Intralesional Injection Of Triamcinolone Acetonide Research Articles

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.

A Three-Step Approach (MUC) for Umbilicoplasty: Creating a Deep Umbilical Depression in Lipoabdominoplasty.

Various methods of umbilicoplasty have been proposed to create an aesthetically pleasing umbilicus. However, following conventional lipoabdominoplasty, some patients, particularly those with a thin layer of abdominal fat, may exhibit a shallow navel. A modified umbilicoplasty with a three-step approach was performed between Jan 2019 and Mar 2023. The three-step procedure included multiple plications, umbilical stalk fixation, umbilical insertion and central gathering (MUC). Patients were followed up for at least 6months. Umbilical depth and complications were recorded. A total of 36patients were performed with MUC umbilicoplasty, with a mean age of 36.1years. Patients were satisfied with umbilical appearance. The average depth of the navel after MUC procedure was 1.8±0.3cm. A patient developed a hypertrophic scar in the umbilicus, which was treated with an intralesional injection of triamcinolone acetonide. No other complications were observed. The MUC approach to umbilicoplasty provides a deep umbilical depression with minimal scars. This three-step procedure is particularly beneficial for patients with a thin layer of abdominal fat. 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 .

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.

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.

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.

Efficacy of Intralesional Methotrexate Injection versus Triamcinolone Acetonide in Nail Psoriasis: A-Systematic Review and Meta-Analysis

Introducion: Psoriasis is a chronic inflammatory skin disease that can affect many parts of the body. Psoriatic involvement of the nail bed or nail matrix results in nail psoriasis that is common. Patients with psoriatic nails have impaired quality of life due to the appearance of nails, and significant morbidity and functional impairments may arise in large cases. The management of nail psoriasis is challenging because it is usually time-consuming with unsure outcomes. The existing evidences suggest that intralesional injection are particularly effective for nail psoriasis. Current studies provide recommendations on the intralesional injection technique, recommending an optimal concentration of methotrexate (MTX), triamcinolone acetonide (TA), and cyclosporine but the comparison of these treatment was still limited. Objective: This study aimed to evaluate the efficacy of intralesional injections of MTX compared with TA in treating nail psoriasis using Nail Psoriasis Severity Index (NAPSI) score. Methods: A systematic literature search was performed using EBSCOhost, Scopus, ProQuest, ScienceDirect, SpringerLink, Elsevier Clinical Key, Cochrane library, ClinicalTrials.gov subgroups terms: “intralesional methotrexate injections for nail psoriasis”, “intralesional triamcinolone acetonide injections for nail psoriasis” and “NAPSI Score”. Three studies were included in the qualitative synthesis and meta-analysis. Results: The overall SMD in NAPSI scores after administration of intralesional injection of MTX and TA was -0.213±0.232 (95% CI = -0.667 to 0.241). The Q statistic value was -0.921 (p=0.357), indicating the insignificant difference in the effectiveness of both therapies. Conclusion: Both MTX and TA were effective in treating nail psoriasis based on the reduction of NAPSI score.

Effective Treatment of Keloids with Three-Dose Moderate-Strength Intralesional Triamcinolone Acetonide (TAC) Regimen

Background: The most devastating consequence of any injury is scar formation. Among all the surgical specialties, plastic surgery faces the worst dilemma as patients expect it to be the scar-less surgery.Objectives: This study aims to set an effective dose of triamcinolone acetonide intralesional injection to achieve successful results in the treatment of keloids.Methods: A prospective interventional study was conducted in the Department of Plastic Surgery, Shaikh Zayed Hospital Lahore for 2 years. Triamcinolone acetonide was injected intralesional at a dose of 4mg/cm2 every 4th week. The improvement in scar appearance, pain, and itch were measured using Vancouver Scar Scale (VSS), Visual Analog Scale (VAS), and the St Andrew's itch egg scale, respectively up to 12 months of therapy.Results: Among the 40 patients, 12 were males and 28 were females. The mean age of patients was 32.8 years and the most common sites were the chest, earlobes, and back. There was a substantial progressive improvement in VSS and VAS scores over one year. A significant reduction in pruritus was also observed in the patients. No recurrence was noted at the end of 12 months.Conclusions: A moderate-strength dose of 4mg/cm2 as a single intralesional injection of triamcinolone acetonide every four weeks is effective in decreasing the size of keloids and relieving the symptoms such as pain and itching.

DERMATOFIBROSARCOMA PROTUBERANS: THE EXPERIENCES OF DIAGNOSIS AND TREATMENT THROUGH A RARE CASE REPORT

Background: Dermatofibrosarcoma protuberans (DFSP) is classified as a soft tissue sarcoma, representing a rare form of skin cancer. Despite its rarity, DFSP is acknowledged as the most common skin sarcoma. The clinical features of DFSP are highly varied, making early-stage diagnosis challenging. Treatment initiated at an advanced stage significantly increases the risk of DFSP recurrence. Case Report: A 65-year-old female patient sought medical attention at our hospital due to a giant tumor on her central back. The lesion had initially appeared two years prior and had been initially misdiagnosed as keloids. Subsequently, the patient underwent intralesional steroid injections and surgery at a private clinic, but the lesion exhibited no improvement and relapsed within two months. Upon presenting to the National Hospital of Dermatology and Venereology, the patient displayed a brown-red raised tumor measuring approximately 8x4cm on her back. Given the suspicion of a cutaneous carcinoma, a biopsy was conducted. The histopathology and immunohistochemistry tests confirmed the diagnosis of DFSP. Consequently, the patient underwent wide excision of the lesion, including 3 cm of normal skin around it and deep into the fascia. No recurrence was recorded after one year of follow-up. Conclusion: DFSP, a rare form of skin carcinoma, can be challenging to differentiate from various other conditions, including keloids. In cases where conventional treatments such as intralesional triamcinolone acetonide injection show poor improvement for suspected keloids, DFSP should be considered and confirmed through histopathology and immunohistochemistry tests. Received 28 June 2023Revised 26 September 2023Accepted 29 November 2023

Effect of Epidermoid Cysts on the Efficacy of Intralesional Corticosteroid Therapy for Hypertrophic Scars and Keloids: A Prospective Pilot Study.

Patients with hypertrophic scars (HSs) or keloids occasionally have epidermoid cysts (ECs), and the effect of ECs on the effectiveness of intralesional corticosteroids (ILCs) treatment in these patients has not been reported. This study aims to evaluate the influence of ECs on the outcomes of ILCs treatment in patients with HSs or keloids. This prospective study included 572 patients with keloids ( n = 461) or HSs ( n = 111). Patients received intralesional triamcinolone acetonide injection (0.05 mL/injection) at a concentration of 40 mg/mL and every 28 days for 4 sessions, with a 1-year follow-up. A higher incidence of ECs was observed in keloid patients (16.92%) compared with HSs patients (7.21%). Keloid patients with ECs were older ( p = .008) and had a longer disease duration ( p = .0148), higher Vancouver scar scale (VSS) scores ( p = .04), and greater thickness ( p = .006). Keloid patients with ECs showed less improvement in VSS scores ( p < .0001) and thickness ( p < .0001) after ILCs treatment, with a higher recurrence rate ( p < .0001). The overall complication rate in keloid patients with ECs after ILCs treatment was 49.51%. Epidermoid cysts under keloids were associated with a poor response to ILCs therapy. Therefore, it is recommended to incorporate ultrasonography as a routine examination for keloid patients to aid in better decision making in clinical practice.

Iatrogenic cushing’s syndrome post intralesional triamcinolone acetonide in oral submucous fibrosis: 2 case reports

BackgroundOral Submucous Fibrosis (OFMF) is an oral potentially malignant disorder (OPMDs), strongly linked to betel quid chewing. It exhibits a significantly higher rate of malignant transformation compared to other OPMDs. The use of Intralesional Triamcinolone Acetonide Injection has emerged as a highly effective treatment option and has become the cornerstone of managing this condition.Case PresentationA 44-year-old female and a 40-year-old male presented with burning sensation and limited mouth opening, leading to diagnosis of OSMF. Both patients were treated with Triamcinolone Acetonide (TAC) Intralesional injections. Following a few months of treatment, a significant improvement in mouth opening was observed. However, both patients began experiencing symptoms such as facial rounding (mooning of the face), a buffalo hump, uneven hair growth, and swelling in the lower extremities. Upon recognizing these symptoms as indicative of Cushing’s Syndrome, the administration of TAC injection was discontinued. Both patients were referred to a higher-level medical facility for confirmatory tests, which revealed elevated cortisol levels in both morning (Cortisol A.M) and evening (Cortisol P.M).ConclusionTAC injection has been established as an effective treatment for OSMF. However, it is crucial to closely monitor patients for any adverse effects resulting from the treatment, which may arise from high dosage or increased frequency.

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.

Local steroid injection in severe idiopathic granulomatous mastitis as a new first-line treatment modality with promising therapeutic efficacy.

Intralesional steroid injection has recently evolved as a novel treatment modality for localized idiopathic granulomatous mastitis (= IGM). We aimed to explore the therapeutic efficacy of local steroid injections (LSI) in patients with severe IGM. Fifty-one patients diagnosed with severe IGM were included in the study and treated with either local steroid injection (LSI) alone (n = 25) or combined LSI with systemic oral steroid treatment (OST) (n = 26). The local steroid injection protocol included an intralesional triamcinolone acetonide injection into the palpable granulomas every 4-week, and topical administration of steroid-containing pomades twice a day on the affected surface of the breast. Patients with a combined LSI and OST received low-dose oral methylprednisolone (<16 mg). Patients with LSI alone required more LSI applications than those in the combined LSI with OST group (LSI: 5 ± 2.9; vs. LSI/OST: 3.5 ± 2.5; p = 0.080) to obtain an effective optimum therapeutic response. At a median of 12 months (range, 4-42), no difference was found in complete response rates between patients in the LSI group and the combined LSI group with OST (52 vs. 53.9%, p = 0.999). However, steroid-related systemic side effects were lower in the LSI alone group (p < 0.008). Local steroid injection could be considered as the first-line treatment in patients with severe IGM until a therapeutic response has been obtained either as the sole treatment modality or combined with oral steroids. Compared with systemic oral steroid therapy, local steroid administration can be considered a new treatment modality with fewer side effects.

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.

Central Giant Cell Granuloma in Pediatric Patient

Central Giant Cell Granuloma (CGCG) is an osteolytic and expansile lesion of the mandible. This lesion affects a younger type of patients which generally require surgical treatment and hospitalization affecting vital structures and causing grow defects. We present a case in a 7-year-old patient using intralesional injections of triamcinolone acetonide. After such a treatment we observed new bone formation and reduction in the size of the lesion which derived in a great outcome in such a young patient. This treatment bypassed any required hospitalization or aggressive surgery reducing postoperative morbidity. This paper report successful treatment of intralesional administration of triamcinolone acetonide in a 7-year-old patient.

Deciphering the single-cell transcriptome network in keloids with intra-lesional injection of triamcinolone acetonide combined with 5-fluorouracil.

Keloid is a highly aggressive fibrotic disease resulting from excessive extracellular matrix deposition after dermal injury. Intra-lesional injection of triamcinolone acetonide (TAC) in combination with 5-fluorouracil (5-FU) is a commonly used pharmacological regimen and long-term repeated injections can achieve sustained inhibition of keloid proliferation. However, the molecular mechanisms underlying the inhibitory effect on keloids remain insufficiently investigated. This study performed single-cell RNA sequencing analysis of keloids treated with TAC+5-FU injections, keloids, and skins to explore patterns of gene expression regulation and cellular reprogramming. The results revealed that TAC+5-FU interrupted the differentiation trajectory of fibroblasts toward pro-fibrotic subtypes and induced keloid atrophy possibly by inhibiting the FGF signaling pathway in intercellular communication. It also stimulated partial fibroblasts to develop the potential for self-replication and multidirectional differentiation, which may be a possible cellular source of keloid recurrence. T cell dynamics demonstrated elevated expression of secretory globulin family members, which may be possible immunotherapeutic targets. Schwann cell populations achieved functional changes by increasing the proportion of apoptotic or senescence-associated cell populations and reducing cell clusters that promote epidermal development and fibroblast proliferation. Our findings elucidated the molecular and cellular reprogramming of keloids by intra-lesional injection of TAC+5-FU, which will provide new insights to understand the mechanism of action and therapeutic targets.