Intralesional Triamcinolone Research Articles

Bimekizumab Effect on the Need for Concomitant Rescue Interventions by HiSCR Response Level in Patients with Moderate to Severe Hidradenitis Suppurativa from BE HEARD I&II

Introduction: Hidradenitis suppurativa (HS) is a chronic, systemic, inflammatory skin disease characterized by deep, painful lesions that negatively impact patients’ (pts’) quality of life.1 These lesions are difficult to treat and require multifaceted treatment, including the need for rescue interventions alongside conventional therapy.1 Bimekizumab (BKZ) is a monoclonal IgG1 antibody that inhibits interleukin (IL)-17F in addition to IL-17A.2 Here, the relationship between increasingly stringent HS Clinical Response (HiSCR) levels achieved with BKZ and the proportion of pts not requiring rescue concomitant interventions is investigated.Procedure/Study: Pooled data are presented from the phase 3 BE HEARD I&II trials maintenance treatment period (Weeks [Wks]16–48).3 Pts were randomized 2:2:2:1 (initial/maintenance treatment period) to BKZ 320 mg every 2 wks (Q2W)/Q2W, BKZ Q2W/Q4W, BKZ Q4W/Q4W, or placebo (PBO)/BKZ Q2W. Data for the individual BKZ randomization arms and pooled across these arms (BKZ Total) are reported. BKZ-randomized pts were grouped by achievement of mutually exclusive HiSCR levels (<50% improvement from baseline [<HiSCR50]; HiSCR50–<75; HiSCR75–100) at Wk16. The incidence of pts not requiring any concomitant rescue interventions during the maintenance treatment period, including medical (antibiotics, analgesics) and procedural (incision/drainage, intralesional triamcinolone injection) interventions, are reported. Data reported as observed case. Results: Overall, 868 pts were randomized to BKZ Q2W/Q2W (N=288), BKZ Q2W/Q4W (N=292), or BKZ Q4W/Q4W (N=288). In BKZ Total, 76.0%/83.2%/89.1% of pts in the HiSCR<50/50–<75/75–100 bands did not receive rescue intervention through Wks16–48, demonstrating a numerical increase with increasing HiSCR bands. Comparable trends across HiSCR<50/50–<75/75–100 bands were observed in pts receiving BKZ Q2W/Q2W (79.8%/90.0%/90.9%), BKZ Q2W/Q4W (75.0%/78.3%/89.0%) or BKZ Q4W/Q4W (73.3%/81.4%/87.1%). Similar trends were observed from the lowest to highest HiSCR bands when separating into any medical or procedural interventions. Conclusion: Overall, the majority of BKZ-randomized pts did not require any concomitant rescue medical or procedural interventions through Wks16–48 and the proportions of these pts increased with increasingly stringent HiSCR bands. These data highlight the additional value to pts of a decreased need for concomitant rescue interventions when they achieve higher HiSCR response levels.

Comparative study of efficacy of intense pulsed light versus Intralesional triamcinolone in the treatment of hypertrophic scars and keloids

Keloids and hypertrophic scars are hyperproliferative response of dermal connective tissue to trauma. Their management remains a challenge for practitioners as there is still no universally accepted treatment, leading to recurrences which are frustrating for patients and clinicians alike. Hence, it becomes essential to determine a modality with highest efficacy, least recurrence and better patient compliance.To compare the therapeutic effectiveness of Intralesional triamcinolone acetonide versus Intense pulsed light for treatment of keloids and hypertrophic scars.A single centre, cross-sectional study was conducted on 60 patients. Patients were randomly allocated in two groups, group one received Intralesional steroids ( ILS)-triamcinolone acetonide and group two was treated by Intense pulsed light(IPL).Both groups were accessed for improvement every 15 days until 5 sessions were complete.Both study groups showed significant changes after treatment. Patients treated with ILS showed greater reduction in height. IPL group showed significant reduction in vascularity . Pigmentary outcomes were more favourable with IPL, whereas with ILS hypopigmentation was noted as a common side effect. Both groups showed significant reduction in pliability.Both regimens showed excellent responses with minimum recurrence rates, indicating their high efficacy in management of keloids and hypertrophic scars.

Interleukin 9 in Oral Lichen Planus: an immunohistochemical study before and after treatment by intralesional steroid injection.

Oral Lichen Planus (OLP) is a chronic inflammatory mucocutaneous disorder of the oral mucosa. Th9 cells secrete IL9, which induces elevated levels of MMP9, exacerbating OLP disease severity. IL9 also increases Th17 levels in OLP lesions. This study aimed to detect IL9 tissue expression in patients with OLP compared to normal controls and to correlate its expression with disease severity and response to intralesional steroid therapy. This study involved 18 patients with OLP and 18 healthy, age- and sex-matched volunteers. The REU scoring system was used to monitor OLP lesions before and after treatment with 20mg/mL intralesional triamcinolone acetonide every 2 weeks for four sessions. Biopsies for H&E and IL-9 expression were taken from patients and controls, with repeat biopsies after the fourth session for patients. A highly statistically significant increase in IL9 expression was observed in the patient group compared with the control group. A highly statistically significant decrease in both the REU score and post-treatment IL-9 expression was detected in the patient group. We can conclude that IL9 is a tissue marker of OLP activity. Future studies on therapies targeting IL-9 in OLP are needed.

Comparison of Efficacy of Intralesional Triamcinolone and Combination of Triamcinolone With 5-Fluorouracil in The Treatment of Keloid

Objectives: To study the efficacy of intralesional Triamcinolone and combination of Triamcinolone with 5-Fluorouracil in the treatment of keloid in terms or reduction in height of lesion. Study Design: Cross-sectional analytical study. Place and Duration Of Study: Department of Plastic Surgery, Combined Military Hospital, Rawalpindi, Jul 2020 to Mar 2021. Methodology: A total of 56 patients suffering from keloid formation were included in our study. Patients who had received previous treatment for keloids were excluded. All patients were assessed for volume of keloid before and after 8 weeks of intervention. Group A patients received therapy with intralesional Triamcinolone 4 mg with 5-Fluorouracil 45 mg once weekly while Group B patients received intralesional Triamcinolone 10 mg alone once weekly. Patients were followed up after 8 weeks to ascertain mean reduction in volume of keloid post-intervention. Data was analyzed by SPSS 26.0. Results: The difference in total volume post-treatment between the two groups was significant, (p=0.001), however the difference in total volume reduction across both groups with treatment was not significant, (p=0.382). Treatment was effective in 23(82.1%) of with the combination of Triamcinolone and 5-Fluorouracil, while this figure was only 16(57.1%) with Triamcinolone alone, (p=0.042). Conclusion: The combination of intralesional Triamcinolone and 5-Fluorouracil is superior to intralesional Triamcinolone alone in the treatment of keloids, and may be considered for therapy in patients who do not respond to treatment with single agents.

Long-term outcomes of intravenous corticosteroid pulse therapy for rapidly progressive alopecia areata: A single-center retrospective analysis of 106 cases and usefulness evaluation of a scoring system originally designed for half-year efficacy prediction for extended periods.

Intravenous corticosteroid pulse therapy (IVPT) has been preferentially conducted for rapidly progressive alopecia areata (RP-AA); however, the evaluation of long-term outcomes has been insufficient. In this study, 106 IVPT-treated RP-AA patients (36 males and 70 females) who were followed up for more than 1 year and up to 6.8 years were retrospectively analyzed. The mean observation period was 1137.8 ± 587.9 days (range 380-2490). The mean severity of alopecia tool (SALT) score before IVPT was 21.3 ± 23.4 but whole-scalp hair loss was observed in all cases after the intervention, suggesting that IVPT was performed soon after the onset. With additional interventions represented by intralesional triamcinolone acetonide injection with or without topical potent corticosteroid for those who insufficiently responded at 6 months after IVPT, 64.2%, 14.2%, and 21.7% of the patients respectively achieved good response (GR; SALT score ≤25), moderate response (MR; 25 < SALT score <75), and poor response (PR; 75 ≤ SALT score) 1 year after IVPT. On the final evaluation, the proportions of patients with GR, MR, and PR were 79 (74.5%), 7 (6.6%), and 20 (18.9%). Sixteen patients achieved and maintained full hair regrowth with IVPT alone until the end of observation. A previously reported scoring system for the short-term outcome prediction was shown to be useful for distinguishing the final-point GR responders from PR responders (P = 0.003). Of note, 21 patients were found to have some symptoms suggestive of the existence of preceding infectious diseases and tended to relapse. The revised scoring system adding the absence of preceding infectious diseases as one factor successfully predicted the occurrence of the relapse in our cohort (P = 0.002). Taken together, previously unreported real-world efficacy of IVPT to RP-AA was elucidated with the invention of a tool putatively enabling optimal long-term management.

ALTERNATIVAS NÃO INVASIVAS NO MANEJO DO GRANULOMA CENTRAL DE CÉLULAS GIGANTES DOS MAXILARES: UMA REVISÃO NARRATIVA DA LITERATURA

Introduction: The Central Giant Cell Granuloma of the jaws is described as an uncommon intraosseous lesion that can exhibit different clinical and imaging characteristics. It can present in an aggressive or non-aggressive manner. When aggressive, the lesion is typically expansive, painful, and associated with bone tissue destruction. The standard treatment is surgical removal, but the choice of the ideal therapeutic approach depends on factors such as the patient’s age, lesion behavior, and its extent. Objective: To explore the main conservative treatment options for the management of Central Giant Cell Granuloma of the jaws. Methods: This is a narrative literature review based on research in databases such as PubMed and Google Scholar, conducted between July and August 2024, using DeCS/MeSH descriptors in English, “calcitonin” OR “interferon” OR “denosumab” AND “central granuloma of giant cells in jaws” AND “central giant-cell lesion” OR “corticosteroids injections” AND “intralesional triamcinolone.” Literature Review: The drug class used for the treatment of Central Giant Cell Granuloma is corticosteroids, which show high rates of therapeutic success, followed by calcitonin, denosumab, and interferon. However, despite promising results, additional clinical trials are necessary to establish the true efficacy of these treatments. Conclusion: All non-invasive treatment modalities have been shown to be effective in reducing or achieving complete regression of Central Giant Cell Granuloma of the jaws, either alone or in combination. However, there are limitations, such as the risk of adverse effects and the limited number of published studies to date.

Efficacy of Nd:YAG Laser and Intralesional Triamcinolone Injection Combination Therapy in the Postoperative Management of Keloids.

Keloids, characterized by protruding scars that extend beyond the original skin damage site, cause significant emotional stress and reduced quality of life. Their exact pathogenesis remains unclear, with various hypotheses including growth factor imbalances and extracellular matrix changes. No single treatment is universally accepted, but multiple modalities like triamcinolone acetonide injection (TAC), laser therapies, and surgery are commonly used. This retrospective study involved East Asian patients who underwent keloid scar excision between March 2019 and June 2022. Patients were divided into two groups: one receiving only TAC injections and the other a combination of TAC and Nd:YAG laser therapy. The efficacy of treatments was evaluated using the modified Vancouver Scar Scale (mVSS) and the Patient and Observer Scar Assessment Scale (POSAS), with follow-ups at six and twelve months after operation. The study involved 111 patients. Both treatment groups showed significant improvements in mVSS and POSAS scores, but the combination therapy group demonstrated a statistically significant improvement in POSAS scores and lower recurrence rates at 12months compared to the TAC-only group. However, there was no significant difference in patient satisfaction between the groups. Dual therapy involving TAC injection and Nd:YAG laser treatment was more effective than TAC injection alone for managing keloid scars after surgery. This combination therapy showed better outcomes in preventing keloid recurrence and improving scar status at 12months after operation, along with significant improvements in patient-reported outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

7854 Ablation Aberration: A Case of Thyroid Dermopathy Exacerbation in a Filipino Male Following Radioactive Iodine Ablation and Total Thyroidectomy Improved by Weekly Intradermal Long-Acting Glucocorticoid Injection

Abstract Disclosure: K.T. Lim: None. O.C. Dampil: None. Ablation Aberration: A Case of Thyroid Dermopathy Exacerbation in a Filipino Male Following Radioactive Iodine Ablation and Total Thyroidectomy Improved by Weekly Intradermal Long-Acting Glucocorticoid Injection Introduction: Thyroid dermopathy (TD) represents an unusual extrathyroidal presentation of Graves' disease (GD), impacting about 0.5–4% of patients. RAI treatment for hyperthyroidism is known to progress Graves' ophthalmopathy. RAI-induced TD exacerbation, however, is rare in literature. Here, we present a case of worsening TD and ophthalmopathy in a Filipino patient with GD who underwent definitive therapy for persistent hyperthyroidism. Clinical Case: A 44-year-old man with GD had bilateral lower extremity indurated, mildly erythematous plaques for 4 years. Hyperthyroidism persisted despite methimazole compliance, so he underwent RAI ablation two years earlier, total thyroidectomy a year later, and has been on levothyroxine since. Despite definitive treatment, his extrathyroidal symptoms worsened. A punch biopsy of the skin lesions revealed upper and mid-lower dermis mucin deposition, with occasional spindle-shaped and stellate fibroblasts, and mast cells. These histopathologic findings were consistent with pretibial myxedema. We assessed his thyroid function and found he was euthyroid with normal TSH (3.1 μIU/mL; reference range 0.27-4.20) and an elevated TRAb (35.73 IU/L; reference range &amp;lt;1.75). Physical examination revealed thickened skin, cobblestone-like plaques, and non-pitting edema on the pretibial, ankle, and pedal areas. A 3.5-cm-diameter, circumscribed, orange-peel-textured, indurated plaque covered his left ankle. Fluocinolone acetonide 0.025% w/w ointment was initiated. After 3 weeks, his cutaneous symptoms improved by 35%, albeit his left ankle circumscribed plaque improved marginally. Triamcinolone acetonide 40 mg/mL was injected into this and other nodular lesions at 4mg (0.1 mL) per 1-cm-diameter circular region. Each dose was equally dispersed by multipoint intradermal injections using a 1 mL syringe with a 0.5”x 25G needle. A week after intralesional triamcinolone injection and continuous topical steroid application on the non-nodular lesions, a 70% improvement in cutaneous manifestations was observed (from baseline) with the plaques becoming thinner and softer. After three weekly intradermal steroid injections, the circumscribed plaque had flattened (with residual hyperpigmentation), and the other plaques and nonpitting edema dissipated. Conclusion: Our experience with this patient highlights a paradoxical TD exacerbation following RAI ablation and definitive surgery for persistent hyperthyroidism in GD. It also reveals that weekly administration of multiple subcutaneous injections of a long-acting glucocorticoid alleviates lesions where topical ointment does not. Presentation: 6/1/2024

Central Retinal Artery Occlusion Following Intralesional Triamcinolone Injection for IgG4-related Orbital Disease.

The risk of blindness associated with periocular and facial injections is well documented. Previous cases describing vision loss following a recent periocular or facial injection have emphasized the importance of facial "danger zones." To date, the literature suggests that nearly half of all cases of central retinal artery occlusion in the setting of a recent periocular or facial injection involve an injection in or around the nose. Here, the authors report the second known case of central retinal artery occlusion following a triamcinolone injection to the lacrimal gland. A 30-year-old female with a diagnosis of IgG4-related disease underwent lacrimal gland debulking with an intralesional steroid injection. She noted OD vision loss immediately after surgery, with posterior segment examination demonstrating retinal whitening with a cherry-red spot and intra-arterial yellow-white plaques. This case serves as a reminder to clinicians regarding the risk of iatrogenic embolism following triamcinolone injections around the face with special attention drawn to the lacrimal gland.

A double-blinded randomised control study to compare the effectiveness and safety of intralesional vitamin D3 with intralesional triamcinolone and its correlation with tissue expression of vitamin D receptors in patients with keloid.

Intralesional steroids commonly used for keloid treatment have adverse effects like cutaneous atrophy and telangiectasias. Safer and more effective therapies are needed. Preliminary studies suggest intralesional vitamin D as a potential alternative treatment. The aim of this study was to compare efficacy and safety of intralesional vitamin D with triamcinolone for keloids, and correlate tissue expression of vitamin D receptors (VDRs) with treatment outcomes. Sixty patients were randomly assigned to two groups: Group A (intralesional vitamin D) and Group B (intralesional triamcinolone). Four injections were given at 4-week intervals, with an 8-week follow-up. Biopsies were taken pre- and post-treatment to examine VDR expression levels and treatment response correlation. The primary outcome of interest was the proportion of patients achieving a 50% reduction in Vancouver Scar Scale (VSS). Secondary outcomes included incidence of adverse effects, and changes in VDR expression before and after treatment. Baseline VSS scores were 9.73 ± 1.01 (vitamin D group) and 10.13 ± 1.07 (triamcinolone group). After treatment, mean VSS decreased to 5.17 ± 0.59 (vitamin D group, p < 0.001) and 4.77 ± 0.77 (triamcinolone group, p < 0.001), with significantly better response in latter (p = 0.03). More than 50% reduction in VSS score was higher in the triamcinolone group (76.7% vs. 50%, p = 0.032). No recurrences were noted during the 8-week follow-up. Hypopigmentation (80% vs. 36.7%, p < 0.001) and atrophy (73.3% vs. 40%, p = 0.009) were more common in the triamcinolone group. No significant difference in pre- and post-treatment VDR receptor expression was observed in either group. Both triamcinolone acetonide and vitamin D were effective for keloids. Triamcinolone was more efficacious, whereas vitamin D was safer, suggesting it as a viable alternative for keloid management.

53189 Optimizing intralesional triamcinolone acetonide treatment for isolated nail psoriasis: An intra-subject randomized controlled trial

53189 Optimizing intralesional triamcinolone acetonide treatment for isolated nail psoriasis: An intra-subject randomized controlled trial

Management of orofacial granulomatosis: A case report

The term orofacial granulomatosis (OFG) was introduced by Wiesenfeld in the year 1985. OFG describes a disease with frequent or persistent edema in the orofacial region. It may be idiopathic or may present as a localized form or generalized form as in Crohn’s disease, tuberculosis, and sarcoidosis. The clinical features include facial or lip swellings, angular cheilitis, oral ulcerations, vertical fissures of lips, gingival enlargement, mucosal tags, and sometimes lymph node enlargement. The diagnosis of OFG is quite challenging and it should be excluded from other granulomatous conditions. The usual treatment for this condition includes corticosteroids, monoclonal antibodies, and tumor necrosis factor-α inhibitors. It has been suggested that intralesional triamcinolone injections are a safe and effective therapeutic strategy in controlling the permanent disfiguring swelling of OFG. Hereby, we present a case of a 34-year-old female patient who reported with swollen upper lips and gingival enlargement.

Efficacy and safety of intralesional triamcinolone acetonide alone and its combination with 5‐ fluorouracil in keloids and hypertrophic scars: Randomized, parallel group, and double blinded trial

AbstractBackgroundTreatment of keloids and hypertrophic scars is challenging. The current first‐line treatment is a steroid which has high resistance and recurrence rate along with unacceptable adverse effects. Different studies involving the combination of TAC and 5‐FU that have been done so far showed better treatment outcomes in terms of efficacy and safety.ObjectiveThe objective of this study was to compare the efficacy and safety of intralesional triamcinolone acetonide alone and its combination with 5‐fluorouracil in patients with keloids and hypertrophic scars at 12 weeks follow‐up.MethodsIn this randomized parallel group double‐blinded clinical trial, we enroled 66 cases of keloids and hypertrophic scars randomly allocated into two treatment groups. Patients received an intralesional injection of triamcinolone acetonide (20 mg/mL) in Group A and an intralesional injection of a combination of triamcinolone acetonide (20 mg/mL) and 5‐fluorouracil (25 mg/mL) in Group B for every 2 weeks until 10 weeks and the final evaluation was done at 12 weeks follow‐up.ResultsThere was a reduction in all the parameters at every follow‐up visit in both groups. The ≥50% reduction in height, reduction in the VSS and POSAS scores, and good to excellent subjective improvement reported by both the patients and the observer were significantly greater in the combination group compared to TAC alone group. The response rate was faster and complications were lesser in the combination group as compared to TAC alone group.LimitationSingle‐centred, no long‐term follow‐up, and recurrence could not be assessed.ConclusionTAC alone and its combination with the 5‐FU both were effective in keloids and hypertrophic scars. Yet, the TAC and 5‐FU combination treatment was more efficacious with a faster response rate and safer than the TAC alone treatment.

Intralesional vitamin D3 versus intralesional triamcinolone acetonoid in patchy alopecia areata: a comparative clinical and dermoscopic study

ABSTRACT Background Alopecia areata (AA) is a common autoimmune T-cell mediated non-scarring, form of hair loss. It affects people of all ages and sexes. Aim To compare the efficacy of intralesional vitamin D3 injection versus that of intralesional triamcinolone acetonide in the treatment of patchy alopecia areata. Patients and methods This clinical study was carried on 40 adult patients with patchy alopecia areata, the patients were categorized into two groups. Group I involved 20 patients who received 1 ml of intralesional injection of vitamin D3 (cholecalciferol aqueous preparation 200 000 IU/2 ml) every 4 weeks for a maximum of three sessions. Group II involved 20 patients who received 1 ml of intralesional injection of triamcinolone acetonide 40 mg/mL every 4 weeks for a maximum of three sessions. Clinical and trichoscopic evaluations were done at the baseline, each session and for 3 months after the last session. Results There was no statistically significant difference between the two studied groups regarding the degree of clinical improvement (p = .8). A statistically significant reduction in AA specific trichoscopic signs was detected at the end of the sessions and after 3 months of follow-up in both groups, without any statistically significant difference between them. Also a statistically significant difference was found between both groups regarding the reported adverse effects with a significant better patient satisfaction encountered toward the intralesional vitamin D3 injection. Conclusion Intralesional vitamin D3 is a promising effective, simple, safe, and inexpensive, therapeutic modality for patchy AA.

Comparison of Intralesional Injection of Hyaluronic Acid with Triamcinolone and Triamcinolone Alone in Treatment of Oral Lichen Planus at Tertiary care Oral &amp; Maxillofacial Center

Objective: To compare the outcome of intralesional injection of Hyaluronic acid with Triamcinolone and Triamcinolone alone in the management of Oral Lichen Planus. Methodology: This randomized controlled trial, conducted in the Oral &amp; Maxillofacial Surgery department at Punjab Dental Hospital(PDH), Lahore, included 30 patients aged 20-70 years with histopathologically confirmed Oral Lichen planus (0.5-4 cm), using a Split mouth technique. One side of the lesion received intralesional Triamcinolone (40 mg/ml), while the other side received a combination of Hyaluronic acid and Triamcinolone. Pain and lesion size were assessed using a Visual Analogue Scale and measured at 2 and 12 weeks. Data was analyzed in SPSS version 20.0, with significance at P &lt; 0.05, comparing mean pain scores and lesion disappearance between groups using t-tests and Chi-square tests. Results: Total 30 patients were included. The mean age of the patients was 48.76±14.67 year. Oral health assessment revealed that 9(30%) patients had good oral hygiene, and 15(50%) average hygiene. At baseline and 2nd week mean pain score in Intervention group was 5.7±1.08, 1.60 ±0.62 and in control patients was 5.6±1.03 and 2.10±0.99. Disappearance of lesion showed no significant difference between groups. Although in intervention group rate of disappearance of lesion was higher. i.e. Intervention: 73.3% vs. Control: 50%, p-value=0.063 Conclusion: The conclusion of the study is that intralesional injection of Hyaluronic acid plus Triamcinolone is more effective than Triamcinolone alone for treating Oral Lichen Planus in terms of pain reduction and lesion disappearance

Regression course of ostium granulomas under topical intranasal steroids coverage after endoscopic dacryocystorhinostomy

This study aimed to elucidate the regression process of ostium granulomas under the usage of intranasal steroid after primary endoscopic dacryocystorhinostomy (DCR). The authors retrospectively reviewed 57 patients (a total of 72 ostia) who had ostium granulomas after primary endoscopic DCR between 2011 and 2015. Topical intranasal steroid spray was applied in all the patients since postoperative day 1. Adjunctive intralesional triamcinolone acetonide injections were administered for extensive and large-sized granulomas that caused impending ostium blockage. Sequential regression of the ostium granulomas and success rates of DCR were assessed using endoscopic photos. The granulomas completely disappeared in 69 (95.8%) ostia, and the average time interval from the surgery to the disappearance was 6.9 ± 2.8 months. Anatomical and functional surgical success rates were 90.3% and 84.7%, respectively. Intralesional steroid injections for ostium granulomas did not alter the outcomes compared to topical intranasal steroid usage significantly (p = 0.445). In conclusion, we observed that, by continuing the usage of intranasal steroids, ostium granulomas disappear gradually at postoperative 6 months. The intranasal surgical manipulation of granulomas, which results in more mucosal cicatricial change and impedes patient satisfaction, can be successfully avoided.

British Society for Skin Care in Immunosuppressed IndividualsOral presentationsBI01 Intralesional triamcinolone acetonide and antiretroviral therapies: a lesser considered drug interaction

British Society for Skin Care in Immunosuppressed IndividualsOral presentationsBI01 Intralesional triamcinolone acetonide and antiretroviral therapies: a lesser considered drug interaction

Fibrotic reaction to hyaluronic acid fillers in the face.

Hyaluronic acids (HAs) can have very different actions not only depending on injector and host factors but also depending on their molecular weight. Whereas short chain HA has immunological activity long chain HA influences fibroblasts and may stimulate them to produce collagen. Although this is generally thought to be a positive feature it may be disadvantageous in certain localizations. We have encountered 23 patients who developed fibrous tissue next to the nasolabial folds accentuating them and becoming very obvious while smiling. Hyaluronidase injection did not reduce this mass. Intralesional triamcinolone acetonide injection led to rapid improvement. Fibrotic tissue reaction not responding to hyaluronidase may be the result of HA injection and can effectively be treated with intralesional steroid injection.

Comparative Outcomes of Propranolol Monotherapy and Combined Therapy with Intralesional Triamcinolone in Infantile Hemangioma

Background: Infantile Hemangiomas (IHs) are the most common vascular tumors of infancy. Oral propranolol has achieved great success in treating IHs since 2008. Recently combined oral propranolol with intralesional injection of Triamcinolone acetonide is the effective method of treatment for infantile Hemangioma with minimal adverse effects. Objectives: To observe the outcome of Propranolol monotherapy and combined therapy with intralesional Triamcinolone in Infantile Hemangioma. Materials and Methods: This prospective study was carried out in the Department of Pediatric Surgery, Sylhet MAG Osmani Medical College Hospital, Sylhet, during the period from January 2018 to December 2019. It included 42 infantile hemangioma patients divided into two groups: Group A (21) treated with oral propranolol, and Group B (21) treated with oral propranolol plus intralesional triamcinolone acetonide. Patients were followed up at regular intervals for 6 months. Results: The data of two groups of patients with IH were compared in the study. The demographic variables, including median age, sex, size, type, and site of IH, were comparable between the two groups. This showed that pre-treatment complications were slightly higher in Group B but not significantly different. Superior size reduction was observed in Group B (71.4% vs. 38.1%), though the difference was not significant statistically. Group B had excellent color regression, which was significantly higher compared to the other group (90.5% vs. 9.5%, p &lt; 0.001). The mean treatment cost was higher in Group B, which was 187.86. taka compared to 124.76. taka in Group A (P value was &lt;0.001). In summary, Group B had better color regression of the pinprick but at a higher cost of treatment as compared to Group A, and other parameters were almost equal in both groups. Conclusion: Combined propranolol and intralesional Triamcinolone is more effective compared to propranolol alone in the treatment of IHs.

Comparison of Intralesional Triamcinolone Acetonide Alone with Intralesional Triamcinolone Acetonide-5-Fluorouracil Combination Injection in Keloid: A Case Report

Keloids are abnormal cutaneous wound healing responses extending beyond the borders of the initial wound, usually appearing pink-purplish to hyperpigmented nodules or plaques with a hard consistency, irregular shape, uneven border, and smooth shiny surface. Most often occur on the chest, shoulder, upper arms, earlobes, and cheeks. This case report aims to compare a case of keloid treated with intralesional triamcinolone acetonide (TAC) alone with intralesional triamcinolone acetonide-5-fluorouracil (TAC + 5-FU) combination injection. A 21-year-old Minahasa male complains of growing pruritic scars in the back area and right and left upper arms since five years ago. Physical examination of the right and left upper arms revealed multiple hyperpigmented nodules and plaques, irregularly shaped, smooth, and shiny surfaces with defined borders and varying sizes. A clinical diagnosis of keloid was made. Treatment was initiated with weekly intralesional TAC alone on the left upper arm vs. intralesional TAC + 5-FU combination injection on the right upper arm. The evaluation was made based on the clinical and modified Vancouver scar scale. One of the most commonly used therapeutic options for keloid is TAC. However, the combination of TAC + 5-FU may be opted for due to its mechanism through the corticosteroid mechanism of action in conjunction with the antimetabolite activity of 5-FU. The combination may yield a more effective and faster outcome with fewer side effects. Intralesional combination TAC + 5-FU injection may be a therapeutic option for keloid with minimal side effects.