by the United States Food and Drug Administration (FDA) in 2003. It is sourced from nonanimal products which confers low immunogenicity and mitigates risk of hypersensitivity reactions and forgoes the need for allergy testing. Restylane has been observed to have excellent longevity secondary to its unique cross‐linking properties, lasting in the skin for up to 12 months. Despite its relatively low‐risk profile, case reports indicate injection site reactions being common, with more serious adverse events being very rare. In these cases, dissolution of Restylane is performed with hyaluronidase, while intralesional steroids can be utilized to manage unwanted inflammatory reactions. Overall, its low reaction potential, established safety profile, facial filler product‐line consistency as well as indication diversity, and prolonged mechanism of action have been leading factors in its continued popularity over the past two decades.

Intralesional steroid injections for inflammatory nail dystrophies in the pediatric population.

Intralesional injections of triamcinolone acetonide are widely used to successfully treat several inflammatory nail conditions. This procedure is well described in adults, but less frequently reported in children and teenagers, being largely considered too invasive and fear-provoking for pediatric patients. Our report shows how this procedure is feasible and successful in children, even without a digital block. The step-by-step technique and tips to reduce pain should encourage clinicians to offer it as an alternative option to children with inflammatory nail disorders.

A rare case of inclusion body fibromatosis

Infantile digital fibromatosis is a marked fibrous proliferation of infancy characterized by occurrence in the fingers and toes and a marked tendency for local recurrence. It accounts for 0.2% of registered soft tissue tumors. The lesion rarely exceeds 2 cm and tends to regress spontaneously. The presence of characteristic inclusion bodies in the cytoplasm of neoplastic fibroblasts distinguishes it from other fibromatosis. Current treatment recommendations include function-preserving excision and intralesional steroid injections for symptomatic lesions. Although lesions recur more than 60% of the time after excision, the ultimate prognosis is excellent.

Treatment of Vocal Fold Nodules: Transnasal Steroid Injection Versus Microlaryngoscopic Phonomicrosurgery

Vocal fold nodules (VFNs) are bilateral, mid-membranous, swellings of the vocal folds. Intralesional steroid injection was successfully tried in the management of benign vocal fold lesions including nodules. The aim of the present study was to compare treatment outcomes of vocal fold steroid injection (VFSI) and surgery in patients with VFNs in terms of lesion regression, subjective, and objective voice parameters. Nonrandomized controlled clinical trial. This bicenter interventional study was conducted on 32 patients with VFNs, in the age range of 16-63 years. Sixteen patients underwent transnasal VFSI under local anesthesia (the injection group), and 16 underwent surgical excision of the nodules under general anesthesia (the surgery group). Prior to intervention and at the follow-up visit, participants were subjected to videolaryngoscopic examination with evaluation of nodules' sizes as well as subjective voice assessment by auditory perceptual assessment (APA) of voice and the international nine-item Voice Handicap Index (VHI-9i). Objective voice assessments including the measurements of cepstral peak prominence, jitter, shimmer, harmonic to noise ratio, and maximum phonation time were also administered. The size of vocal fold nodules was significantly decreased postintervention in both studied groups. There was a decrease in the VHI-9i score, a decrease in the values of jitter and shimmer, together with an increase in the values of cepstral peak prominence and maximum phonation time after interventions indicating improvement of subjective and objective voice outcomes in both groups. Office-based transnasal VFSI is a safe and tolerable therapy option for VFNs. Voice outcomes of VFSI were comparable to surgery, hereby VFSI can be considered a promising therapy for VFNs and could be used as an alternative to surgery in selected cases.

FUNCTIONAL OUTCOME FOLLOWING PERCUTANEOUS RELEASE OF TRIGGER FINGER IN A TERTIARY CARE CENTRE

Background: Trigger nger is a common clinical disorder caused by irritation of the exor tendon as it slides through the bro-osseous sheath and characterized by pain and catching as the patient exes and extends digits because of disproportion between the diameter of exor tendons and the A1 pulley. Its surgical options include open and percutaneous minimally invasive methods. A prospective study was conducted in Methods: Gauhati Medical college and Hospital over the course of 4 months in which 23 patients aged 23-66 years presenting with trigger nger were treated with percutaneous release. Percutaneous trigger nger release of A1 pulley was done with the help of 18G hypodermic needle under local anaesthetic cover as a day care procedure. Subsequently the patient was followed up at 1 week,3 weeks and 2 months. Outcome was assessed by level of satisfaction, complications, days to resume work and complications Results:All patients were completely resolved of their symptoms with no serious complications. 3 patients had temporary wound related complications which was resolved in 3 days .2 patients had temporary stiffness which resolved completely within a month. Percutaneous release of trigger nger Conclusion: is effective, convenient, cost effective day care surgery without any signicant complications and presents a suitable alternative to intralesional steroids

Mucocele of the lower lip: A case report of a benign salivary gland cyst

We report a case of Mucocele in a 35-year-old male patient. Mucoceles are one of the most frequent lesion of the oral mucosa. The most common affected site is the lower lip. The most common treatment for mucocele is excision, however recurrence is common. Other treatment modalities available are Cryosurgery, CO 2 laser ablation, Intralesional steroid injection, and Diode lasers.

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.

Long-Term Follow-up of 64 Patients With Idiopathic Subglottic Stenosis: Treatment Pathways, Outcomes, and Impact of Serial Intralesional Steroid Injections.

To describe treatment pathways and long-term outcomes in 64 patients with idiopathic subglottic stenosis (iSGS), including the impact of serial intralesional steroid injection (SILSI) on degree of stenosis, need for subsequent operation, and patient-reported outcome measures. Retrospective review of 64 female patients with iSGS undergoing varied management approaches, 57 of whom underwent SILSI as at least part of their care. Treatment pathways included SILSI only, endoscopic intervention followed by SILSI only, endoscopic interventions only, endoscopic intervention followed by SILSI followed by need for repeat endoscopic intervention, open surgery, and tracheotomy. Outcomes assessed included subjectively estimated percent airway stenosis, dyspnea index (DI), modified medical research council (MMRC) dyspnea scale, voice handicap index-10 (VHI-10), number of operative and office-based procedures performed, need for subsequent operative intervention, and inter-operative interval. Treatment pathways included SILSI alone (n = 6), endoscopic intervention(s) followed by SILSI only (n = 31), SILSI followed by additional endoscopic or office-based procedures (n = 16), open surgery (n = 3), and tracheostomy (n = 4). 57 of 64 patients underwent SILSI as at least part of their treatment. Inter-operative interval was increased after starting SILSI. Of patients undergoing SILSI, those with more procedures or shorter inter-operative interval prior to SILSI were more likely to return to the operating room. Estimated stenosis, DI, MMRC, and VHI-10 decreased with SILSI. Stenosis was not correlated with DI, MMRC, or VHI-10, though DI was correlated with both MMRC and VHI-10 score. Of 57 patients undergoing SILSI, 37 did not require further operative intervention. Improvements in inter-operative interval, dyspnea, and voice were observed across patients. Randomized trials to identify which patients may benefit most from SILSI are warranted.