Triamcinolone Acetonide Group Research Articles

Comparison of dual-plane micro-drop injection of botulinum toxin type A with two traditional methods for treating hypertrophic scars in the tension zone: A long-term clinical application study.

Patients with hypertrophic scarring tend to experience recurrence after treatment, which often occurs in areas of the body with high skin tension. To evaluate better treatments aimed at reducing the risk of scar recurrence in areas of high skin tension. Patients were randomly divided into the following three treatment groups: botulinum toxin type A (BTA) via dual-plane micro-drop injections, triamcinolone acetonide (TAC) suspension, and CO2 via fractional CO2 laser. Interventions were implemented in all three groups once a month for three consecutive sessions. After the final treatment, scarring was evaluated at 1, 3, 6, 12, and 24 months using the Patient and Observer Scar Assessment Scale (POSAS). The 3-month POSAS score for each scar indicator in the treatment groups was significantly lower than that in the preoperative groups (p < 0.001). The scar score in the TAC group decreased at 3 months and increased thereafter. For other groups, the scar score continually decreased at all time points according to the Patient Scar Assessment Scale. Based on the Observer Scar Assessment Scale, the scar score continuously decreased at all time points in the BTA group; in the TAC group, it decreased at 1 month and increased thereafter; and in the CO2 group, the scar score decreased at 3 months and subsequently stabilized. All three treatment methods were effective. However, the BTA group experienced a reduced risk of scar recurrence and maintained long-term treatment effects.

Effect of aflibercept combined with triamcinolone acetonide on aqueous humor growth factor and inflammatory mediators in diabetic macular edema.

To investigate the efficacy of aflibercept combined with sub-tenon injection of triamcinolone acetonide (TA) in treating diabetic macular edema (DME) and to examine changes in growth factors and inflammatory mediator levels in aqueous humor after injection. Totally 67 DME patients (67 eyes) and 30 cataract patients (32 eyes) were enrolled as the DME group and the control group, respectively. The DME group was divided into the aflibercept group (34 cases) and the aflibercept combined with TA group (combined group, 33 cases). The aqueous humor of both groups was collected during the study period. The aqueous levels of vascular endothelial growth factor (VEGF), monocyte chemoattractant protein-1 (MCP-1), interleukin-6 (IL-6), interleukin-8 (IL-8), and interleukin-1β (IL-1β) were detected using a microsphere suspension array technology (Luminex 200TM). Aqueous cytokines, best-corrected visual acuity (BCVA), central macular thickness (CMT), and complications before and after treatment were compared between the aflibercept group and combined group. The concentrations of VEGF, MCP-1, IL-6, and IL-8 in the aqueous humor were significantly higher in the DME group than those of the control group (all P<0.01). After 1mo of surgery, the concentrations of VEGF, MCP-1, IL-6, and IL-8 in the aqueous humor were significantly lower in the combined group than those of the aflibercept group (all P<0.01). The BCVA and CMT values of the two groups were statistically different after 1 and 2mo of treatment (P<0.01). However, the difference was not statistically significant after 3mo of treatment (P>0.05). The cytokines VEGF, MCP-1, IL-6, and IL-8 in the aqueous humor of DME patients are significantly increased. Aflibercept and aflibercept combined with TA have good efficacy in DME patients, can effectively reduce CMT, improve the patient's vision, and have high safety. Aflibercept combined with TA can quickly down-regulate the aqueous humor cytokines and help to relieve macular edema rapidly. However, the long-term efficacy is comparable to that of aflibercept alone.

Impact of intravitreal triamcinolone injection following epiretinal membrane peeling on ectopic inner foveal layer classification.

This study aimed to evaluate the impact of intravitreal triamcinolone acetonide (TA) administration after peeling of idiopathic epiretinal membranes (iERM) on both anatomical and visual outcomes, utilizing the ectopic inner foveal layer (EIFL) staging scheme. In this retrospective case-control study, we analyzed 43 eyes from 43 patients diagnosed with iERM between June 2019 and December 2021. All participants were categorized into the TA or control groups based on administering intravitreal TA injection following ERM peeling. We thoroughly reviewed the clinical data, including the preoperative and postoperative best-corrected visual acuity (BCVA), central foveal thickness (CFT), and macular cube volume (VOL), with ERM stages classified according to the EIFL staging scheme. The study enrolled 22 eyes in the TA and 21 in the control groups. Following a mean follow-up period of 11.07 ± 2.02 months, noteworthy improvements in EIFL stages were observed in both cohorts (p < 0.01), but without significant distinctions between groups. In the TA group, 63.64% of eyes demonstrated improvements in EIFL stages, while the control group exhibited 76.19% (p = 0.37). At the final visit, both groups experienced a noteworthy reduction in the postoperative CFT and VOL (p < 0.05), coupled with significant improvement in BCVA (p < 0.01). No substantial differences appeared between the two groups concerning BCVA, CFT, and VOL (all p > 0.05). Our study suggested that concurrent intravitreal TA injection following ERM removal did not provide additional benefits regarding anatomical and visual improvement in iERM cases classified as Stages 2 and 3.

A comparative study of fractional CO2 laser with topical triamcinolone acetonide versus intralesional triamcinolone acetonide in the treatment of alopecia areata.

Alopecia areata (AA) is a non-scarring alopecia of chronic autoimmune etiology with heterogenous severity against the anagen hair follicle over the scalp, beard, or any part of the body and is associated with a significant psychological morbidity in the mental status of the patients leading the patients to seek treatment for cosmetic reasons. The management of AA is very unpredictable and is associated with various cosmetic adverse effects. This study aimed at comparing the efficacy and safety of a novel procedure of laser-assisted drug delivery system of steroids with the first-line procedure of intralesional steroids (ILS) for the treatment of patchy AA. To assess and compare the efficacy and safety of fractional CO2 laser in combination with topical triamcinolone acetonide aqueous solution and intralesional triamcinolone acetonide as a monotherapy and in the treatment of AA. A total of 60 patchy AA patients were included in this study. Patients were randomized into two equal groups: Group A and Group B with 30 patients in each group using a computer-generated block randomization. Patients in Group A received fractional CO2 laser with topical triamcinolone acetonide aqueous solution and Group B received ILS. Both groups received treatment for five settings with each setting a gap of 3 weeks. The efficacy and safety of treatment modalities in both groups were assessed using global photograph assessment (GPA)-scale, lesional area density score percentage of improvement (LAD score improvement %), visual discomfort scale (VDS), visual analogue scale, and documentation of adverse effects in each setting. Efficacy of treatment modality-assessed using means score of GPA-scale and LAD score improvement % suggests quicker results to patients in Group B in initial settings but drastic improvement happens to patients in Group A in subsequent settings. At the end of 5th setting, GPA-scale and LAD score improvement % suggest maximum efficacy in patients in Group A and they are statistically significant (P-value < 0.001). The mean VDS in both groups suggests maximum discomfort in Group A, yet the patient satisfaction at the end of 5th setting was maximum with patients in Group A and they are statistically significant (P-value < 0.001). Cosmetic notable adverse effect of atrophy of skin was documented in 30% of patients in Group B. This study showed that fractional CO2 laser with topical triamcinolone acetonide is a better treatment modality than the intralesional triamcinolone acetonide for the treatment of AA with respect to efficacy, safety, and adverse events.

Efficacy of Clobetasol Propionate (0.05%), Amlexanox (5%), and Triamcinolone Acetonide (0.1%) in the Treatment of Oral Lichen Planus.

This study aimed to compare the efficiencies of 0.05% clobetasol propionate, 0.1% triamcinolone acetonide, and 5% amlexanox in the management of oral lichen planus (OLP). A total of 120 patients diagnosed with oral lichen planus were equally divided into three groups and treated with 0.05% clobetasol propionate (group A), 0.1% triamcinolone acetonide (group B), and 5% amlexanox (group C) topical medicaments. The patients were evaluated for pain using the visual analog scale (VAS) and erosive lesion. There was a statistically significant decrease in the VAS pain scale score from day 1 to day 15 in all of the tested groups. There was also a reduction in the erosive area on the right and left buccal mucosa on the 15th day with all three tested drugs. Triamcinolone acetonide (0.1%) was effective in reducing the erosive lesions on buccal mucosa when compared with 0.05% clobetasol propionate and 5% amlexanox. Clobetasol propionate, triamcinolone acetonide, and amlexanox were effective in treating OLP patients.

Efficacy of Aloe Vera, Amlexanox (5%), and Triamcinolone Acetonide (0.1%) in the Management of Oral Lichen Planus.

This research assessed the efficiencies of aloe vera, 0.1% triamcinolone acetonide, and 5% amlexanox in the management of OLP. A total of 120 participants diagnosed with oral lichen planus (OLP) were equally divided into three groups and treated with: aloe vera, (Group A), 0.1% triamcinolone acetonide (Group B), and 5% amlexanox (Group C) topical medicaments. The patients were evaluated for pain, using the visual analogue scale (VAS). They were also evaluated for ulcerative lesion type and erosive area on days 1, 7, and 15 of the study. There was a statistically considerable decrease in the VAS pain scale score, reduction in the erosive area on buccal mucosa, and healing of ulcer from day 1st to 15th day with all three tested drugs. All drugs used in this study; aloe vera, triamcinolone acetonide, and amlexanox were effective in treating OLP patients.

Early use of intravitreal triamcinolone to inhibit traumatic proliferative vitreoretinopathy: a randomised clinical trial

AimsTo evaluate the efficacy and safety of intravitreal triamcinolone acetonide (TA) injection at the end of emergency surgery for open globe injury (OGI) to suppress traumatic proliferative vitreoretinopathy (TPVR).MethodsA single-centre,...

Evaluation of a steroid delivery system to mitigate the severity of proliferative vitreoretinopathy in a minipig model

PurposeTo investigate the efficacy of liposomal prednisolone phosphate to mitigate the severity of proliferative vitreoretinopathy (PVR) in a minipig model of PVR.MethodsA total of 18 eyes of 9 minipigs underwent PVR induction surgically. Eyes were randomized equally into three groups: intravitreal injection of liposomal prednisolone phosphate (LPP), triamcinolone acetonide (TA), and controls. PVR severity was graded on fundoscopic examination using a modified version of the Silicon Study Classification System. Severe PVR was defined as grade 2-5 on this classification, and the proportion of eyes with retinal detachment from severe PVR, defined as retinal re-detachment, i.e., PVR grade 2-5, was compared between treatment and control groups.ResultsOn day 28, five eyes (83.3%) in the control group were observed to have severe PVR. Within the LPP group, one (16.7%) eye developed retinal detachment due to severe PVR. Grade 0 PVR was observed in four (66.7%) eyes, grade 1 in one (16.7%) eye, and grade 5 in one (16.7%) eye. Within the TA group, grade 0 PVR was observed in four eyes (66.7%), grade 1 in two eyes (16.6%), and grade 5 in one (16.7%) eye. The difference in the proportion of eyes with severe PVR was significantly lower in the LPP group compared to controls at day 28 (16.7% vs 83.3%, p=0.02). There was no significant difference in the rate of severe PVR or median PVR grade between the liposomal prednisolone phosphate and triamcinolone acetonide groups.ConclusionLiposomal prednisolone phosphate reduces the severity of PVR in a minipig model of PVR.

Clinical evaluation of intralesional umbilical cord-derived mesenchymal stem cells, conditioned medium and triamcinolone acetonide injection for keloid treatment: A pilot study.

Topical keloid therapy is performed with triamcinolone acetonide (TA) intralesional injection. However, the recurrence rate is high with various side effects. Mesenchymal stem cells (MSCs) have high proliferative abilities and reduce the activity and proliferation of fibroblast cells in keloids. To overcome the costs and limitations, conditioned medium (CM) is used. This study aims to evaluate feasibility of intralesional injection of umbilical cord MSC (UC-MSC) and conditioned medium (UC-CM) compared to TA for keloid therapy. Twenty-four patients with keloids who met the inclusion criteria were included, randomized into three treatment groups and then got assessed for the sociodemographic data, keloid volume, histopathology (type 1:3 collagen ratio), interleukin-10 (IL-10) levels and Patient and Observer Scar Assessment Scale (POSAS) score during visits. Largest volume regression occurred in the UC-MSC group, followed by UC-CM and then the TA group (UC-MSC: 45.32% ± 2.61%; UC-CM: 43.61% ± 3.67%; TA: 28.34% ± 3.81%; p = 0.003). Similar pattern was also observed in increase in IL-10 levels, the decrease in POSAS scores and the reduction of type 1:3 collagen ratio. Hence, UC-MSC and UC-CM are promisingly more effective than TA for keloid therapy, showcasing their superiority in reducing keloid volume, symptoms and type 1:3 collagen ratio, as well as increasing the levels of IL-10.

Assessing keloid treatment efficacy: a comparison of intralesional umbilical-cord mesenchymal stem cells, their conditioned medium, and triamcinolone acetonide injection through macroscopic and microscopic examination

Link Video Abstract: https://youtu.be/NAnsqP7dPd0 Background: Current keloid treatment involves intralesional injection of triamcinolone acetonide (TA), which, despite its usage, is associated with high recurrence rates and adverse effects. Mesenchymal stem cells (MSCs) exhibit potent proliferative abilities and can curb fibroblast activity and proliferation within keloids. It is now known that umbilical cord mesenchymal stem cells (UC-MSCs) have been shown to have greater proliferative potential than bone marrow-derived MSCs (BM-MSCs), and other advantages of UC-MSCs include being easily accessible and less immunogenic. To assess the viability of administering umbilical cord MSC (UC-MSC) and its conditioned medium (UC-CM) via intralesional injection compared to TA in reducing macroscopic keloid volume and type 1:3 collagen ratio. Methods: This randomized controlled trial enrolled twenty-four keloid patients by consecutive sampling. Eligible patients were required to have keloids on the chest, back, abdomen, or extremities. Patients with hypertrophic scars, a history of kidney failure, hypertension, blood disorders, malignancy, pregnancy, breastfeeding, or keloid treatment were excluded. Sociodemographic data, keloid size, and tissue biopsies were collected during scheduled visits. Bivariate analyses applied were considered significant at a p-value of &lt;0.05. Results: The study revealed that the most significant decrease in macroscopic volume occurred within the UC-MSC group, followed by the UC-CM group, and then the TA group (UC-MSC: 50.24% ± 3.58%; UC-CM: 43.97% ± 3.04%; TA: 33.53% ± 2.64; p = 0.004. The UC-CM group exhibited the most substantial decrease in the type 1:3 collagen ratios (4.80±0.26), with UC-MSC (4.60(4.15-8.05)) and TA (3.96(1.63-4.14)) following in sequence (p=0.002). Conclusion: The findings of this study indicate that the use of UC-MSC and UC-CM exhibits promising superiority over TA in terms of reducing macroscopic keloid volume and type 1:3 collagen ratio.

Our Experience at Tertiary Medical College-Intralesional Injection of Triamcinolone Acetonide Versus Injection Verapamil Following Keloidectomy with Fillet Flap in Auricular Keloids.

Keloid, which forms as an excessive tissue response to trauma to the skin, is a benign, hyperproliferative, recurrent growth of dermal collagen without a quiescent or regressive period throughout the process of wound healing. The aim of this study was to evaluate patient satisfaction with treatment and to compare the efficacy of intralesional injection of triamcinolone acetonide against verapamil after keloidectomy with fillet flap in auricular keloids. Our study was Duration based prospective observational study with a Duration of two years from June 2021 till May 2023 with study population inclusive of 50 patients aged between 20 and 70years having recurrent keloid(s) over the pinna of any size or site. Keloidectomy with fillet flap and intralesional injection of trimcinolone acetonide was performed on 25 patients (30 keloids) in Group A, and keloidectomy with fillet flap and intralesional injection of verapamil was performed on 25 patients (30 keloids) in Group B. With a recurrence rate of 27%, eight keloids in Group A patients had an early recurrence three months following surgery. At nine months, nine more mixed-type cases with a 30% recurrence rate resurfaced. Recurrence seen in eight keloids out of 28 showed a 28.57% recurrence rate 12months following surgery. Three people in Group B with three sessile keloids experienced an early recurrence at three months after surgery, with a recurrence rate of 10%. At nine months, four more cases of mixed kind returned, with a recurrence rate of 13%. A recurrence rate of 14.28% was found in 4 of 28 keloids at 12months postoperatively. The Patient and ObserverScar Assesment Scale scores (POSAS scores) were consistently higher than Beausang scores at 1year, indicating high patient satisfaction compared to physician assessment in both groups A and B. A keloid recurrence-free interval of 11.36months was obtained by the Kaplan-Meier survival test (p < 0.05) in group A. Keloid recurrence-free interval of 10.98months was evaluated by the Kaplan-Meier survival test (p < 0.05) in group B. Among Keloidectomy with fillet flap surgery with intralesional injection of triamcinolone acetonide (group A) and keloidectomy with fillet surgery with intralesional injection of verapamil (group B), at each follow-up the success rate of group B was higher than group A indicating better trend of success in this group in terms of both absence of recurrence and absence of complications without statistically significant difference between them which shown both procedures more or less similar.

A therapeutic evaluation of various modalities of treatment of keloid-A randomized open label study

Keloid and hypertrophic scar are the result of abnormal growth of fibrous tissue following healing of a cutaneous injury in predisposed individuals. Some treatment options are pressure garments, radiation therapy, excision, intralesional injections, cryotherapy, silicone gel dressing and lasers though no single modality is completely effective.To study the efficacy, to compare and to study the adverse effects of 4 different modalities of treatment of keloid namely, Intralesional triamcinolone acetonide (TAC), Intralesional triamcinolone acetonide and 5-fluoro uracil (5-FU), Intralesional triamcinolone acetonide and silicone gel sheet (SGS) and Intralesional Radiofrequency (RF). Arandomized open label study was conducted in the dermatology department of a tertiary care hospital in Gujarat from Nov 2020 to December 2022. 108 patients were allocated to 4 groups, Group 1(TAC), Group 2( + 5FU), Group 3( + SGS) and Group 4(RF). Group 1 received Intralesional injections of Triamcinolone acetonide (alone), Group 2 received Intralesional injections of Triamcinolone acetonide and 5- fluorouracil, Group 3 was given Intralesional injections of Triamcinolone acetonide and topical silicone gel sheet and Group 4 was treated with intralesional radiofrequency.A total of 108 patients of age group 18-52 years were enrolled and was divided into 4 groups consisting of 27 patients each Improvement of pliability, vascularity, pigmentation and height of keloid was maximum in TAC + 5FU group and least was in TAC + SGS group. At the end of 4 weeks, excellent improvement was found highest in 29.6% of TAC+5FU group, 22.2% in TAC alone, 18.5% in RF group and 11.1% in TAC+SGS group. At the end of 8 weeks, excellent improvement was found highest in 51.8% of TAC+5FU group, 44.4% in TAC alone, 40.7% RF group and 25.9% in TAC+SGS group. The difference was statistically significant.Skin atrophy, telangiectasia, hypopigmentation and recurrence were observed more TAC group therapies whereas, ulceration and infection were more frequent with RF treatment, however few cases were also seen TAC+5FU group.In this study in terms of pliability and overall improvement maximum response was seen in group TAC + 5 FU and TAC + SGS was least effective.

CO2 laser vaporisation in treating oral lichen planus: A split-mouth randomised clinical trial.

This study aimed to compare the effectiveness of carbon dioxide (CO2 ) laser vaporisation versus intralesional injection of triamcinolone acetonide (TA) in the management of oral lichen planus (OLP). A randomised clinical trial with a split-mouth design was conducted on 16 patients with bilateral symptomatic OLP lesions. One side was treated with CO2 laser vaporisation, and the counterpart was treated with TA intralesional injection. The reticular-erythematous-ulcerative (REU) score, Thongprasom sign scoring (TSS), visual analogue scale (VAS) and lesion area were used to evaluate the lesions at weeks 0, 4 and 9. All participants were followed up for 9 months. Reduction in the REU, TSS scores and lesion area from baseline to the end of treatment was significantly greater in the CO2 group than in the TA group (p values were 0.001, 0.002 and 0.048 respectively). However, the reduction in VAS score did not differ between the two groups (p = 0.54). The recurrence rate was significantly higher in the TA group than in the CO2 group (75% vs. 31.1%; p = 0.016). CO2 laser vaporisation was more effective than TA intralesional injection in managing OLP and decreased recurrence rates.

Comparing the Efficacy and Safety of Combination Triamcinolone Acetonide and 5-Fluorouracil versus Monotherapy Triamcinolone Acetonide or 5-Fluorouracil in the Treatment of Hypertrophic Scars and Keloids: A Systematic Review and Meta-Analysis.

Keloids and hypertrophic scars cause physical and psychosocial problems. Combination 5-fluorouracil (5-FU) with triamcinolone acetonide (TAC) may enhance the treatment of pathological scars, although the evidence base is limited. We aimed to evaluate the efficacy and complication rates of combination intralesional TAC and 5-FU in comparison to monotherapy intralesional TAC or 5-FU for the treatment of keloids and hypertrophic scars. EMBASE, MEDLINE and CENTRAL were searched by two independent reviewers. The primary outcome was treatment efficacy (51% to 100% improvement). Study quality and risk of bias were assessed using Cochrane's risk of bias tool, respectively. Of 277 articles screened, 13 studies were included comprising 12 randomised control trials (RCT) and 1 non-randomised study. There were six and nine studies comparing combination intralesional therapy versus monotherapy 5-FU and monotherapy TAC, respectively. The combined group demonstrated superior objective treatment efficacy compared to the monotherapy TAC group (OR 3.45, 95% C.I: [2.22-5.35], I 2=0%, P<0.00001) and monotherapy 5-FU group (OR 4.17, 95% C.I: [2.21-7.87], I 2=0%, P<0.0001). Telangiectasia was less frequent in combination therapy (OR 0.24, 95% CI: [0.11-0.52], I 2=0%, P=0.0003) compared to monotherapy TAC. Combined intralesional TAC and 5-FU administration demonstrated superior treatment efficacy outcomes compared to monotherapy TAC or 5-FU. Patient-reported outcome measures, lacking here, should be incorporated in the design of future research to justify clinical recommendations.

Histological features of knee osteoarthritis treated with triamcinolone acetonide and hyaluronic acid.

Osteoarthritis (OA) is one of the most common degenerative joint diseases leading to disability in the end stage. Although intra-articular triamcinolone acetonide (TA) is one of the OA treatments that have been widely used, the side effects of such corticosteroids are still controversial. Intra-articular hyaluronic acid (HA) injection is another therapeutic option for patients with OA who do not want to use corticosteroids because of their side effects. However, the difference between the histological features associated with TA and HA in the treatment of OA remains unclear. Thus, the present study aimed to compare the histological effects of TA and HA on the cartilage of patients with knee OA. In the current study, 31 patients diagnosed with grade 3-4 knee OA on the Kellgren-Lawrence radiographic grading scale were separated into three groups: TA (n=12); HA (n=7) and untreated group (n=12). Histological examination of the whole articular cartilages of the patients was performed with hematoxylin and eosin and Alcian staining, as well as using a TUNEL assay. Clinical data such as cartilage thickness, structural and component deterioration, proteoglycan levels, apoptosis and empty lacunae were compared between the three groups. The results showed a high level of deterioration in both TA and HA groups but not in the untreated group, although the thickness of cartilage in the HA group was lower compared with that in the TA and untreated groups. The proteoglycan levels in the TA group were lower compared with those in the HA group. Moreover, the number of empty lacunae in the HA group was higher compared with that in the TA group, while no difference in apoptosis was found between TA and HA groups. A significant difference was not found in the histological staining between TA and HA groups. On the other hand, a significant difference was found in cartilage deterioration between the medial and lateral sides in these groups. TA and HA groups showed comparable histological results. TA injection is cheaper and easier but has more adverse effects for patients with knee OA than HA injection. Therefore, orthopaedists should select TA or HA based on the economic and specific needs of patients.

Fractional carbon dioxide laser alone and as an assisted drug delivery for treatment of alopecia areata: a clinical, dermoscopic and immunohistochemical study

Alopecia areata (AA) is a common cause of hair loss with no available universally successful treatment. Thus, new innovative treatments are urgently needed. This research aimed to evaluate the effectiveness of fractional carbon dioxide laser (FCL) alone or combined with triamcinolone acetonide (TA) solution, platelet-rich plasma (PRP), or vitamin D3 solution in treating AA. Sixty-four AA patients with 185 lesions were recruited and divided into four treatment groups. All patients received FCL either alone (group A, n = 19) or followed by topical TA (group B, n = 16) or PRP (group C, n = 15), or vitamin D3 solution (group D, n = 14). The response was assessed using Alopecia Areata Severity Index (AASI), MacDonald Hull and Norris grading, and trichoscopy. Histopathological features and immunohistochemical decorin expression were studied. All groups showed significant improvement in AASI compared to the baseline, with insignificant differences between them. Post-treatment, trichoscopic features of disease activity significantly decreased in all groups. Compared to control biopsies, both anagen follicles and decorin expression were significantly decreased in all pretreatment specimens. After treatment, all groups showed significantly increased anagen follicles and decorin expression compared to the baseline. Accordingly, FCL is an effective treatment for AA alone or combined with TA, PRP, or vitamin D3 solution. In AA, Decorin expression was downregulated, while enhanced expression following successful treatment occurred. This suggests the role of decorin in AA pathogenesis. However, further research is still recommended to clarify the exact role of decorin in AA pathogenesis and to investigate the therapeutic benefits of decorin-based therapy.

Clinical Effects of Pulsed Dye Laser Dynamically Combined with Triamcinolone Acetonide in the Treatment of Postoperative Recurrence Keloids.

This study aimed to explore the clinical effects of pulsed dye laser (PDL) dynamically combined with triamcinolone acetonide (TAC) in the treatment of post-operative keloids recurrence. This study retrospectively analysed the clinical data of 29 keloid patients (with 39 keloids) from April 2014 to February 2020. The patients were divided into TAC group (14 patients with 19 keloids) and dynamic treatment group (15 patients with 20 keloids) according to the post-operative treatment that they received. The keloids were assessed by Vancouver scar scale (VSS), patient and observer scar assessment scale (POSAS) and the effect of keloids on the quality of life of patients was evaluated with dermatology life quality index (DLQI) scale before the surgical treatment, at any time of relapse, and 24 months after the surgical treatment. The recurrence-free interval, relative cure time, and the cumulative times of TAC injection when the relative cure could be assessed as achieved, and the incidence of adverse reactions were calculated. Patients experiencing a recurrence within 2 years after surgery included 19 keloids (25.33%) that developed a recurrent event within 6 months, 34 keloids (45.33%) that within 12 months, and 39 keloids (52.00%) that within 24 months after surgery. Anterior chest keloid had the highest recurrence rate and ear keloid had the lowest recurrence rate. The total pigmentation and vascularity (VSS and POSAS) scores of patients' keloids in TAC group and dynamic treatment group 24 months after treatment were significantly lower than those before treatment and at relapse (P < 0.05), the total VSS and POSAS scores were significantly lower at 24 months than before treatment and at relapse (P < 0.05), and the DLQI scale score was significantly lower at 24 months than before treatment (P < 0.05). The VSS and POSAS scores of patients' keloids at 24 months after treatment were significantly lower in the dynamic treatment group than in the TAC group. The relative cure time of patients' keloids in the dynamic treatment group was 6.47 ± 2.72 months, which was significantly shorter than 8.65 ± 3.67 months in the TAC group (P < 0.05). The cumulative number of TAC injections that were given to achieve a relative cure of patients' keloids in dynamic treatment group was 3.60 ± 1.76, which was significantly less than 5.24 ± 2.25 in TAC group. The total incidence of adverse reactions was lower in the dynamic group than in TAC group, but this difference did not reach statistical significance (P > 0.05). Compared with TAC injection alone, PDL dynamically combined with TAC in the treatment of keloid with post-operative recurrence can shorten the relative cure time, reduce the number of TAC injections and improve the clinical efficacy.

Efficacy and Safety of Verapamil Versus Triamcinolone Acetonide in Treating Keloids and Hypertrophic Scars: A Systematic Review and Meta-Analysis.

Keloids and hypertrophic scars can affect the appearance and normal function of patients, and may severely affect patients' physical and mental health. Many methods have been used for the treatment of keloids and hypertrophic scars, there is no standardized method so far. The aim of this study was to compare the efficacy and safety of verapamil and triamcinolone acetonide (TAC) in treating keloids and hypertrophic scars. All studies from their inception date up to August 2022 were searched using four databases (PubMed, Cochrane Library, MEDLINE, and EMBASE). The weighted mean differences and the risk ratio were calculated for comparing continuous variables and dichotomous variables, respectively. A total of nine randomized controlled trials involving 567 patients were identified. This meta-analysis indicated that TAC group showed significantly better effects compared with verapamil group in the reduction of height at 3 and 9 weeks, pliability at 3, 9, and 18 weeks, vascularity at 3, 6, 9, 12, 18, and 24 weeks, whereas verapamil group showed significantly better effects compared with TAC group in the reduction of pliability at 21 and 24 weeks. Verapamil group showed a significantly lower incidence of skin atrophy, telangiectasia, and hypopigmentation compared with TAC group. However, the incidence of burning sensation in verapamil group was higher than that in TAC group. Concerning the treatment of keloids and hypertrophic scars, TAC was more effective than verapamil for improving vascularity; TAC was superior to verapamil in improving height within 9 weeks of treatment; TAC produced superior result for improving pliability within 18 weeks of treatment, whereas verapamil produced superior result between 18 and 24 weeks of treatment. Verapamil had fewer adverse events than TAC and can be used as a safer alternative for the treatment of keloids and hypertrophic scars. 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 .

A pilot study of viscoelastic agent to prevent recurrent vitreous hemorrhage after vitrectomy for proliferative diabetic retinopathy

BackgroundTo evaluate the possibilty of preventing recurrent vitreous hemorrhage (RVH) after vitrectomy in proliferative diabetic retinopathy (PDR) patients with unabsorbed vitreous hemorrhage (VH) by intravitreal injection of viscoelastic agent (VA) at the end of the surgery and compared its effect with triamcinolone acetonide (TA).MethodsThis was a pilot prospective, observational study. PDR patients with VH who underwent vitrectomy were assigned to 3 groups according to the tamponade applicated at the end of the surgery, including VA group (intravitreally injected 1 ml VA if the retina was prone to bleed during the operation), TA group (intravitreally injected 2 mg TA when there was much exudates), or balanced salt solution (BSS) group (no tamponade). Then postoperative follow-up was performed routinely until 6 months after surgery. The primary outcome was the incidence of RVH, secondary outcome were the best-corrected visual acuity (BCVA) and introcular pressure (IOP). Cataract formation and other complication were also assessed.ResultsA total of 68 eyes, from 68 patients, were included. 18,18,32 eyes were enrolled in the VA group, TA group and BSS group, respectively. The integral incidence of RVH after vitrectomy was 5.6%, 5.6% and 12.5% respectively (P = 0.602). There was no early RVH in VA or TA group, whereas 3 early RVHs were identified in BSS group, however there was no significant difference (P = 0.171). Every group had one late RVH case. In all groups, final BCVA showed significant improvement compared to baseline. BCVA at any postoperative visit showed no significant differences among 3 groups. Mean IOP was higher 1 week after surgery in VA group compared with the other groups; however, in other times the differences were not significant. No cataract formation and other complication was noted in 3 groups.ConclusionIntravitreal injection of VA or TA at the end of vitrectomy for PDR patients with unabsorbed VH tend to reduce the incidence of early RVH after vitrectomy similarly. As VA was preferred to applicate in the eyes that were prone to bleed, intravitreal injection of VA at the end of vitrectomy might be a promising method for preventing RVH in PDR patients.

Fibrin glue: an anti-fibrotic agent for contracted socket

Background: The contracted socket is caused by fibrosis leading to the shortening of the orbital tissue. Vascular endothelial growth factor (VEGF) is a profibrotic factor in postoperative wound healing. The novel option to prevent fibrosis is the use of fibrin glue. This study aims to evaluate the role of fibrin glue in reducing the VEGF expression in cells that cause post-socket surgery scar. Methods: An in vivo experimental study using an animal model was conducted. We used twenty eyes of white rabbit species as the study sample. The evisceration was carried out and distributed to the animals in four experimental groups consisting of the control group, the MMC group (0.1 ml of mitomycin-C (MMC) 0.4 mg/ml), the triamcinolone acetonide (TCA) group (0.1 ml of TCA 40 mg/ml), and the fibrin glue group (0,1 ml of fibrin glue). The treatment was performed through injection of the subconjunctival. After 14 days, rabbits were euthanized, and conjunctiva samples were cut. Immunoreactivity scores (IRS) were used to analyze the expression of VEGF in epithelia conjunctiva with a significant level of p &lt;0.05. Data were analyzed using SPSS version 26 for Windows. Results: All groups showed a statistically significant difference in VEGF expression with a p-value 0,000 (p&lt;0,05). The VEGF level was significantly lower in the three treatment groups compared with the control group. The VEGF expression was highest for the control group, followed by fibrin glue, TCA and MMC group. We found significant differences between the control group and the three treatment groups; the MMC group (p=0.001), the TCA group (p=0.002), and the fibrin glue group (p=0.005). While differences in VEGF expression between the three treatment groups could not be proven statistically. Conclusion: Fibrin glue is proven to reduce VEGF expression as a marker of fibrosis; thus, fibrin glue can be an alternative anti-fibrotic agent.