Intralesional Triamcinolone Acetonide Research Articles

Efficacy of intralesional injections of platelet-rich plasma in patients with oral lichen planus: A pilot randomized clinical trial.

ObjectiveTo evaluate the clinical efficacy of intralesional platelet‐rich plasma (PRP) injections compared to intralesional triamcinolone acetonide (TA) injections in the treatment of erosive oral lichen planus (EOLP).Material and MethodsTwenty patients with EOLP were assigned randomly to either PRP or TA group. Patients received weekly intralesional injections for 4 weeks, and then followed up for 3 months on regular visits every 2 weeks. Pain scores using numerical pain score and clinical score were recorded by a blinded assessor each visit for all patients and remission score at the end of the trial was recorded.ResultsBoth groups showed significant improvement in the clinical parameters (pain and clinical score) “p = .001.” Regarding remission of the lesions, 80% of patients in the PRP group showed complete remission compared to 70% in the TA group. However, there is no statistical significance when comparing the two groups in pain score, clinical score, or remission.ConclusionsPRP injections could be considered as an effective alternative single treatment modality for EOLP. The protocol for this study registered in Clinicaltrials.gov registry under the identifier number: NCT03293368.

EFFICACY OF SURGICAL EXCISION COMBINED WITH INTRALESIONAL TRIAMCINOLONE ACETONIDE THERAPY IN EAR KELOID: CASE SERIES

Keloids occur due to abnormal wound healing resulting in extension of raised scar tissue beyond its original margins and rarely they regresses spontaneously. The etiology of keloid is still not clear. Cosmetic concerns, pain, erythema, pruritus, paresthesia, and impairment of function are all keloid related symptoms. There is no single effective treatment for keloids. Keloid’s surgical excision in absence of any adjuvant therapy is considered obsolete due to the high recurrence rate. Corticosteroids are also used as adjuncts to surgical excision to prevent a recurrence. In this prospective, interventional, and case series, six subjects with ear keloid were treated for pre-operative three doses of intralesional Triamcinolone acetonide (TA) injection followed by surgical excision and post-operative two doses of Triamcinolone acetonide injection at the scar site. No signs of recurrence were shown in any lesion.

A Study of Management of Primary Chalazion in Adults by Intralesional Injection of Triamcinolone Acetonide

Abstract Introduction A chalazion is a common non-effective granuloma of the meibomian glands of eyelids. They are commonly found on the tarsal conjunctival surface and the eyelid margins. It may be ignored by the patients until it reaches a considerable size. Recently the use of intralesional corticosteroids has shown promising results. We in the present study tried to evaluate the outcomes of intralesional triamcinolone acetonide injection in the management of Chalazion. Methods The current study was carried on Patients with chalazion attending Ophthalmology OPD of Rajiv Gandhi Institute of Medical Sciences, [RIMS], Adilabad. Successive patients with small multiple marginal chalazia were included. Patients were selected based on the amenability of treatment with intralesional triamcinolone acetonide injections. A chalazion is a common non-infective granuloma of the meibomian glands of eyelids. They are commonly found on the tarsal conjunctival surface and the eyelid margins. It may be ignored by the patients until it reaches a considerable size. Recently the use of intralesional corticosteroids has shown promising results. We in the present study tried to evaluate the outcomes of intralesional triamcinolone acetonide injection in the management of Chalazion. Results Group I with very small-sized chalazia< 5 mm out of n=22 included in Group I resolution after one week following treatment was found in 72.72%. Resolution following repeated injection after one week was found in 18.18%. In group II (chalazia size 5-7 mm) out of n=28 cases, 46.24% resolved after first injection and 39.28% cases resolved after the second injection and no resolution was found in 14.28% cases after one month. Conclusion Patients with small chalazia who are not amenable to incision and curettage intralesional triamcinolone acetonide injection appear to be a better option. Intralesional triamcinolone acetonide injections were found to be effective in resolving acute and sub-acute chalazia of soft to firm consistency irrespective of their duration.

Pulse dye laser therapy and superficial cryotherapy as a novel combination treatment for hypertrophic scars and keloids

Background: Hypertrophic scars are benign and fibrotic skin lesions caused by defects in the regulation of cellularity during the wound-healingprocess, in which there is higher collagen production and less degradation. Genetic predisposing factors and different skin injuries may play a role in developing these types of lesions. On the other hand, keloids are overgrowths of fibrous tissue outside the original boundaries of trauma, yet these may also occur spontaneously. There are numerous treatment options for both conditions, including silicone gel sheeting, pressure therapy, intralesional triamcinolone acetonide, radiation, laser therapy, cryosurgery, interferon, 5-fluorouracil, and surgical excision as well as a multitude of extracts and topical agents. Objective: The objective was to evaluate the effectiveness of pulse dye laser (PDL) therapy and superficial cryotherapy as a combination treatment for hypertrophic scars and keloids. Method: Four Arabic female patients were seen at the outpatient clinic of the Department of Dermatology at the King Fahd Hospital of the University in Khobar, Saudi Arabia. The patients had keloids and hypertrophic scars. Treatment with cryotherapy every week for three weeks followed by one session of pulsed dye laser was administered rotationally for three to six months until the lesions displayed remarkable physical improvement or complete resolution. Results: All patients experienced significant improvement, showing a reduction in the size, erythema, pliability, and pruritus. None of the hypertrophic scars or keloids deteriorated during the one year of treatment. No complications were noted during the treatment period. Conclusion: Sequential PDL therapy combined with superficial cryotherapy may be an option for treating hypertrophic scars and keloids.

Concomitant therapy of surgical shave excision and intralesional injections for ear keloids: Early results from a retrospective cohort study.

IntroductionKeloids are hypertrophic scars that commonly arise in the ear region. The authors’ objectives were to (1) evaluate effectiveness of surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections; and (2) evaluate safety and patient satisfaction.Methods and MaterialsThis study was a retrospective chart review of patients who received treatment of extralesional surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections to treat ear keloids at a single outpatient dermatology clinic. A prospective patient questionnaire was administered to the same patient population to collect recurrence and patient satisfaction.ResultsA total of 45 patients were included, consisting of 84.4% females (n = 38) and 15.6% males (n = 7) with a mean age of 25.5 years. Through retrospective chart review, early recurrence was seen in 6.7% of patients (n = 3), and via the prospective patient questionnaire, 11.1% of patients noted early keloid recurrence (n = 5). Of the patients who expressed their level of satisfaction in-clinic, 96.0% (n = 24) reported being satisfied or very satisfied and 4.0% (n = 1) were dissatisfied. Satisfaction was also assessed through the prospective patient questionnaire; of those who consented to the questionnaire, 100.0% (n = 24) were satisfied or very satisfied. Only 20.0% (n = 9) of all patients reported experiencing side effects, consisting of pruritus (11.1%; n = 5), tenderness (4.4%; n = 2), pain (2.2%; n = 1), and mild atrophy (2.2%; n = 1).ConclusionExtralesional surgical shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections may represent a promising treatment option for ear keloids.Evidence Level: 3 retrospective cohort study.Lay SummaryKeloids are a type of raised scar, which can be painful and itchy for patients. Keloids can occur on various part of the body, including on the ear. They are challenging to treat and tend to come back. There are many treatment options, however, there is not one universal best treatment for keloids on the ear. We hoped to discover if shave excision followed by intralesional triamcinolone acetonide and onabotulinumtoxinA injections is effective at treating keloids on the ear. In order to answer this we completed a chart review of clinic patients, who have already completed the following combination treatment for keloids on the ear. The keloids were treated first by physically removing the bulk of the keloid with a scalpel, which is called shave excision. After the removal, triamcinolone acetonide and onabotulinumtoxinA were injected directly into the keloid. The rate of patient satisfaction and the rate of the keloid returning were collected during in-clinic visits and an optional post-clinic patient questionnaire. The treatment effectiveness and side effects experienced were reported during in-clinic visits. This indicated that with the low rate of side effects, high patient satisfaction, and low rate of keloid return, this treatment combination should be considered as an option for keloids on the ear. However, since this review was completed at one clinic with a small population of patients, it is not fully known if this treatment combination will work for all patients.

A Comparative Study of the Efficacy of Intralesional 5 Fluorouracil vs Combination of 5 Fluorouracil with Triamcinolone Acetonide in Keloids.

Keloids are defined as scars that invade the adjacent tissues and rarely regress. In recent years, antimitotic drugs have been used in the management of keloids with promising results. This study highlights the effectiveness of 5-fluorouracil (5-FU) in keloids. To study the efficacy of intralesional 5-FU in keloids as a solo agent and in combination with triamcinolone acetonide and to study the side effects of both the drugs. A total of 30 patients with keloids were randomly allocated into two groups. Group A received 50 mg/mL of 5-FU intralesionally. Group B patients received a combination of 40 mg/mL of intralesional triamcinolone acetonide and 50 mg/mL of 5-FU. The patients were observed for immediate and delayed complications and the treatment was continued for a total of 3 months. ANOVA, Mann-Whitney test, Fisher's test, Chi-square test. The patients in both groups showed a significant reduction in the size and thickness of the lesions. The reduction in the length of keloid was highly significant in both the groups but in comparison, there was no statistically significant difference in the reduction of lesions among both the groups. Hence, both modalities of treatment can be claimed to be equally efficacious. The therapeutic response was good to excellent in most patients with only one patient opting out of the therapy in the 5-FU group due to the inability to tolerate the pain. The common side effects noted were pain, itching, ulceration, burning sensation, and bulla formation. 5-FU, both as a single agent or in combination with steroids is equally efficacious in reducing the keloid size. The side effects are lesser with the combination group.

Clinical Evaluation of Efficacy of Triamcinolone Acetonide with Tacrolimus in the Management of Oral Lichen Planus: A Pilot Prospective Observational Study.

Introduction:Lichen planus (LP) is a relatively common chronic, mucocutaneous disease of autoimmune origin, involves oral mucosa, skin, scalp, nails, and genital mucosa. The prevalence of oral LP (OLP) varies worldwide, commonly seen in middle-aged and elderly people. It usually presents as symmetrical and bilateral or multiple lesions with burning sensation (BS) sometimes accompanied by pain. Corticosteroids and calcineurin inhibitors have shown promising results in the treatment of OLP, but its chronic course and unpredictable exacerbations/remission continues to result in a high degree of morbidity. The study aimed to evaluate the efficacy of intralesional triamcinolone acetonide (injection TA) combined with topical application of TA orabase and Tacrolimus (TAC) ointment for symptomatic cases of OLP.Materials and Methods:The prospective study included 52 symptomatic OLP patients to receive (0.5 ml) intralesional injection of TA once a week for the first 4 weeks followed by one injection in the 6th week along with TA mucosal paste (0.1%.) and TAC ointment (0.03%) in tapering dose till 8th week. The subjective symptoms including BS and pain were assessed on a 10 cm visual analog scale (VAS) and objective signs like size and site of the lesion were scored according to criterion scale modified by Thongprasom et al. Differences were compared after 8 weeks treatment course and follow-up observations were performed at 20th week to record any recurrent lesion.Results:41 patients (78.8%) had complete remission of disease and 11 (21%) had shown partial improvement. The VAS scores for BS and pain improved significantly. Improvement was also noted with decrease in the average size of active lesions and the number of sites with treatment. The relapse was seen in 17 patients (41%) in the 20th week.Conclusion:TA combined with TAC is a valuable therapeutic option for the treatment of symptomatic OLP. Our findings suggest that patients have shown statistically significant improvement.

Comparison of Surgical Excision with Aspiration followed by Intra-lesional Steroid Injection in Managing the Dorsal Wrist Ganglion

Objective: To evaluate the outcomes of surgical excision vs aspiration combined with intralesional triamcinolone acetonide injection in the treatment of dorsal wrist ganglion (DWG). Methods: A total of 60 patients with diagnosis of DWG from January-2020 to December-2020 from Islam Teaching Hospital Sialkot were recruited for this comparative study. Two groups of patients were formed based on the kind of therapy they received. Aspiration and Triamcinolone acetate (triamcinolone acetate) injections were used in Group A. Treatment in Group B was comprised of aspiration followed by surgical excision. Follow-up was done at one, three, six, and twelve months after therapy ended. The absence of the cyst on the patient's last visit was considered proof of a successful therapy. Treatment was deemed ineffective if recurrence occurred. Results: Among 60 patients, 37 (61.7%) were female and 23 (38.3%) were males. The most common presenting symptom was swelling found in 60 (100%) patients, followed by pain/discomfort in 48 (80%) patients. Recurrence occurred in 5 (16.7%) patients in group B and in 4 (13.3%) patients in group A. The 1-year success rate was 86.7% in group A and 83.3% in group B (p-value 0.71). Conclusion: Aspiration followed by triamcinolone acetone injection is a good alternative to surgical excision in DWG patients. Keywords: Aspiration, Surgical excision, Dorsal wrist ganglion.

An approach to treatment modalities of keloids: a comparative study

<p class="abstract"><strong>Background:</strong> In spite of the presence of such an array of treatment modalities, none of these can be claimed to be an ideal treatment option as most of them have limited efficacy, significant side effects or increased chances of recurrence. Hence the study was undertaken to search an ideal treatment for keloids which is safe, effective, and with low rate of recurrence.</p><p class="abstract"><strong>Methods:</strong> Total of 200 patients were recruited out of which only 160 patients were included in study. The patients were divided into three groups and administered with different modes of treatment. Patients in all the groups were followed up at 3 weekly intervals for evaluation of response. At the end of the study, the data was compiled and analysed using appropriate statistical tests.<strong></strong></p><p class="abstract"><strong>Results:</strong> In only 32 patients completed study in group 1, 2 and 3 respectively. Group 1, 2 and 3 were more or less equally efficacious with clearance rate. Complete clearance was seen in 24 patients in group 1 patients, in group 2 there were 22 patients with complete clearance and in group 3 there were 24 patients.</p><p class="abstract"><strong>Conclusions:</strong> Intralesional triamcinolone acetonide, intralesional triamcinolone acetonide with hyaluronidase and intralesional radiofrequency with intralesional triamcinolone acetonide are almost equally effective modalities for the treatment of keloids. But, intralesional triamcinolone acetonide with hyaluronidase fares better than other two as far as safety is concerned with least side effects.</p><p class="after-h2"> </p>

To compare the efficacy and safety of intralesional kenacort injection vs surgical intervention (Incision and Curettage) in primary Chalazion

ABSTRACT 
 
 PURPOSE
 To compare the efficacy and safety of intralesional steroid injection versus surgical intervention (Incision and Curettage) in Primary Chalazion.
 
 STUDY DESIGN
 A six months prospective, comparative and interventional hospital based study.
 PLACE AND DURATION OF STUDY
 Study was done at Shaheed Mohtarma Benazir Bhutto Medical College Lyari and Sindh Government Lyari General Hospital, Karachi. Duration of study was six months from 15th October, 2016 to 15th April, 2017.
 
 MATERAILS AND METHODS
 
 This was a Prospective, Comparative, Interventional study with the use of probability sampling technique. The Study was conducted at Shaheed Mohtarma Benazir Bhutto Medical College Lyari and Sindh Government Lyari General Hospital, Karachi for duration of six months from 15th October, 2016 to 15th April, 2017.
 
 50 eyes of 50 patients between the age group of 15 to 40 years and of either gender diagnosed with chalazion on clinical basis from the Out patients department of Ophthalmology of Shaheed Mohtarma Benazir Bhutto Medical College Lyari were included in the study. All patients were randomly divided into two groups with 25 patients in each group. Group 1 received intralesional 0.2 ml triamcinolone acetonide while Group 2 received surgical intervention (Incision and Curettage).
 
 RESULTS
 In a total of 50 patients the mean age was 25±12.2 with male to female ratio of 2:1. 19 (76%) patients achieved complete resolution of chalazion after intra lesional triamcinolone acetonide in group I and 21 (84%) patients out of 25 achieved complete resolution of chalazion after incision and curettage in group II. No ocular complication such as bleeding, elevation of intra ocular pressure, eye lid de-pigmentation or any loss of vision in either group was observed.
 
 CONCLUSION
 Intra lesional triamcinolone acetonide injection is equally effective as incision and curettage in primary chalazion. It means it is a good alternative first line treatment in cases where diagnosis is straight forward.
 
 KEYWORDS
 Intra Lesional Triamcinolone Acetonide, Surgical Intervention

The use of intralesional corticosteroid combined with narrowband ultraviolet B in vitiligo treatment: clinical, histopathologic, and histometric evaluation

Treatment of vitiligo with intralesional steroid (ILS) injections has shown to be successful in quite a few studies. It is a simple and safe treatment when used with caution with a better response in localized lesions. The aim of the present study is to explore the efficacy and safety of using different concentrations of intralesional corticosteroid combined with NB-UVB phototherapy in the treatment of non-segmental vitiligo (NSV) patients. Twenty patients with non-segmental vitiligo were subjected to different concentrations of ILS injections (triamcinolone acetonide); that was carried out monthly for six sessions. All patients were also subjected to twice-weekly sessions of NB-UVB for 6 months. Punch biopsy was taken from each patch before and at the end of treatment sessions. Each biopsy was stained with hematoxylin and eosin (H&E), Orcein, and Masson's trichrome stains. There was a significant difference between all groups in their repigmentation response (P = 0.017). After treatment, the epidermal thickness (histometry) was decreased (epidermal atrophy), especially with concentrations of 2.5 and 5 mg/ml of intralesional triamcinolone acetonide injection with decreased and disorganized collagen fibers. Intralesional corticosteroid injections combined with NB-UVB showed a good and well-tolerated therapeutic option for vitiligo. The concentrations of 0.625 and 1.25 mg/ml of triamcinolone acetonide were the safest with fewer side effects and complications. However, higher concentrations of 2.5 and 5 mg/ml were more effective but with more side effects.

EFFICACY OF INTRALESIONAL VERAPAMIL HYDROCHLORIDE VERSUS INTRALESIONAL TRIAMCINOLONE ACETONIDE IN HYPERTROPHIC SCARS AND KELOIDS

Background: Keloids and hypertrophic scars are dermal fibro-proliferative disorders lead to disfigurement, pain and pruritus. Their management is still challenging as there is no universally accepted treatment regimen. Corticosteroid injections, most commonly triamcinolone acetonide, continue to play a major role in the management of keloids. Verapamil is a phenylalkylamine calcium channel blocker antiarrhythmic agent that has antifibrotic effect. Objective: To compare efficacy of intralesional verapamil hydrochloride and triamcinolone acetonide in hypertrophic scars and keloids. Patients and methods: Forty Egyptian patients with keloids or hypertrophic scars were divided into two equal groups. The patients were recruited from the Dermatology outpatient clinics of Al-Zahraa University Hospital during the period from May 2016 to May 2017. Informed written consents were obtained from all patients. Group A: Intralesional Verapamil Hydrochloride. Group B: Intralesional Triamcinolone Acetonide. The efficacy of treatment was evaluated by Digital photography and Vancouver scar scale before and after treatment. Two- fine millimeter punch biopsies were taken from 5 patients of the verapamil group before and after treatment to demonstrate the histopathological changes induced by verapamil. Results: Both drugs improved total Vancouver scar scale, vascularity score and pliability score of keloid or hypertrophic scar nearly equally with no statistical significant difference. Both drugs improved height of keloid or hypertrophic scar significantly, but triamcinolone showed better improvement. Verapamil highly improved pigmentation score of keloids and hypertrophic scars, but triamcinolone showed non- significant improvement. Side effects were reported in 4 patients of triamcinolone group with no side effects in verapamil group. The histopathological examination after treatment with verapamil injection showed marked reduction of collagen deposition and alteration of the fibroblast shape (from elongated to spherical), and these changes are similar to histopathological changes which occur after corticosteroids injection. Conclusion: Verapamil was among the several therapeutic modalities, have an option for keloids and hypertrophic scars with an extremely low cost and fewer adverse effects.

Comparative efficacy of intralesional verapamil hydrochloride, triamcinolone acetonide and combination of both drug in hypertrophic scars and keloids at tertiary care center

Background: Keloids and hypertrophic scars are still a therapeutic problem. Despite numerous proposed therapies reported in the literature, the management of keloid and hypertrophic scars is still challenging as there is no universally accepted treatment regimen. Compare the efficacy intralesional verapamil hydrochloride and triamcinolone acetonide separately as well as combination of both drug in treatment of hypertrophic scars and keloids.Methods: A retrospective study was carried out at the general surgery department (plastic surgery unit) at the JNUIMSRC Jaipur, Rajasthan. Total of 150 patients (60 males and 90 females) between 18 to 60 years of age were enrolled fulfilling the inclusion criteria. They were randomly categorized in to three groups (group A, B and C), based on treatment they received viz. verapamil alone, triamcinolone alone and combination of both drugs respectively. Assessment of the scars were done prior to or on the day of the first injection and at 24 weeks after the end of injection scheme by Vancouver scar scale (VSS). The decreasing values reflected clinical improvement of the scar.Results: Better improvement observed in all four parameters: height, vascularity, pliability and pigmentation among patients receiving combination of both triamcinolone-verapamil drugs as compare to those patients receiving drugs separately either verapamil or triamcinolone alone. For parameters height, pliability and pigmentation, the improvement was found to be statistically significant (p<0.05)Conclusions: Study highlights that the combined verapamil and triamcinolone therapy scheme causes remarkable scar improvement in keloid and hypertrophic scars in comparison to single drug scheme.

Efficacy and Safety of Intralesional Triamcinolone Acetonide Injection in The Treatment of Alopecia Areata

Background: Alopecia areata (AA) is a chronic, immune mediated inflammatory disorder of anagen hair follicles leading to relapsing, nonscarring hair loss. Many therapies are available for the treatment of AA, including topical, systemic, and injectable modalities however, these treatment methods produce variable clinical outcomes and there are no currently available treatments that induce and sustain remission. Intralesional injection of corticosteroids (ILCs) is considered relatively simple, effective, and minimally invasive. Objective: The aim of the work wasto investigate the efficacy and safety of intralesional Triamcinolone acetonide injection in the treatment of AA. Patients and methods: Thirty-six patients suffering from AA were included in the study. All patients were subjected to complete history taking, general examination and dermatological examination for evaluation of site, size of the patches and type of Alopecia. Confirmation of diagnosis was done by dermoscopy. Evaluation of severity of the disease using SALT scoring system was done. After that, all the patients were treated by ILCs (Triamcinolone acetonide). 5 mg/ml of Triamcinolone acetonide was injected and the Injections were repeated every 4 weeks. Patients were assessed clinically at baseline and every month till the end of the sessions and were asked about their satisfaction on hair growth. Side effects were also monitored every session during and after injection. Results: Hair growth after Intralesional Triamcinolone Acetonide treatment ranged from 0 to 5. 5.6% of patients showed excellent response, 5.6% showed very good response, 55.6% showed good response, 5.6% showed moderate response, 16.7% showed mild response while four patients showed poor response. Side effects were minimal like pain and atrophy (11.1%). Conclusion: Intralesional Triamcinolone acetonide injection is safe and effective in the treatment of alopecia areata.

Intralesional pentoxifylline, triamcinolone acetonide, and their combination for treatment of keloid scars.

Keloids are common fibroproliferative tumors, and their treatment still represents a dilemma. Intralesional triamcinolone acetonide (TAC) injection is effective, but frequently associated with side effects. Pentoxifyllin (PTX) is a vasodilator, anti-inflammatory, and antifibrotic agent. Its intralesional injection in keloids has not been evaluated yet. Evaluating the efficacy and safety of intralesional PTX versus intralesional TAC and their combination for treatment of keloids. Thirty patients with keloids were divided into three equal groups and treated by intralesional injection of TAC, PTX, or their combination (admixed in 1:1 ratio). Injections were repeated every 3weeks until lesional flattening or for maximum of 5sessions. The evaluation was done using the Vancouver Scar Scale and the Verbal Rating Scale for pain and itching. A significant improvement in VSS was detected in all groups. Significantly better improvements in keloid height, pliability, pain, and itching were detected in the TAC and combination groups than in the PTX group. There was a significantly higher incidence of side effects (atrophy, hypopigmentation, telangiectasia, and precipitation of TAC) in the TAC group than in the combination group, while no side effects were reported in the PTX group. A statistically significant reduction in the number of treatment sessions (required to achieve best results) was detected in patients in the combination group. Intralesional injection of PTX is a potentially helpful, safe, and well-tolerated therapeutic tool for keloids, but with lower efficacy than intralesional TAC when used solely. Combining PTX and TAC produces significantly better results for keloid treatment and lowers the risk of TAC-induced side effects.

Intralesional methotrexate versus triamcinolone acetonide for localized alopecia areata treatment: A randomized clinical trial.

Multiple therapeutic modalities are available for alopecia areata (AA) but still a challenging disease with variable severity, recurrence, and a major cosmetic concern. Compare the effectiveness and safety of intralesional methotrexate (MTX) versus triamcinolone acetonide (TrA) in the treatment of localized AA in adults, both clinically and trichoscopically. 40 adult patients with localized AA were recruited and divided into two groups. 20 patients were treated by intralesional TrA and the other 20 patients were treated by intralesional MTX every 3weeks, for maximum four sessions. Clinical and trichoscopic evaluation at baseline, each session and for 3months after the last session was performed. At the end of sessions (12weeks), regrowth scale was significantly higher in TrA group compared to MTX group (p-value=0.028). But, after 3-month follow-up, regrowth scale was higher in MTX group compared to TrA group (p-value=0.153). A statistically significant reduction in AA specific trichoscopic signs after 12weeks and at the 3-month follow-up in both groups. Local adverse events in both groups were transient and disappeared during the follow-up period. Intralesional MTX in treatment of localized AA in adults can be promising and comparable to intralesional TrA with the need for further controlled and extensive trials. Trichoscopy can reveal early clinical response through disappearance of AA-specific trichoscopic signs and also early detection of adverse effects.

Botulinum toxin and platelet rich plasma as innovative therapeutic modalities for keloids.

Keloids characterize a definitely challenging type of cutaneous scars for which a diversity of therapeutic modalities has been suggested. The aim of this work was to compare the therapeutic efficacy of intralesional injection of botulinum toxin type-A (BTX-A), platelet rich plasma (PRP), and triamcinolone acetonide (TAC) in keloids. A total of 60 keloids patients were enrolled and divided randomly into three equal groups. Group I treated by intralesional BTX-A injection, group II treated by intralesional PRP injection, and group III treated by intralesional TAC injection. Clinical assessment was done by Vancouver Scar Scale (VSS), Verbal Rating Scale (VRS), and dermoscopic examination. Additionally, histopathology and immunohistochemistry of connective tissue growth factor (CTGF) expression were evaluated. The results of this study revealed significant improvement of both VSS and VRS in response to all treatment modalities. There was significant improvement of VSS in BTX-A and PRP groups more than TAC group. However, no significant difference observed between BTX-A and PRP groups. Immunohistochemical examination showed significant decrease of CTGF expression after treatment in BTX-A and PRP groups more than TAC group. In conclusion, both BTX-A and PRP could yield a chance for cosmetically better outcomes in keloids treatment than conventional TAC injection.

Familial median canaliform dystrophy of heller affecting multiple nails: a rare clinical entity

<p class="abstract">Median canaliform dystrophy (MCD); first described by Heller in 1928 is characterized by a midline or paramedian split in the nail plate. Mostly idiopathic, some identifiable causes include habitual picking of the nails, oral isotretinoin use and positive family history. The familial occurrence of MCD has rarely been described. Till date, no therapy has proven to be consistently successful in effectively managing the condition. Commonly utilized treatments have been intralesional triamcinolone acetonide injections into the dystrophic nail, topical 0.1% tacrolimus ointment and topical tazarotene 0.05% ointment. Despite available treatment options, the condition has a tendency to recur. Here; we report a case of a 14‑year‑old male presenting with familial MCD affecting multiple finger and toe nails.</p>

Keloid Scars: An Updated Review of Combination Therapies.

Keloid scars are a common yet poorly understood complication of wound healing that can cause a diminished quality of life. Currently, there is little agreement amongst the medical community regarding the best treatment modality for keloids. For this reason, we have created an updated review of the most successful combination therapies for keloid scars and compared their efficacy based on rates of recurrence following treatment. Additionally, these combination therapies have been compared with intralesional triamcinolone acetonide corticosteroid (TAC), which is considered the mainstay monotherapy for keloids. All combination therapies included in our review were shown to produce superior outcomes than TAC monotherapy. We have also found that certain combination therapies are known to produce superior results when used in specific anatomic locations. Intralesional TAC plus intralesional cryotherapy appeared to have the most promising results for non-auricular keloids, and the authors suggest considering this as a first-line treatment. Additionally, the use of surgical excision plus compression therapy achieved superior results for auricular keloids and should be considered first-line for keloids in these locations.

Comparison of Intralesional Triamcinolone Acetonide Injection Efficacy for Chalazion According to Age and Lesion Size

ëª©ì  나이와 크기에 따른 콩다래끼 병소 내에 시행한 ìŠ¤í Œë¡œì´ë“œ 국소주사의 효과에 대하여 비교 ì—°êµ¬í•´ë³´ê³ ìž 하였다. 대상과 방법 2017ë „ 1월부터 2018ë „ 2월까지 본원에서 콩다래끼로 진단 ë°›ê³ ìŠ¤í Œë¡œì´ë“œ 국소 ì£¼ìž ìˆ ì„ 시행 받은 108ëª ì˜ 환자를 대상으로 하였다. 환자를 나이 및 병소의 크기에 따라 세 군으로 나누어 다래끼 크기에 따라 사용한 ì•½ì œì˜ 치료 ì„±ê³µë¥ , 합병증 등을 í›„í–¥ì ìœ¼ë¡œ 조사하였다. ê²°ê³¼ ì „ì²´ 108병소의 콩다래끼 치료 ëˆ„ì  ì„±ê³µë¥ ì€ 1회 주사로 69.4%, 2회 주사로 80.6%였으며, 2회 주사까지 ê³ ë ¤í•œ 7세 미만의 환자 30병소, 7세 이상 17세 미만의 22병소, 17세 이상의 56병소에서 각각 ëˆ„ì ì„±ê³µë¥ ì€ 86.7%, 81.8%, 76.8%였다. 콩다래끼 병소의 지름 10 mm 미만 27병소, 10 mm 이상 15 mm 미만 70병소, 15 mm 이상 20 mm 미만 11병소에서 ëˆ„ì ì„±ê³µë¥ ì„ ë³´ë©´ 85.2%, 80%, 72.7%로 각각 확인되었으나, í†µê³„ì ìœ¼ë¡œ ìœ ì˜í•œ 차이는 보이지 않았다. ê²°ë¡ ì½©ë‹¤ëž˜ë¼ì˜ 치료에 있어서 ìŠ¤í Œë¡œì´ë“œ 국소주사는 매우 ìœ ìš©í•˜ë©° 특히 나이가 어릴수록, 크기가 작을수록 치료 효과가 좋다. Keywords: Chalazion, Intralesional triamcinolone