Intralesional Triamcinolone Injection Research Articles

Saint Rita of Cascia: Patron Saint for Women with Frontal Fibrosing Alopecia?

Roman Catholic tradition has made Saints the protectors of various aspects of life. Christian hagiography deals with the account of the Saints' lives and passion, and Christian iconography with the Saints' depiction in religious art. Catholic churches are full of images of Saints. Appreciation of religious art is deepened by knowledge of what is depicted. Saints are only sometimes labeled with their names. The clues to their identity are rather given in their appearance or in what they are holding. St. Rita of Cascia (1381–1457) is a Saint venerated in the Roman Catholic Church and bestowed the title of Patroness for impossible causes. Various miracles have been attributed to her. In Christian iconography, she is depicted with a bleeding forehead wound and sometimes holding a thorn. The forehead wound is understood to represent partial religious stigmatization and external sign of mystical union with Christ. In our opinion, it is at the same time reminiscent of the thorn frontal fibrosing alopecia represents to women affected with the condition, and its treatment with intralesional triamcinolone injections along the frontal hairline, much alike the forehead wounds caused by the crown of thorns. Few practices of the Catholic Church are so misunderstood as the devotion to patron Saints. Nevertheless, Saints help to find community and to break out of the isolation, anonymity, and dumbness of modern society. The communion of Saints is a spiritual union, in which each member shares in the welfare of all. The patron Saints help to believe in the possibility of miracles and miraculous healings. Ultimately, the exemplary lives of the Saints show us how salvation can be the positive effect of suffering.

Intralesional Triamcinolone Injection as Adjunct Therapy in Eosinophilic Esophagitis Patients With Stricturing Disease

Intralesional Triamcinolone Injection as Adjunct Therapy in Eosinophilic Esophagitis Patients With Stricturing Disease

DON’T LET THE DRY MOUTH FOOL YOU

SESSION TITLE: Signs and Symptoms of Chest Disease SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Sarcoidosis is a well-known though poorly understood disease process with a multitude of manifestations. Clinicians should be aware of the diverse manifestations, as any evidence of active sarcoidosis requires consideration for treatment. We present a case of Mikulicz syndrome, a rare presentation of sarcoidosis in which the parotid and lacrimal glands are infiltrated by granulomas with resulting dry mouth, dry eyes and occasionally recurrent fevers. CASE PRESENTATION: The patient is a thirty-seven-year-old African-American female with a history of pulmonary and dermatologic sarcoidosis. She was diagnosed after a skin biopsy revealed noncaseating granulomas in the setting of chronic dyspnea with bilateral hilar lymphadenopathy. Systemic glucocorticoids were initiated with improvement in her dyspnea and skin lesions. Over the next several years, she did not tolerate weaning attempts and experienced frequent flares requiring escalating doses of methotrexate and glucocorticoids that led to significant side effects to include diabetes, obesity and bilateral hip avascular necrosis. Ultimately, her dyspnea and cough resolved on methotrexate and her skin lesions improved with a combination of intralesional triamcinolone injections and hydroxychloroquine with successful weaning off of her steroids. However, in subsequent visits, she reported swelling in her jaw along with a dry mouth with no recurrent skin lesions or dyspnea. On exam, enlargement of the parotid and lacrimal glands was recognized as Mikulicz syndrome. As a result, adalimumab was initiated with resolution of her symptoms. DISCUSSION: Mikulicz syndrome is a rare presentation of sarcoidosis, occurring in only 2% of patients with systemic sarcoidosis. It can easily be overlooked or attributed to a different disease process such as Sjogren’s syndrome, IgG4 related disease, lymphoma, vasculitis and HIV. However, it has been associated with significant symptoms affecting quality of life and most importantly represents active disease that requires consideration of treatment. In this case, the early recognition of Mikulicz syndrome led to appropriate treatment with a TNF-alpha antagonist that otherwise may not have been started as her skin and pulmonary sarcoid was relatively quiescent. CONCLUSIONS: Sarcoidosis can present with symptoms in nearly any organ system with significant impact on treatment course and quality of life. Providers who routinely treat sarcoid should be aware of the diverse manifestations of the disease, including the relatively rare presentations like Mikulicz syndrome as they may alter treatment strategy. Reference #1: Ungprasert, Patompong, Cynthia S. Crowson, and Eric L. Matteson. "Clinical characteristics of parotid gland sarcoidosis: a population based study.” JAMA otolaryngology--head & neck surgery 142.5 (2016): 503. Reference #2: Rao, Dinesh, et al. "A Case Report of Mikulicz Syndrome.” Journal of radiology case reports 11.7 (2017): 1. DISCLOSURES: No relevant relationships by Arthur Holtzclaw, source=Web Response No relevant relationships by John Sherner, source=Web Response

Comparative Effect of Ablative Fractional CO2 Laser Plus Triamcinolone Acetonide Cream Versus Intralesional Injection of Triamcinolone Acetonide in Keloid and Hypertrophic Scars: A Randomized Clinical Trial

Background: The current study was performed to compare the effects of ablative fractional CO2 laser plus triamcinolone acetonide cream versus intralesional injection of triamcinolone acetonide in the treatment of hypertrophic and keloid scars. Methods: This quasi-experimental study was performed among 33 patients visiting dermatology clinics of two referral teaching hospitals during 2013 - 2014.A lesion of these patients was divided in to two equal parts, one half was injected with triamcinolone acetonide at a dose of 10 - 20 mg/mL, and in the combination treatment, we administered ablative fractional CO2 laser treatment (level: 15, point of shot: 5, PW: 5, pitch: 0.5; Unixel, Korea) with topical triamcinolone acetonide in the other half. The settings of the laser device for each session were set according to the thickness of the scar. Immediately after laser treatment (in the first two seconds) and up to one week later, the triamcinolone acetonide 0.1% cream was applied twice a day. Each patient underwent 3 - 5 treatment sessions of laser treatment at 4-week intervals for one lesion. One hour before each session, the local anesthetic, lidocaine-p gel, was administered around the lesion. Results: The general appearance of the wound was better in the intralesional triamcinolone group (1.53 vs. 2.15, P < 0.0001). Dyschromia showed more improvement in the combination treatment (1.13 vs. 1.47, P < 0.0001), while hypertrophy improved more as a result of intralesional triamcinolone acetonide injection (2.19 vs. 1.52, P < 0.0001). Additionally, combination treatment was more effective on texture (1.61 vs. 2.11, P < 0.0001). The improvement of symptoms scores was 2.73 out of a total of three. Conclusions: It can be concluded that topical corticosteroids plus fractional laser therapy is more effective than intralesional injection of corticosteroids for the amelioration of dyschromia and texture of hypertrophic and keloid scars. However, general appearance and hypertrophy showed a better response to intralesional injection of triamcinolone. Accordingly, in non-homogenous lesions with dyschromia, the use of local corticosteroids plus fractional laser is recommended.

Treatment of Extensive Central Giant Cell Lesion of the Mandible with Corticosteroid and Calcitonin: a Case Report

A 25-year-old woman complained of an 8-month history of swelling in the chin. An intra-oral examination showed edema in the anterior and posterior regions of the mandible, with an expansion of the external cortical bone. A panoramic radiograph revealed a multilocular radiolucent lesion involving the entire mandibular bone. Computed tomography analysis showed expansive and diffuse osteolytic lesions, involving the roots of the lower incisor, canine, and premolar teeth. An incisional biopsy was performed, and the histopathological analysis revealed a central giant cell lesion. Laboratory tests were negative for hyperparathyroidism. The treatment chosen was weekly intralesional injections of triamcinolone 2.5 mg/dL + lidocaine 1%, infiltrating 1 mL/cm3 of the lesion, and a nasal spray of calcitonin daily, for 5 weeks. After 4 months, bone neoformation could be observed in several regions, and the patient is under a rigorous clinical and imaging monitoring regime.

Long-term efficacy and safety of intralesional steroid injection plus oral steroid administration in preventing stricture after endoscopic submucosal dissection for esophageal epithelial neoplasms.

Endoscopic submucosal dissection (ESD) has been widely accepted as the treatment for early-stage esophageal epithelial neoplasms. However, stricture is a common complication after large-circumference ESD. This retrospective study is conducted to evaluate the efficacy and safety of intralesional steroid injection plus oral steroid administration in preventing esophageal stricture. 70 patients with a mucosal defect extending over more than two-thirds of the circumference after esophageal ESD for epithelial neoplasms were enrolled in this study. Those who received intralesional triamcinolone injection combined with oral prednisolone administration were assigned to the treatment group, while those who were treated without any prophylaxis of esophageal stricture were assigned to the control group. The primary observation result was the frequency of stricture. The secondary observation results were the number of endoscopic balloon dilation (EBD) sessions and rate of complications. Compared with the control group, the frequency of stricture (14.7% 5/34 patients vs. 51.5% 19/36 patients) and number of EBD sessions (mean 0.2 vs. 3.3) were significantly lower in the treatment group. One patient suffered from perforation in the treatment group and recovered with conservative treatment. None steroid-related complications were found during a long-term follow-up. Intralesional steroid injection plus oral steroid administration is safe and effective in preventing stricture following esophageal ESD for esophageal epithelial neoplasms with a mucosal defect extending no less than two-thirds of the circumference in a long-term follow-up.

Immunoexpression of calcitonin and glucocorticoid receptors in central giant cell lesions of the jaws.

This study analyzed the immunoexpression of calcitonin receptor (CTR) and glucocorticoid receptor (GR) in central giant cell lesions (CGCLs) and verified potential associations with patient's response to clinical treatment with intralesional injection of triamcinolone. Fifty-four cases of CGCLs, including 22 non-aggressive, and 32 aggressive, were investigated by immunohistochemistry. Surgery was the therapeutic choice for 53.1% of the aggressive CGCLs, and 46.9% were submitted to the conservative treatment with intralesional triamcinolone injections. Among patients submitted to conservative treatment, 60% (n=9) showed favorable response. CTR expression was observed in 68.51%, and GR in 94.44% of the total sample. There were no differences in the expression of CTR, neither GR in mononucleated stromal cells (MSCs) or multinucleated giant cells (MGCs), in relation to aggressiveness, treatment performed for and the response to conservative treatment. Both markers showed a positive correlation between their expression in MSCs and MGCs in the total sample (P<0.0001). CTR expression on MSCs showed a positive correlation with MGCs in the aggressive and non-aggressive groups (P<0.0001). Calcitonin receptor and GR expression were diffuse and similar in non-aggressive and aggressive cases, and it did not influence the response to clinical treatment with triamcinolone in the sample studied.

Efficacy and Safety of Endoscopic Intralesional Triamcinolone Injection for Benign Esophageal Strictures.

Objectives To evaluate the efficacy and safety of endoscopic intralesional triamcinolone injection (ITI) for benign esophageal strictures combined with endoscopic dilation (ED). Methods Online databases including MEDLINE, EMBASE, the Cochrane Library, and Web of Science were comprehensively searched for prospective randomized control trials (RCTs) between 1966 and March 2018. A meta-analysis was conducted according to the methods recommended by the Cochrane Collaboration. Results Six RCTs consisting of 176 patients were selected. Meta-analysis results showed that additional ITI had a significant advantage in terms of stricture rate and required ED sessions. Surgery-related and non-surgery-related strictures showed similar results. Additional ITI was not associated with significantly increased risk of complications. Conclusions Our meta-analysis showed that additional ITI therapy was supposed to be effective and safe for benign esophageal strictures as it reduced the stricture rate and required ED sessions. However, more RCTs are necessary to support these findings.

Treatment of keloid scars with intralesional triamcinolone and 5-fluorouracil injections – a randomized controlled trial

Keloids have high recurrence rates. Current first-line therapy is triamcinolone (TAC) injection, but it has been suggested that approximately 50% of keloids are steroid resistant. We compared the efficacy of intralesional 5-fluorouracil (5-FU) and triamcinalone injections in a double-blind randomized controlled trial. Forty-three patients with 50 keloid scars were treated with either intralesional TAC or 5-FU-injections over 6 months. There was no statistically significant difference in the remission rate at 6 months between the 5-FU and TAC groups (46% vs 60%, respectively). Local adverse effects were higher in the TAC group compared to the 5-FU group. Occurrence of skin atrophy in TAC group was 44% and in the 5-FU group 8% (p < 0.05). Also the occurrence of telangiectasia in the TAC group was 50% and in the 5-FU 21% (p < 0.05). Vascularity of the keloids, assessed by spectral imaging and immunohistochemical staining for blood vessels, after treatment decreased in the TAC group, but not in the 5-FU group (p < 0.05). Fibroblast proliferation evaluated by Ki-67 staining significantly decreased in the TAC group (p < 0.05) but increased in the 5-FU group (p < 0.05). TAC and 5-FU injections did not differ in their clinical effectivity in this randomized study, but 5-FU injections lead to increased proliferation rate and did not affect vascular density in histological assessment. Due to the greater number of adverse effects observed after TAC treatment, 5-FU injections may be preferable for cosmetically sensitive skin areas.

A randomized comparison of efficacy and safety of intralesional triamcinolone injection and clobetasol propionate ointment for psoriatic nails

Background: Even though the traditional therapy for nail psoriasis has been used for decades, no randomized, controlled trial of such treatment has been conducted to date.Objective: To evaluate the efficacy and safety of intralesional triamcinolone injections compared with 0.05% clobetasol ointment for psoriatic nails.Materials and methods: Psoriasis patients, each with three fingernails with similar degrees of severity, were randomly recruited for intralesional triamcinolone injection group, 0.05% clobetasol ointment group, and a control group. The target Nail Psoriasis Severity Index (NAPSI) score of each finger was evaluated, any adverse effects were recorded, and photographs were taken.Results: Forty-eight affected nails were analyzed. At the second month, a significantly greater reduction of the target NAPSI score was observed in the injection group compared to the control group (p = .003). There was a greatest reduction of the score in the following two month-period, which showed significant difference from the topical group (p = .003) and the control group (p = < .001). The score of the injection group, however, subsequently rose at the six-month visit so that there was no longer any statistically-significant difference between the three groups.Conclusions: In spite of its temporary effect, the intralesional triamcinolone injection is an effective and safe treatment for psoriatic nails.

A Retrospective Analysis of Efficacy and Safety of Intralesional Triamcinolone Injections in the Treatment of Frontal Fibrosing Alopecia Either as Monotherapy or as a Concomitant Therapy.

Context:Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia characterized by progressive recession of frontal, and often temporoparietal, hairline mainly in postmenopausal women. Currently, there are no guidelines or proposed evidence-based treatment for FFA.Aims:The aim of this study was to retrospectively evaluate the effect and safety of intralesional triamcinolone acetonide injections (ITAIs) either as monotherapy or as concomitant treatment in the management of hairline recession in FFA.Subjects and Methods:All patients with FFA, who visited our specialist hair clinic from July 2012 to October 2016 and were treated with ITAI either as monotherapy or as concomitant treatment, were enrolled in our study. Measurements were performed from five different points on the scalp. The analysis of data included demographics, associated symptoms, clinical and dermoscopic findings, comorbidities, family history of FFA, concomitant medication, treatment outcome, and recording of adverse events.Statistical Analysis:Statistical analysis was performed using the Statistical Package for the Social Sciences, version 22.0.Results:A total of 40 patients, all females were enrolled in our study. The mean age of the patients was 65.88 ± 8.18 whereas the mean age of the diagnosis was 61.24 ± 7.4. A total of 39 patients were treated with a combination of treatments, including ITAI, and only one with ITAI as monotherapy. There was a halting of the progress of the disease, and no significant adverse events were noted, apart from mild pain.Conclusions:A halting in the progression of FFA was achieved, with unremarkable adverse events. ITAI could serve as an effective and safe option for the treatment of FFA, although difficult to assess it as monotherapy. Further randomized controlled trials are needed to evaluate its efficacy and safety as the sole treatment in the management of FFA.

Combined oral propranolol with intralesional injection of triamcinolone acetonide in treatment of infantile periocular hemangiomas.

AimTo evaluate the clinical effectiveness of combined oral propranolol with intralesional injection of triamcinolone acetonide in the treatment of infantile periorbital capillary hemangioma.Patients and MethodsThis prospective interventional study included children diagnosed with periocular infantile hemangiomas in the proliferative phase with vision-threatening lesions. The children presented to the oculoplastic unit in Sohag University Hospital in the period between January 2016 and February 2017 and were treated with a combined intralesional injection of triamcinolone acetonide with oral propranolol, with a follow-up period of 6 months. Treatment response was evaluated according to the size of the tumor (horizontal diameter); additionally, complications of both treatment methods were recorded.ResultsThis study included 33 infants: 21 females (64%) and 12 males (36%). The mean age at the time of injection was 4.9±2.6 months. The study included three modes of treatment response: regression of the tumor, 28 patients (85%); stabilization, three patients (9%); and failure, two patients (6%), which necessitated repeated intralesional injection of triamcinolone but with minimal response. Regarding complications, only one patient reported with subconjunctival hemorrhage during intralesional injection of steroids; there were no recorded cases of hypotension, bradycardia, or hypoglycemia during the course of oral propranolol treatment. After the end of the follow-up period, there were no reported cases of recurrent increase in the size of the regressed group of infantile hemangiomas with stable tumor size.ConclusionCombined oral propranolol with intralesional injection of triamcinolone acetonide is the effective method of treatment for infantile periorbital capillary hemangioma with minimal adverse effects.

Clinical Analysis of Esophageal Stricture in Patients Treated with Intralesional Triamcinolone Injection after Endoscopic Submucosal Dissection for Superficial Esophageal Cancer

Introduction: Endoscopic submucosal dissection (ESD) has been widely used in the resection of superficial esophageal cancers. Since its use has been extended to cases involving large esophageal tumors occupying nearly the whole or the whole circumference of the lumen, the occurrence of esophageal stricture has increased. Although endoscopic injection of triamcinolone (TA) is widely used for the prevention of postoperative stricture, a significant number of patients still develop stricture after TA injection therapy. Methods: We performed a retrospective study to identify the clinical parameters that predispose post-ESD patients to esophageal stricture after TA injection therapy. Results: A total of 207 patients who were diagnosed with superficial esophageal cancer and subsequently underwent ESD were enrolled in this study. Among these patients, 53 patients and 57 lesions bearing mucosal defects covering greater than two-thirds of the esophageal circumference after ESD were treated with TA injection therapy. The rate of esophageal stricture was found to be highest in cases involving mucosal defects that covered more than seven-eighths of the circumference. Conclusion: Endoscopic TA injection is not sufficient for preventing esophageal stricture in patients bearing mucosal defects covering more than seven-eighths of the esophageal circumference after ESD.

Treatment of ear keloids: algorithm for a multimodal therapy regimen

Keloids are benign cutaneous lesions, arising from proliferating fibroblasts. Keloids of the ear may occur after trauma, surgery or helix piercings and are difficult to treat, since they tend to form recurrences. Guidelines suggest multimodal therapy; however, recurrence rates remain high and distinct algorithms for the combination of different modalities are missing. To unravel the most effective combination of therapeutic options for keloids of the ear, 38 patients with the diagnosis of an ear keloid were included in our cohort. In a prospective subgroup (B) of this cohort (n=17), patients either underwent surgery using the "fillet technique" (a meticulous peeling of the keloid skin) and intra-lesional injections of triamcinolone 10mg/ml every 4-6weeks for 6months, or they were additionally treated with a non-customized pressure device which was recommended for at least 16/24h per day over 6months. To further compare our results, the remaining 21 patients of our cohort, who were treated at our clinic before, were retrospectively evaluated concerning their recurrence rates. The mean follow-up was 48months. The mean count of adjuvant steroid injections was two in all patients, four in subgroup B. The recurrence rate was 30% (13/38) in all patients (subgroup B 0/17). Aesthetic results were good to excellent in all non-recurrent cases. No patient treated with fillet technique showed recurrence (p<0.001). However, we could not confirm a significant effect but a trend of repeated steroid injections for preventing recurrences (p=0.099). The application of pressure using our non-customized clip also showed a clear trend towards preventing recurrences in cross-table analysis (p=0.057). Although several studies on different treatment regimens for keloids of the ear exist, the effectiveness of a multimodal treatment regimen needs to be elucidated. Overall, the best results in preventing recurrences were achieved by combining three different treatments. However, the fillet technique was the only modality preventing recurrences of keloids in uni- and multivariate analysis. The application of pressure with a non-customized clip and repeated steroid injections also showed a positive trend but failed level of significance. Based on our data and the literature we recommend, when feasible, the combination of more than one therapeutic regimen, since relapse risk went down from single to dual and triple therapy from 40% (8/20) to 14.3% (2/14) to 0% (0/4), respectively in our cohort. The use of "fillet technique" was especially beneficial.

EXTENSIVE CENTRAL GIANT CELL LESION IN THE MAXILLARY REGION

A 9-year-old male patient was referred to the oral diagnosis clinic with asymptomatic swelling in the right maxilla. The lesion measured 45 mm and involved teeth 11 to 17. The lesion caused tooth displacement and mobility, showing similar color to the normal mucosa, with erythematous areas. An incisional biopsy was performed, and the histopathologic analysis revealed features consistent with central giant cell lesion (CGCL). The treatment chosen was weekly intralesional injections of triamcinolone for 10 weeks. A significant reduction in the lesion size was achieved. However, additional applications were necessary. After 2 months of the last application, the panoramic radiography revealed a residual radiolucent image. Four months later, the lesion had regressed more and cytologic analysis revealed absence of the CGCL features. The patient returned periodically for evaluation, and the treatment was found to be satisfactory. There were no relapses during the 5 years of follow-up. Supported by FAPEMIG.

Management of postburn perioral contracture using a customized static commissural splint and intralesional injections of triamcinolone

A perioral facial burn is usually accompanied by a reduction in size of the oral orifice because of the contraction of the healing wound. Perioral contracture leads to microstomia, restricting nutrition, speech, and jaw movements and impairing the esthetic appearance of the face. It is imperative to introduce splints as early as possible to prevent the postburn sequelae. A delay in splinting allows postburn contractures. Overcoming these contractures to regain the size of the stoma requires restructuring of the hypertrophic scar using mechanical force and the biomodification of the tissues. This article describes the treatment of microstomia and the hypertrophic scarring of the perioral tissue using a novel static commissural splint with customizable components in conjunction with intralesional injections of triamcinolone. Within 6 months, the splint together with the steroid injections had helped increase the vertical opening of the mouth by 15 mm and the intercommissural distance by 16 mm.

Conservative management of Oral Submucous Fibrosis in early and intermediate stage

Aims & objectiveTo evaluate the efficacy of combined intralesional injection of Hyaloronidase and Triamcinolone with third molar removal in early and intermediate stage (Stage II & III) of Oral Submucous Fibrosis (OSMF) for improvement in mouth opening and hypersensitivity to food. Study design48 patients in stage II & III OSMF were selected for the study. All the third molars were extracted in each patient followed by 6–8 doses of combined intralesional injection of Hyaloronidase and triamcinolone at 10days interval targeting the fibrotic bands. Mouth opening and improvement in hypersensitivity to food was noted by numerical grading. The patients were followed for one year at regular intervals. The data was expressed as mean±SD, and a probability (p) value of <0.05 was considered significant. ResultsThe initial mouth opening in Stage II patients (n=27) was 30±3.0mm and in Stage III patients (n=21) was 19±3.5mm and the increase in mouth opening at the end of treatment was 11.3±1.9mm and 10.2±2.3mm respectively. The mean improvement in hypersensitivity to food in both the groups was 2.9 and 2.2 respectively. ConclusionThere is significant improvement in grade II patients in mouth opening and hypersensitivity to food. Grade III patients show variable improvement or no improvement wherein surgery becomes the only option. Third molar extraction helps in reducing inflammation and fibrosis in the retromolar region thus easing in mouth opening. This combined approach for moderately staged OSMF can be proposed as a viable conservative modality.

Treatment of Tongue Lymphangioma with Intralesional Combination Injection of Steroid, Bleomycin and Bevacizumab.

Lymphangioma is a congenital malformed lymphatic tumor that rarely involves the tongue. In our clinic, a 10-year-old female presented with lymphangioma circumscriptum involving the right two-thirds of the tongue. We administered an intralesional combination injection of triamcinolone, bleomycin, and bevacizumab as a treatment. Almost complete remission after combination therapy was achieved without complications such as edema, swallowing difficulties or recurrence. Bevacizumab, an inhibitor of vascular endothelial growth factor, was effective for the treatment of lymphangioma of the tongue in this case. No recurrence was noted at the 1-year follow up.

Effect of Intralesional Triamcinolone Injection in Patients of Esophageal Stricture Post Acid Ingestion

Effect of Intralesional Triamcinolone Injection in Patients of Esophageal Stricture Post Acid Ingestion

Evidence of invasive and noninvasive treatment modalities for hypertrophic scars: A systematic review.

Currently, there are various therapeutic approaches to reduce hypertrophic scarring; however, there is no standard evidence-based treatment protocol. Hence, a systematic review was performed to obtain a summary of the latest clinical trials to evaluate evidence for the treatment of hypertrophic scars. The review protocol was registered and approved by PROSPERO (CRD42015027040). PubMed and Web of Science were searched using predefined MeSH-Terms to identify studies published within the last 10 years regarding treatment for hypertrophic scars. Exclusion criteria included a level of evidence (LoE) lower than I, nonhuman in vivo studies, in vitro studies, studies on keloids, literature reviews, and non-English articles. The literature search identified 1,029 unique articles, whereas 6 articles were prospective, randomized, blinded, controlled clinical trials with a LoE I, and were thus included in the systematic analysis. Three clinical trials evaluated silicone products and pressure garments, and the other three studies investigated the efficacy of intralesional injections of triamcinolone (TAC), 5-Fluorouracil (5-FU) combined with TAC as well as the additional irradiation with a 585 nm pulsed-dye laser (PDL). Intralesional injections revealed significant improvements of the scar quality in terms of height, thickness, erythema, and pigmentation. Pressure garments showed favorable results but there was no evidence that silicone products were able to improve the scar quality. The systematic review demonstrated that there are just a few clinical trials with a LoE of I. Consequently, evidence is still lacking especially for noninvasive treatment regimens for hypertrophic scars. Intralesional injections of 5-FU mixed with a low dose of TAC can be seen as most appropriate treatment modality. Prospective clinical trials to determine the efficiency of silicone products are warranted.