Triamcinolone Research Articles

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.

Delayed onset Cutibacterium (formerly Propionibecterium) acnes endophthalmitis triggered by intravitreal steroid injection.

We report a case of delayed onset Cutibacterium acnes (C. acnes, formerly Propionibacterium acnes or P. acnes) endophthalmitis with onset triggered by intravitreal steroid (triamcinolone acetonide; TA) injection in a pseudophakic patient, 7 years after cataract surgery.Methods/Patients: A 67 years old, male presented with gradual worsening of vision, eye redness and photosensitivity that started a month after intravitreal TA injection (Triescience, 4mg/0.1mL, Alcon Labs, Fort Worth, TX) for cystoid macular edema secondary to branch retinal vein occlusion in the right eye. Patient had undergone cataract surgery with intraocular lens (IOL) in that eye 7 years prior. Exam showed visual acuity of counting fingers at 3 feet, conjunctival injection, with 2+ anterior chamber cell and 2+ vitreous haze. Uveitis work up including Angiotensin converting enzyme (ACE), Quantiferon Gold, and syphilis IgG screen was negative. Diagnostic pars plana vitrectomy (PPV) with intravitreal injection of antibiotics was performed and vitreous sample was sent for detailed laboratory analysis. Vitreous fluid analysis was positive for C. acnes and negative for viral, fungal and malignant cells. Although the patient received intravitreal antibiotics injection twice, the intraocular infection and inflammation persisted which eventually required an IOL and capsular bag removal, followed by insertion of a secondary IOL later. Delayed onset C. acnes endophthalmitis may be triggered by an intravitreal steroid injection in pseudophakic patients.

Comparison of Clinical Efficacy and Trichoscopic Changes in Alopecia Areata of the Scalp following Treatment with Intralesional Triamcinolone Acetonide and Autologous Platelet-Rich Plasma

Background: Alopecia areata (AA) is an autoimmune disease affecting the scalp and body, resulting in hair loss. The fundamental goal of management is to keep the pathology under control. Intralesional corticosteroids suppress T-cell-mediated attacks on hair follicles. Platelet-rich plasma (PRP) contains growth factors that stimulate hair follicle stem cells and have anti-inflammatory properties with fewer side effects. Trichoscopy shows exclamation hair and black dots in the acute stage, yellow dots in long-standing cases, and short vellus hair in regrowing patches. Objective: The aim of this study was to evaluate and compare the efficacy of intralesional triamcinolone acetonide with autologous PRP in the treatment of two different scalp AA patches in the same individual. Materials and Methods: This was a hospital-based prospective follow-up study. Patients with two different patches of alopecia were selected. One was treated with intralesional triamcinolone acetonide (10 mg/ml) and the other with PRP given at 3-week intervals for four treatment sessions. Comparison of results was based on MacDonald Hull and Norris grading system and trichoscopy. Results: Out of 32 patients, 8 (25%) in triamcinolone-treated patches and 3 (9.4%) in PRP-treated patches showed complete hair regrowth at 12 weeks. Furthermore, a faster response was seen with triamcinolone. On trichoscopy, both patches showed an increase in short vellus and terminal hair and a reduction in yellow dots and exclamation hair. No changes in black dots were seen. Conclusion: Intralesional triamcinolone acetonide is more effective than PRP in the treatment of AA of the scalp and is safe. Trichoscopic findings indicate response to treatment and reduction of disease activity.

The Protection and Antioxidant Mechanisms of Corticosteroids in LPSTreated Retinal Pigment Epithelial Cells

Dexamethasone (DEX) and triamcinolone acetonide (TA) are two corticosteroids as anti-inflammatory agents that have been used as an anti-inflammation in several diseases to protect against oxidative damage. The present study examined the anti?oxidant effect of DEX and TA on lipopolysaccharide (LPS)-induced intracellular reactive oxygen species (ROS) in human retinol epithelium ARPE-19 cells. DEX and TA markedly inhibited the LPSinduced intracellular ROS level. DEX and TA also inhibited the expression of NADPH oxidase subunit gp91 and p22. Moreover, the expression of two antioxidant enzymes, heme oxygenase-1 (HO-1) expression and gammaglutamylcysteine synthetase (gamma-GCS), were increased by DEX and TA treatment in LPS-treated ARPE-19 cells. These results indicate that DEX and TA inhibits the intracellular ROS response by blocking the NADPH oxidase pathway and may increase some antioxidant enzymes in LPS -induced ARPE-19 cells. Therefore, DEX and TA may be useful as antioxidant agents against oxidative damage in anti-inflammatory diseases.

Analysis of Corticosteroid-Induced Glaucoma Using the Japanese Adverse Drug Event Reporting Database.

Glaucoma is the most common cause of blindness, which significantly reduces quality of life. Most glaucoma cases are primary glaucoma; nevertheless, many patients suffer from glaucoma caused by drugs, such as corticosteroids. A comprehensive review of the risks associated with corticosteroid-induced glaucoma is limited. Therefore, we used the Japanese Adverse Drug Event Reporting Database (JADER) published by the Pharmaceuticals and Medical Devices Agency (PMDA) to analyze the risk factors associated with glaucoma and the trends and characteristics of corticosteroid-induced glaucoma. We did not find sex or age differences associated with the onset of glaucoma. Hierarchical clustering and principal component analysis revealed that triamcinolone acetonide and betamethasone sodium phosphate, which are used around the eyes in Japan, are more likely to induce intraocular pressure (IOP) elevation compared with other corticosteroids. Increased IOP is a direct cause of glaucoma. Based on these findings, it may be necessary to limit or avoid the use of these corticosteroids.

Intraocular Pressure Elevation Following Intra-Vitreal Injection of Bevacizumab, Ranibizumab and Triamcinolone Acetonide

Purpose: To record intraocular pressure (IOP) at different time intervals after intravitreal injection (IVI) and to correlate the rise in IOP with refractive error and post-injection reflux. Study Design: Retrospective review of records. Place and Duration of Study: Sri Aurobindo Medical College &amp; Postgraduate institute, Indore, Madhya Pradesh, India. September 2022 and December 2022. Method: We included 126 untreated eyes of 120 patients. The indications of IVI were macular edema, and age-related macular degeneration.IOP and refractive status were determined. Bevacizumab, Ranibizumabor Triamcinolone Acetonidewas injected. Presence of vitreous reflux was noted at the injection site immediately after injection. IOP was measured at 10, 20, 30, and 45-minutes after injection. Descriptive statistics were calculated as mean and standard deviation for quantitative variables and frequency and percentage for qualitative variables. Repeated measure ANOVA was applied and p-value of &lt;0.05 was considered significant. Results: Transient IOP rise was observed in 95.24% cases whereas 4.76% patients showed sustained rise beyond 30minutes, which returned to normal after use of topical beta-blocker.Hypermetropic eyesinjected withTriamcinolone injection showed significant sustained rise of IOP (p&lt;0.05). Vitreous reflux was seen in 47 (37.3%) eyes that showed significantlylowermean IOP of 20.89 ± 5.159 mm Hg (p&lt;0.05) when compared to eyes with no vitreous reflux (IOP=30.75± 7.384 mm Hg). Conclusion: IVI results in transientrise of IOP which is lesser with vitreous reflux. Triamcinolonehasa propensity to cause sustained rise of IOP especially in hypermetropic eyes that requires intervention.

Chronic Plantar Fasciitis Treatment: A Randomized Trial Comparing Corticosteroid Injections Followed by Therapeutic Ultrasound with Extracorporeal Shock Wave Therapy

This study aims to compare the effect of corticosteroid injection (CSI) followed by therapeutic ultrasound (TUS) with that of extracorporeal shock wave therapy (ESWT) in patients with chronic plantar fasciitis (PF) and to explore the impact of a sedentary lifestyle and obesity on treatment outcomes. Female patients with PF were randomly allocated to receive ESWT (group A, n = 25) or CSI + TUS (group B, n = 25). Interventions: Group A received four once-weekly sessions of ESWT (2000 shocks, 2.5 bar pressure, 10.0 Hz frequency). Group B received a local injection of 40 mg triamcinolone acetonide with 2 mL 1% xylocaine, followed by three sessions of TUS per week for two weeks. Pain visual analog scale (VAS pain), plantar fasciitis pain and disability scale (PFPDS), and fascia thickness using musculoskeletal ultrasound were all measured at baseline, 4 weeks, and 12 weeks after the end of treatment. VAS pain and PFPDS improved significantly in both groups after 4 and 12 weeks. In the ESWT group, the pain improved significantly more at 12 weeks (p = 0.004). In obese patients (BMI &gt; 29.9 kg/m2), ESWT gave more long-term pain relief at 12 weeks follow-up. In both the ESWT and CSI + TUS groups, after 12 weeks, the VAS pain improved more in patients with a sedentary daily life than in those with active life (p = 0.021 and p = 0.014, resp.), as well as the PFPDS (p = 0.014 and p = 0.019, resp.). Plantar fascia thickness decreased in both groups at 12 weeks. In both groups, improvements in function (PFPDS) correlated significantly with decreased plantar fascia thickness at 4 and 12 weeks. In the CSI + TUS group only, the decrease in plantar fascia thickness was correlated with pain improvement at both follow-up visits. Echogenicity changed from hypoechoic to iso- or hyperechoic and improved significantly in both groups at 12 weeks follow-up, but changes were not different between the groups (p = 0.208). Both CSI + TUS and ESWT are effective treatments for female patients with chronic plantar fasciitis resulting in pain relief and improved function and fascia thickness. ESWT gave more pain relief at 12 weeks follow-up. CSI + TUS is effective as a rapid and short-term modality for relieving PF pain. According to previous studies, the addition of TUS does not appear to make CSI much more effective.

Short term effects of intraarticular triamcinolone acetonide injection on serum testosterone, luteinizing hormone, and follicle stimulating hormone levels in male veterans: A prospective pilot study.

Despite the common practice of intraarticular corticosteroid injections (ICSIs) for peripheral joint disease, little is known about their systemic effects on the hypothalamic-pituitary-gonadal axis. To assess the short-term effects of ICSIs on serum testosterone (T), luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels together with changes in Shoulder Pain and Disability Index (SPADI) scores in a veteran population. Prospective pilot study. Outpatient musculoskeletal clinic. Thirty male veterans, median age 50 (range 30-69) years. Ultrasound-guided glenohumeral joint injection using 3 mL of 1% lidocaine HCl and 1 mL of 40 mg triamcinolone acetonide (Kenalog). Serum T, FSH, and LH levels, Quantitative Androgen Deficiency in the Aging Male (qADAM), and SPADI questionnaires at baseline, 1, and 4 week(s) post procedure. At 1 week post injection, serum T levels decreased by 56.8 ng/dL (95% confidence interval (CI): 91.8, 21.7, p = .002) compared with baseline. Between 1 and 4 weeks post injection, serum T levels increased by 63.9 ng/dL (95% CI: 26.5, 101.2, p = .001), recovering to near baseline levels. SPADI scores were reduced at 1 week (-18.3, 95% CI: -24.4, -12.1, p < .001) and 4 weeks (-14.5, 95% CI -21.1, -7.9, p < .001). A single ICSI can temporarily suppress the male gonadal axis. Future studies are needed to evaluate for long-term effects of multiple injections at a single setting and/or higher corticosteroid doses on male reproductive axis function.

Effect of triamcinolone acetonide in trigeminal neuralgia (TN) pain

Background: Trigeminal neuralgia is a form of neuropathic pain caused by trigeminal nerve. Anticonvulsants are primary class of pharmaceuticals used to treat pain in trigeminal neuralgia patients. Another conservative treatment option for controlling this pain includes blocking of nerve. Objectives: To determine how trigeminal neuralgia patients respond to triamcinolone acetonide. Methods: The department of oral and maxillofacial surgery at de'Montmorency College of Dentistry/Punjab dental hospital conducted a cross-sectional study over a six-month period. 35 study participants underwent a clinical examination along with a history-taking process. Written consent was obtained. After gathering the necessary information, the affected nerve was identified followed by the administration of local anesthesia. The most painful area was identified and 5 mL of bupivacaine and 40 mg of triamcinolone acetonide was administered at that side. After five minutes, the participant's level of pain was assessed, and they were contacted back for follow-up after seven days. Every item on the post-op list of targeted goals was checked off in the participant's questionnaire at the follow-up day. With SPSS version 24, the statistical analysis was completed. Results: There were 35 participants in the study overall, with the majority of them being in their 40s or 50s.

BI24 Cutaneous pseudolymphoma secondary to pembrolizumab

Abstract A 35-year-old man presented with a 7-week history of itchy, nontender, indurated erythematous plaques and nodules on his forehead and upper back, with no discriminatory clinical features. He was systemically well. Three months previously, he had completed a 12-month course of adjuvant pembrolizumab for stage IIIC melanoma. The primary melanoma had been excised from his left cheek, with involvement of left parotid and supraclavicular lymph nodes, treated with clearance via superficial parotidectomy and left neck dissection. Clinical and imaging surveillance revealed no evidence of melanoma recurrence. Incisional biopsies of the lesions on his back and forehead both demonstrated a superficial and deep dermal perivascular and periadnexal infiltrate of small- and medium-sized lymphoid cells. There was no epidermotropism and B- and T-cell clonality studies were negative. Morphological appearance and immunophenotype favoured a CD4+-reactive lymphoid process in keeping with cutaneous pseudolymphoma (CPL), secondary to pembrolizumab. The conspicuous forehead lesion was unresponsive to clobetasol propionate under occlusion. A single course of intralesional triamcinolone acetonide 10 mg mL–1 resulted in significant improvement within days, with subsequent complete resolution. The lesion on the back resolved spontaneously. Drug-induced CPL describes an adverse cutaneous drug reaction mimicking B- or T-cell lymphomas clinically and/or histologically. It has been described with anticonvulsants, antidepressants and biologic agents, often with resolution on cessation of the responsible drug (Etesami I, Kalantari Y, Tavakolpour S et al. Drug-induced cutaneous pseudolymphoma: a systematic review of the literature. Australas J Dermatol 2023; 64:41–9). It has been proposed that the drugs affect immune surveillance, leading to an abnormal cutaneous lymphocyte response. A case report (Ayoubi N, Haque A, Vera N et al. Ipilimumab/nivolumab-induced pseudolymphoma in a patient with malignant melanoma. J Cutan Pathol 2020; 47:390–3) has described drug-induced CPL secondary to ipilimumab and nivolumab in a 38-year-old man presenting with erythematous plaques on the hands and face, similar to the presentation of our patient, which responded to prednisolone. As with the other adverse effects of immunotherapy, it is likely that CPL in this cohort is due to an iatrogenic immune dysregulation leading to T-cell overactivity. We present the first reported case of CPL secondary to pembrolizumab and highlight the successful use of intralesional steroid as a treatment option. It is important to recognize CPL as an adverse cutaneous effect of immunotherapy and be aware that it can present after completing treatment due to an ongoing immune response.

DS11 A double-blinded randomized 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

Abstract Intralesional steroids are the first line of treatment for keloids, and intralesional vitamin D has shown promise in the management of keloids in a few small studies. The aim was to compare the efficacy and safety of intralesional vitamin D with intralesional triamcinolone and its correlation with tissue expression of vitamin D receptors (VDRs) in the treatment of keloids. Sixty patients were randomly divided into two groups in 1 : 1 ratio. Patients in group A received intralesional vitamin D (200 000 IU, dose 0.2 mL cm−2); those in group B received intralesional triamcinolone acetonide (20 mg mL−1, dose 0.1 mL cm−2). Four monthly injections were given, and the patients were followed-up for a further 24 weeks. The Vancouver Scar Scale (VSS) was used for keloid evaluation. Pre- and post-treatment biopsies of 20 patients from both groups were taken to assess the correlation between the expression of VDR receptor levels before and after treatment. The mean VSS scores of patients in both groups were statistically significantly reduced over the course of the follow-up (P &amp;lt; 0.001). Mean (SD) reduction in VSS at the end of treatment period was 5.17 (0.59) in patients in group A and 4.77 (0.77) in those in group B. The proportion of the patients showing &amp;gt; 50% reduction in VSS score was higher in patients in group B vs. those in group A (77% vs. 50%; P = 0.032). Rates of recurrence were comparable between the two groups (P = 0.51). Hypopigmentation (80% vs. 37%; P &amp;lt; 0.001) and atrophy (73% vs. 40%; P = 0.009) were more common in patients in group B than in those in group A. There was no significant difference in pre- and post-treatment values of tissue VDR expression in either group. Both triamcinolone and vitamin D are effective in the management of keloids. Although the reduction in VSS score was higher with corticosteroids than vitamin D, an intralesional injection of vitamin D had lower incidence of adverse effects such as atrophy and hypopigmentation.

P60 Intralesional steroids vs. liquid nitrogen cryotherapy vs. 595 nm pulsed dye laser in the management of chest keloids: a comparative study

Abstract Chest keloids often result in cosmetic disfigurement, contractures, pruritus and pain. Inflammatory truncal acne often triggers chest keloid. Management is often challenging as they are relatively resistant to treatment and recurrence rates are high. The objective of the study was to compare the clinical efficacy and safety of intralesional triamcinolone acetonide (40 mg mL−1) vs. liquid nitrogen cryotherapy vs. 595 nm pulsed dye laser in the management of chest keloids. We conducted a comparative prospective study in a total of 42 patients with chest keloids from July 2021 to July 2022. These patients were randomly divided into three treatment groups via the envelope method. The Vancouver Scar Scale (VSS) was used to assess the clinical efficacy of the treatment modality. Patients were scored at the initiation of therapy and every 4 weeks until 16 weeks. Seven patients were lost to follow-up (response rate 83%). Treatment arms consisted of intralesional triamcinolone acetonide (n = 10), liquid nitrogen cryotherapy (n = 11) and pulsed dye laser (n = 14). There was a near-equal sex distribution of chest keloids (male-to-female ratio 1.21 : 1), with 15 patients (35.7%) having additional keloids in other body parts. The mean (SD) age of patients with chest keloids was 27.2 (13.6) years with a common incidence in those aged 20–30 years. Comparison of mean VSS as baseline and at 16 weeks revealed a statistically significant decrease in the score in all three treatment arms (P &amp;lt; 0.05). Comparison between the three different treatment arms revealed pulsed dye laser to be the most effective modality in decreasing VSS at the 16-week follow-up (Anova followed by post hoc analysis with Tukey’s test). With regard to the adverse clinical event profile, acneiform eruptions were reported following steroid injections, blistering and depigmentation were reported following liquid nitrogen cryotherapy, and blistering was reported following pulsed dye laser therapy. Thus, the pulsed dye laser (595 nm) appears to be a safe and efficacious treatment modality in the management of chest keloids.

EARLY DETECTION OF VERRUCOUS CARCINOMA USING METHYLENE BLUE STAINING IN SUSPECTED LEUKOPLAKIA LESION: A CASE REPORT

Introduction: Verrucous carcinoma is one of squamous cell carcinoma in the oral cavity which can caused by smoking, alcohol consumption, HPV etc. Verrucous carcinoma can mimick as pre cancer lesion such as leukoplakia, so that early detection is mandatory. Vital staining can be done by toluidine blue, but it reported toxic in organ. Methylene blue had similar chemical structure and exhibited similar physicochemical properties to toluidine blue.The aim of this case report is to report the case of early detection verrucous carcinoma using methylene blue in leukoplakia among smoker and alcoholic patient. Case: A 46-year-old male patient came to RSIGM Sultan Agung Semarang complaint that there was a wound on the left cheek that has not healed for the last 3 years. The wound was not painful but sore when exposed to food. The wound had been treated using Albothyl but there was no change. The patient had been an active smoker since 20 years ago and consume as much as 2-3 packs of cigarettes/day and also consumed alcohol about 4 years ago. Intraoral examination nodular white plaques, unscrappable with pigmentation areas and painless. Clinical diagnosis was nodular leukoplakia. Case Treatment: Early detection using methylene blue 1% was obtained and a positive dark blue indicated a change in malignancy. Patients were given symptomatic therapy of triamcinolone acetonide in orabase 0.1% then an excisional biopsy was performed and a histopathological appearance shows thickening and changes in polarity of the epithelial cells and dysplasia. The final diagnosis is verrucous carcinoma. Conclusion: The persistent white plaque with the risk factors of smoking and alcohol is a suspicion toward malignancy, early detection using methylene blue staining can performed before biopsy.

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

Keloids and hypertrophic scars cause physical and psychosocial problems. A combination of 5-fluorouracil (5-FU) and triamcinolone acetonide (TAC) may enhance the treatment of pathologic scars, although the evidence base is limited. The authors compared the efficacy and complication rates of combination intralesional TAC and 5-FU with those of 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 the Cochrane risk of bias tool. Of 277 articles screened, 13 studies were included, comprising 12 randomized control trials and one nonrandomized study. Six studies compared combination intralesional therapy versus monotherapy 5-FU, and nine studies compared combination intralesional therapy versus monotherapy TAC. The combined group demonstrated superior objective treatment efficacy compared with the monotherapy TAC group (OR, 3.45; 95% CI, 2.22 to 5.35; I 2 = 0%; P < 0.00001) and monotherapy 5-FU group (OR, 4.17; 95% CI, 2.21 to 7.87; I 2 = 0%; P < 0.0001). Telangiectasia was less frequent in combination therapy (OR, 0.24; 95% CI, 0.11 to 0.52; I 2 = 0%; P = 0.0003) compared with monotherapy TAC. Combined intralesional TAC and 5-FU administration demonstrated superior treatment efficacy outcomes compared with monotherapy TAC or 5-FU. Patient-reported outcome measures should be incorporated in the design of future research to justify clinical recommendations. Combined TAC and 5-FU has demonstrated superior treatment efficacy outcomes compared to monotherapy TAC or 5-FU in the treatment of hypertrophic scars and keloids.

Comparison of Effectiveness of Hiora SG Gel With Triamcinolone Acetonide Gel in Recurrent Aphthous Stomatitis.

Background The oral condition known as recurrent aphthous ulceration (RAU) or recurrent aphthous stomatitis (RAS) is very prevalent. Its etiopathogenesis is unknown; hence, symptomatic therapy is all that can be offered if it manifests clinically. Lesion care aims to minimize discomfort and the frequency of relapses by bringing active illness under local control in the affected area. The current treatment options that may have negative side effects include the use of topical and systemic steroids, antibiotics, cauterization, and laser therapy. Objectives and Importance This study aimed to compare the efficiency of HiOra SG gel with triamcinolone acetonide gel in the management of RAS. Materials and Methods Fifty individuals with RAS were recruited for the trial and randomly assigned to either group I (HiOra SG gel) or group II (0.1% triamcinolone acetonide ointment; Oraways). After each meal for a total of 10 days, those with mouth ulcers were instructed to topically administer the drugs. The clinical data were analyzed by comparing the ulcer severity scores from the first, fifth, and 10th days. Results There was a statistically significant (p = 0.001) reduction in reported pain, pain duration, and overall ulcer severity across all groups. After therapy, however, neither the HiOra gel group nor the triamcinolone group showed any discernible improvement over the other. Conclusion The present study's findings corroborate the efficacy of HiOra SG gel in the treatment of RAS when compared to triamcinolone acetonide gel (0.1%). In this trial, no patients had any negative reactions to HiOra SG gel. In the future, further studies are needed with larger samples to prove its benefits.

CHALLENGES OF MANDIBLE CENTRAL GIANT CELL GRANULOMA TREATMENT: A CASE REPORT

Central giant cell granuloma (CGCG) is considered to be a rare benign intraosseous lesion of unknown etiology, that is non-neoplastic but locally aggressive, and is present in gnathic bones. This study aimed to present the challenges of a CGCG treatment. A 27-year-old woman was referred for treatment of CGCG in the mandible. Clinical examination, panoramic X-ray, and cone-beam tomography revealed a large lesion involving the right posterior region of the mandible, causing facial asymmetry. The lesion was initial treated with 18 sessions of intralesional triamcinolone acetonide infiltrations. There was a partial response in forming the basal cortical bone. After, a surgical procedure fully enucleated the lesion. After 6 years, radiographic exams showed adequate bone formation, and a third approach was performed for rehabilitation with implants and prothesis. After 9 years of follow-up, the patient is asymptomatic, showing satisfactory functional and esthetic conditions. Central giant cell granuloma (CGCG) is considered to be a rare benign intraosseous lesion of unknown etiology, that is non-neoplastic but locally aggressive, and is present in gnathic bones. This study aimed to present the challenges of a CGCG treatment. A 27-year-old woman was referred for treatment of CGCG in the mandible. Clinical examination, panoramic X-ray, and cone-beam tomography revealed a large lesion involving the right posterior region of the mandible, causing facial asymmetry. The lesion was initial treated with 18 sessions of intralesional triamcinolone acetonide infiltrations. There was a partial response in forming the basal cortical bone. After, a surgical procedure fully enucleated the lesion. After 6 years, radiographic exams showed adequate bone formation, and a third approach was performed for rehabilitation with implants and prothesis. After 9 years of follow-up, the patient is asymptomatic, showing satisfactory functional and esthetic conditions.

Vaccination approach in patients with an allergic reaction to COVID-19 vaccines or at risk of developing allergic reactions

There is consensus that patients at risk of developing an allergic reaction to COVID-19 vaccines should be evaluated by an immunologist-allergist to determine whether vaccination should be recommended. We wanted to share our experiences in the management of these high-risk patients, from diagnostic tests in allergological evaluation to the vaccination process. Our retrospective cross-sectional study included patients who had previously developed an allergic reaction to COVID-19 vaccines or drugs and therefore were referred to our allergy and immunology clinic. Prick and intradermal tests were performed on all patients with methylprednisolone acetate (Depo-Medrol®, Pfizer) 40 mg/mL containing polyethylene Glycol (PEG) and triamcinolone acetonide (Kenacort®, Deva) 40 mg/mL containing polysorbate 80. While vaccination with desensitization was recommended for all patients with positive skin tests, split-dose vaccination was recommended for patients with negative skin tests. After explaining the risks and benefits, the choice of the vaccine (Pfizer/BioNTech or Sinovac/ CoronoVac) was left to the patients' discretion. A total of 41 patients, 10 males, and 31 females, with a mean age of 42.37 ± 14.177 years were included. Eighteen patients with a history of allergy after COVID-19 vaccines were analyzed according to the type of reaction and type of vaccine administered (Pfizer/BioNTech/Coronovac; Anaphylaxis: 4/1, Urticaria: 11/2). Moreover, there was a history of drug allergy in 23 patients who had not been vaccinated before. Skin tests with PEG were positive in a total of seven patients while skin tests with polysorbate 80 were negative in all patients. No allergic reaction developed in seven patients who underwent desensitization and in 34 patients who received a split dose. Considering the potentially life-saving benefits of vaccination in a global pandemic environment, it is a safe and effective method to administer vaccines to at-risk patients using desensitization or split dosing techniques, based on their sensitivity status determined through a PEG skin test. This approach allows for the avoidance of preventing access to vaccines, while still ensuring the safety of patients.

Faricimab for Diabetic Macular Edema in Patients Refractory to Ranibizumab or Aflibercept.

Background and Objectives: Faricimab is the first intravitreal injection of vascular endothelial growth factor-A and angiopoietin-2 bispecific monoclonal antibody. Here, we evaluate the functional and anatomical outcomes of faricimab treatment in patients with diabetic macular edema (DME) that was refractory to ranibizumab or aflibercept. Materials and Methods: We performed a retrospective, observational, consecutive-case study of patients who had DME that was refractory to treatment with ranibizumab or aflibercept and were treated with faricimab between July 2022 and January 2023 under a pro re nata regimen. All the participants were followed for ≥4 months after the initiation of faricimab. The primary outcome was a recurrence interval of ≥12 weeks, and the secondary outcomes were the changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT). Results: We analyzed 18 eyes of 18 patients. The mean recurrence interval of previous anti-VEGF injection was 5.8 ± 2.5 weeks, which was significantly extended to 10.8 ± 4.9 weeks (p = 0.0005) by the switch to faricimab. Eight patients (44.4%) achieved a recurrence interval of ≥12 weeks. A history of subtenon injection of triamcinolone acetonide (p = 0.0034) and the presence of disorganization of the retinal inner layers (p = 0.0326) were found to be significantly associated with a recurrence interval of <12 weeks. The mean BCVAs were 0.23 ± 0.28 logMAR and 0.19 ± 0.23 logMAR, and the mean CMTs were 473.8 ± 222.0 µm and 381.3 ± 219.4 µm at baseline and 4 months, respectively, but these changes were not statistically significant. None of the patients experienced serious adverse events. Conclusions: Faricimab may extend the treatment interval for patients with DME that is refractory to ranibizumab or aflibercept. DME previously treated with the subtenon injection of triamcinolone acetonide or associated with disorganization of the retinal inner layers may be less likely to be associated with a longer recurrence interval after switching to faricimab.

Comparison of the Functional OutcomeBetween Intra-Articular Corticosteroid Injection versus Platelet-Rich Plasma in Patients with Adhesive Capsulitis

Objective: To compare mean resting pain relief and passive external rotation improvement by Intra-articular Steroid versus intra-articular Platelet Rich Plasma injection in patients with adhesive capsulitis.&#x0D; Study Design: Prospective comparative study.&#x0D; Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi Pakistan, from Jan to Jun 2019.&#x0D; Methodology: A total of 60 patients were included in the study. Group-A and B received Intra-articular 40mg Triamcinolone Acetonide with 1 ml 1% Lignocaine and platelet-rich plasma injections in affected shoulders, respectively. Pain severity was assessed on the Numeric Rating Scale, and passive external rotation was assessed by goniometry at baseline, i.e., preintervention, six weeks and 12 weeks intervals.&#x0D; Results: In our study, the NRS scale for pain was 3.030.76 at six weeks and 1.230.77 at 12 weeks with PRP versus 5.070.87 at six weeks and 3.200.89 with Corticosteroids at 12 weeks post-intervention, with the p-value of &lt;0.001 showing increased efficacy of PRP. While passive external rotation was 70.275.26 at six weeks and 82.304.84 at 12 weeks with PRP versus 61.35.28 at six weeks and 71.806.99 with corticosteroids at 12 weeks post-intervention, with the p-value of &lt;0.001 showing increased efficacy of PRP.&#x0D; Conclusion: There was a significant improvement in mean resting pain relief and passive external rotation after platelet-rich plasma injection in the shoulder joint adhesive capsulitis compared to intra-articular Steroids.

Efficacy and Safety of Detachable Microneedle Patch Containing Triamcinolone Acetonide in the Treatment of Inflammatory Acne.

Detachable microneedles (DMNs) are dissolvable microneedles that detach from the base during administration. The use of DMNs-containing steroids for acne has never been investigated. Thirty-five patients with facial inflammatory acne were evaluated for acne treatment efficacy and safety of DMNs and DMNs containing triamcinolone acetonide (TA) via a 28-day randomized, double-blind, controlled trial. Four inflammatory acne lesions were selected from each participant and randomly treated with a single application of 700 µm DMNs containing 262.02 ± 15.62 µg TA (700DMNTA), 1000 µm DMNs containing 160.00 ± 34.92 µg TA (1000DMNTA), 700 µm DMN without TA (700DMN), and a control. Efficacy was measured by assessing physical grading, diameter, volume, erythema index, and melanin index. Safety was evaluated by assessing reports of adverse effects from patients and physicians. All three treatment groups achieved resolution of inflammatory acne significantly faster than the control group, with median times for resolution of 4.6, 5.25, 6.7, and 8.1 days in the 1000DMNTA, 700DMNTA, 700DMN, and control, respectively. When compared to the control group, the diameters and post-acne erythema of inflammatory acne were significantly reduced in the treatment groups. The 1000DMNTA decreased acne size and erythema more than other treatments. DMNTA also tended to decrease acne size and erythema more than DMN with no TA, but there was no statistically significant difference. All participants preferred DMN over conventional intralesional steroid injection due to less pain and self-application. No adverse effect was observed. DMNTA is a safe, effective alternative treatment for inflammatory acne and significantly reduces post-acne erythema.