Intralesional corticosteroid injections for infantile hemangioma

Infantile hemangiomas(IHs) are the most common benign soft-tissue tumors in infancy;about 10%–15% of them may result in various complications that require active management. The current first-line treatment for IH is oral propranolol;however, some studies recommend intralesional corticosteroid injections for small, limited, deep, or prominent tumors because of concern regarding serious systemic complications related to propranolol. This review summarizes and analyzes the current clinical studies on corticosteroid injections in IHs, discusses treatment norms, and explores future research directions.

A randomized clinical trial assessing the efficacy of single and multiple intralesional collagenase injections for treating contracted scars

Background:Scar contractions caused by trauma or burns can cause secondary physical dysfunction and disfigurement.Many minimally invasive methods for scar contraction have shown limited applicability and efficacy.This study investigated the feasibility and efficacy of intralesional collagenase injections for scar contraction treatment.Methods:Patients with contracted scars who had limited joint movement and physical disfiguration for>1 year were enrolled in this single-blind,randomized clinical trial from July 2017 to February 2018 at Shanghai Ninth People’s Hospital.Collagenase was injected into the firm-contracted scar(15 U/cm^(2))three times at 4-week intervals in the multiple treatment group and once in the single treatment group,and a placebo injection was performed in the control group.Scar length and skin texture were documented at the 4-and 12-week follow-ups.The safety of the collagenase treatment was also evaluated.Results:The contracted scar was significantly elongated after both single and multiple collagenase treatments.The results showed that,compared to a one-time treatment,repeated injections were more effective at 12 weeks,with an average improvement of 26.83(15.79%).At 12 weeks,78.9% of the patients in the multiple group and 52.9%in the single group achieved significant improvement at 12 weeks.No severe adverse events were observed.Conclusion:Intralesional collagenase injection showed promising results in improving scar contraction and provides an alternative treatment for patients.

Intralesional steroid injection therapy in the management of resistant gastrointestinal strictures

Esophageal strictures are a problem frequently encountered by gastroenterologists. Dilation has been the customary treatment for benign esophageal strictures, and dilation techniques have advanced over the years. Depending on their characteristics and the response to treatment, esophageal strictures can be classified into two types: 1, simple (Schatzki rings, webs, peptic injury, and following sclerotherapy) - these are easily amenable to dilation, with a low recurrence rate after initial treatment; and 2, complex (caused by caustic ingestion, radiation injury, anastomotic strictures, and photodynamic therapy) - these are difficult to dilate and are associated with higher recurrence rates. Refractory strictures are those in which it is not possible to relieve the anatomic restriction successfully up to a diameter of 14 mm over five sessions at 2-weekly in- tervals, due to cicatricial luminal compromise or fibrosis; and recurrent strictures are those in which it is not possible to maintain a satisfactory luminal diameter for 4 wk once the target diameter of 14 mm has been achieved. There are no standard recommendations for the management of refractory strictures. The various techniques used include intralesional steroid injectioncombined with dilation; endoscopic incisional therapy, with or without dilation; placement of self-expanding metal stents, Polyflex stents, or biodegradable stents; self-bougienage; and endoscopic surgery. This review discusses the indications, technique, results, and complications of the use of intralesional steroid injections combined with dilation and endoscopic incisional therapy with dilation in refractory strictures.

Intralesional steroid is beneficial in benign refractory esophageal strictures:A meta-analysis

AIM To analyze the effect of intralesional steroid injections in addition to endoscopic dilation of benign refractory esophageal strictures.METHODS A comprehensive search was performed in three databases from inception to 10 April 2017 to identify trials, comparing the efficacy of endoscopic dilation to dilation combined with intralesional steroid injections. Following the data extraction, meta-analytical calculations were performed on measures of outcome by the randomeffects method of Der Simonian and Laird. Heterogeneity of the studies was tested by Cochrane's Q and I^2 statistics. Risk of quality and bias was assessed by the Newcastle Ottawa Scale and JADAD assessment tools.RESULTS Eleven articles were identified suitable for analyses, involving 343 patients, 235 cases and 229 controls in total. Four studies used crossover design with 121 subjects enrolled. The periodic dilation index(PDI) was comparable in 4 studies, where the pooled result showed a significant improvement of PDI in the steroid group(MD:-1.12 dilation/month, 95% CI:-1.99 to -0.25 P = 0.012; I^2 = 74.4%). The total number of repeat dilations(TNRD) was comparable in 5 studies and showed a non-significant decrease(MD:-1.17, 95%CI:-0.24-0.05, P = 0.057; I^2 = 0), while the dysphagia score(DS) was comparable in 5 studies and did not improve(SMD: 0.35, 95%CI:-0.38, 1.08, P = 0.351; I^2 = 83.98%) after intralesional steroid injection.CONCLUSION Intralesional steroid injection increases the time between endoscopic dilations of benign refractory esophageal strictures. However, its potential role needs further research.

Low-dose intralesional injection of 5-fluorouracil and triamcinolone reduces tissue resident memory T cells in chronic eczema

BACKGROUND Tissue resident memory T(TRM)cells have been reported to play a significant role in the pathogenesis and relapse of chronic eczema.AIM To compare the efficacy and safety of the intralesional injection of 5-fluorouracil(5-FU)and triamcinolone(TA)with those associated with TA alone for the treatment of chronic eczema.METHODS A total of 168 patients were randomized to 5-FU+TA or TA groups and received a one-time intralesional injection of 5-FU+TA or TA only.Biopsies were collected before and 2 wk after treatment for evaluation of histopathological changes.All patients were followed up monthly for up to 1 year.RESULTS No serious adverse event was observed in either group.Although the mean atopic dermatitis severity index scores and effective rates were comparable between the two groups after 2 wk of treatment,the relapse rate was significantly lower in the 5-FU+TA group than in the TA group.Histological examination showed significantly fewer CD8^(+)and CD103^(+)T cells but not CD4^(+)T cells in the 5-FU+TA group.CONCLUSION One-time intralesional injection of 5-FU+TA is effective and safe for chronic eczema treatment and can further reduce the retention of T_(RM) cells in the lesional skin and the relapse rate of chronic eczema.

Direct Transplant of Melanocytes from Normal Donor Area into Vitiligenous Recipient Area by Intralesional Injection of Melanocytes Using Spade Like Needle Technique

Background: Vitiligo is a common autoimmune inflammatory skin disease, where there are different surgical techniques for treatment of stable patches of vitiligo .Objective: To find non-costly, minimally invasive, simple technique by direct melanocytes transplant by spade needle technique in treatment of vitiligo. Patients and Methods: This interventional, therapeutic, comparative study was done in Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq from April 2014-March 2015. Twenty patients with localized, generalized and segmental vitiligo were included. Full history and examination for each patient was done with 4 (20%) males and 16 (80%) females and their ages ranged from 9 - 40 (23.15 ± 11.44) years. Forty one patches in 20 patients treated by spade grafting technique and the donor and recipient sites were demarcated and anesthesia done by xylocaine 2% with adrenalin 1:100,000. Transplantation was started by using disposable needle gauge 18 (the sharp end of needle was cut by a scissor to make it a spade like) with medical syringe 5 ml supplied with normal saline. The micro-pieces were taken from donor site and transplanted directly, easily and rapidly into dermis of recipient site and followed by pushing normal saline and the procedure was repeated to cover all recipient sites with 5 mm distance between injection points. The surface area of the lesions was calculated and the reduction rate was estimated every month till the end of the 4th month period of the treatment. Results: Including 41 patches in 20 patients with the surface area of the patches ranged from 1.5 - 90 cm2 (13.78 ± 17.57) cm2. The mean ±SD of surface area of lesions was decreased from 13.78 ± 17.57 cm2 at baseline visit to 13.61 ± 17.48 cm2 at the second visit (after 2 weeks ) which was statistically significant (p value ≤ 0.001). The mean surface area continued to be reduced till reaching 12.20 ± 15.68 cm2 at the third visit and 12.01 ± 15.55 cm2 at the fourth visit. All were statistically significant when compared to baseline visit. There was reduction in surface area 1.1% at two weeks, 9.93%, and 12.5% at the 2nd, 4th months respectively. Conclusions: Intradermal injection of melanocytes in patients with vitiligo by spade like needle was very quick and simple non-costly technique, and gave 12.5% reduction which could be repeated at different times until satisfactory re-pigmentation of vitiligenous skin is achieved.

Tuberculin as Intralesional Therapy for Viral Warts—Single-Blind, Split, Placebo, Controlled Study

Background: BCG vaccine as an antigen has proved its effectiveness as an immunotherapy for viral warts. Tuberculin is an antigenic extract of M. tuberculosis capable of eliciting an immunological skin reaction. Objective: To assess the efficacy of tuberculin intralesional injection in the treatment of viral warts. Patients and Methods: This single ,blind, placebo controlled study was conducted at the Department of Dermatology, Baghdad Teaching Hospital, Baghdad, Iraq from March 2010 to July 2011.Forty-one patients with different types of viral warts were enrolled in this study;tuberculin test was done to patients prior to instillation of intralesional treatment. Then the patients treated by intralesional tuberculin in each lesion located on the right side of the body, and intralesional distilled water in each lesion located on the left side of to a maximum of 3 injections, at 2 weeks interval or until full resolution of these lesions. Patients were evaluated every 2 weeks to assess the regression of their lesions and to record any local and systemic adverse effects. The response to treatment was evaluated by decrease in size and reduction in number of warts. Scoring of response to treatment was as follow: 1) Responders: including patients who showed complete cure or those with good response (>50% reduction). 2) Non responders: including patients who showed minimal response (<50% reduction), or those with no improvement (stable disease and disease progression). The follow up period lasted up to 2 months after the last dose. Results: Thirty out of 41 patients had completed the study, of them 14 (46.66%) patients showed response of their lesions on the right side of the body that were treated with tuberculin;15 patients showed no response, 1 patient showed minimal response, 7 patients showed good response and 7 patients showed complete cure (23.33%). Regarding the lesions treated with intralesional distilled water, 25 patients showed no response, 3 patients showed minimal response, 2(6.66) patients showed good response and no patient showed complete cure of their warts. Of the 14 responder patients to intralesional tuberculin, 10 patients were tuberculin tested positive, and 4 patients were tested negative, and of the 16 non responder patients to intralesional tuberculin, 3 patients were tuberculin tested positive, and 13 patients were tuberculin tested negative which was statistically significant difference. No side effects reported from tuberculin therapy apart from mild pain at site of injection. Conclusion: Intralesional injection of tuberculin is an effective therapy for viral warts when compared with control, possibly through its local immunological action and had no systemic immunological response. Patients with previous BCG vaccine showed better response to tuberculin injection.

Treatment of mouth and jaw diseases with intralesional steroid injection

Many lesions of the oral region are treated with surgical methods such as curettage and resection. Chemotherapy and radiation therapy with or without surgical intervention can be used as an adjunct in some cases. Intralesional steroid injection is a conservative procedure which is already used in various regions of the body andjoints. This technique is used also for a number of mouth and jaw lesions. Localized langerhans cell histiocytosis, central giant cell granuloma, oral submucous fibrosis, oral lichen planus, lichen sclerosus of the oral mucosa, lymphatic malformations and orofacial granulomatosis can be considered among these diseases. The purpose of this review is to investigate the effects of intralesional steroid injections in the treatment of oral diseases.

Use of intralesional collagenase in the treatment of peyronie's disease: A review

AIM:To review the relevant literature in an effort to examine the body of evidence available to date.METHODS:Ovid MEDLINE search database was queried using MeS H terms"penile induration","peyronie’s disease","Collagenases"and"Collagenase"using various permutations.No temporal parameters were employed.RESULTS:In all,5 relevant clinical trials were isolated from 34 results.These trials were analyzed using the Oxford Centre for Evidence-Based Medicine criteria.They were further examined based on study design and methods;the primary and secondary outcomes were reviewed for treatment efficacy and collagenase-related side effects.CONCLUSION:Intralesional collagenase appears to be safe and effective in the non-surgical treatment of Peyronie’s disease.However,the data remains limited and further inquiries into the safety of collagenase,treatment standardization and standardized outcomesreporting remain necessary.Furthermore,studies comparing intralesional collagenase to alternative medical and surgical therapy will be important in guiding the future treatment decision process.

Intralesional Interstitial Injection of Bleomycin for Management of Extracranial Arteriovenous Malformations in Children

Background Despite many advances in the treatment for extracranial arteriovenous mal­formations(AVMs),they still result in tedious dissection and potential unacceptable com­plications,particularly in children.Therefore,this study aimed to investigate the efficacy and safety of intralesional interstitial injection of bleomycin for the treatment of children with AVMs.Methods A total of 10 children(6 boys and 4 girls)with AVMs were treated with serial interstitial bleomycin injections between May 2014 and January 2017.Maximum single doses of 15 U and 1 U/kg per session were administered for six sessions at a 1-month inter­val.Therapeutic effectiveness was evaluated and classified into four categories:complete response(CR),partial response(PR),no response,and worsening at 3 months after the last session.Further clinical follow-up outcomes were classified as improved,stable,or aggra­vated.Adverse events were recorded according to the Society of Interventional Radiology classification.Results All 10 children completed the sessions and follow-ups.CR occurred in 3(30%)patients,PR in 6(60%),and no response in 1(20%).Minor complications(class A)included maculopapular rash,bulla,vomiting,and hyperpigmentation,whereas no major complications occurred.Conclusion Intralesional interstitial injection of bleomycin is a feasible approach for the treatment of AVMs in children and provides safe and effective outcomes.This method may be an earlier treatment alternative in children to prevent potential destructive progression,considering the serious complications of currently available therapeutic methods.

Intralesional injection treatment of hypertrophic scars and keloids:a systematic review regarding outcomes

Background:The aim of this review was to explore the existing body of literature focusing on the intralesional treatments of keloids and hypertrophic scars.Methods:A comprehensive systematic review of related articles was conducted across multiple databases.Article selection was limited to those published in the English language between 1950 and 2014.Search terms for the on-line research were"scar(s),""keloid(s),""hypertrophic,""injection,""intralesional,"and"treatment".Results:The initial search returned 2548 published articles.After full text review,the final search yielded 11 articles that met inclusion criteria.A total of 14 patient samples in 11 articles were collected.The most frequent intralesional injection treatment studied was triamcinolone(n=5),fol owed by bleomycin(n=3),5-fluorouracil(n=2),verapamil(n=2),cryosurgery,and collagenase.The scar height reduction for all but one study was demonstrated,with acceptable complication and recurrence rate.Only three articles reported a follow-up period longer than 18 months,and only two studies used standardized outcome criteria with a quantitative scale.Conclusions:Although many treatment options have already been described in the literature,there is no universal y accepted treatment resulting in permanent hypertrophic or keloid scar ablation.The lack of adequately long-term powered randomized control ed trials does not permit to establish definitive conclusions with implications for routine clinical practice.Level of

Successful Treatment of Infraorbital Trapdoor Following Transposition Flap Using Intralesional Corticosteroid: A Case Report

Introduction: The trapdoor effect can pose a significant cosmetic issue after transposition flap surgery or trauma. It is characterized with bulging of tissue around a circular or semi-circular scar commonly found after removal of cutaneous tumors.Case presentation: A 60-year-old female patient with trapdoor effect after surgery was successfully treated with long-term non-invasive technique of intralesional triamcinolone acetate set with a biweekly interval for twelve months.Discussion: There are currently no definitive methods of removing this condition. Non-surgical approach is often more preferred by patients, such as with the use of intralesional corticosteroid of triamcinolone acetate. However, information about this is still limited. In this case, the patient experienced satisfying result without observed complications related to corticosteroids injection on the infraorbital region.Conclusion: Intralesional corticosteroid is a safe and economical method to treat the trapdoor effect.

Advances and established therapies in linear scar prevention

Linear scars are scars formed after surgery or other trauma-healing procedures that typically exhibit a linear morphology.Optimal linear scars are characterized by narrowness,flatness,and a color closely resembling the adjacent tissue.Failure to meet these criteria can have detrimental effects on the physical and psychological wellbeing of patients.Thus,early intervention for linear scars can effectively improve functionality and aesthetics.This review aimed to consolidate the prevailing agreement on scar prevention therapies and provide clinical physicians with comprehensive and cutting-edge guidance.

面神经肿瘤内的异物蓄积1例

1临床资料 患者男性,42岁,右面瘫1年半就诊,发病以来曾被多家医院诊断为“贝尔麻痹”,经多种保守治疗无任何好转。体检：右完全性周围性面瘫,HBⅥ级,面肌已有轻度萎缩。电耳镜下右外耳道后下壁呈半球状膨隆,高约0.5cm,直径约1cm,鼓膜无异常。视诊右腮腺区饱满,但扪诊无明显异常。螺旋CT显示患者的右面神经乳突段完全被肿瘤取代,瘤体破坏右外耳道后骨壁,

Non-surgical therapy of Peyronie＇s disease

The present paper provides a review of the available non-surgical treatments for Peyronie＇s disease （PD）. A review of published literature on oral, intralesional, external energy and iontophoresis therapies for PD was performed, and the published results of available treatment options reviewed. The authors＇ recommendations for appropriate non-surgical management of PD are provided. Although there are many published reports that show the efficacy of non-surgical therapies for PD, there is a lack of large scale, multicenter controlled clinical trials, which makes treatment recommendations difficult. Careful review of the literature does suggest that there are treatment options that make scientific sense and appear to stabilize the disease process, reduce deformity, and improve function. Offering no treatment at all will encourage our patients to pursue alternative treatments, which might do harm, and misses the opportunity to do some good. Clearly further work is necessary to develop safe and effective non-surgical treatments for PD.

In vivo assessment of intratumoral aspirin injection to treat hepatic tumors

AIM: To study the antineoplastic efficacy of 10% aspirin intralesional injection on VX2 hepatic tumors in a rabbit model. METHODS: Thirty-two male rabbits (age: 6-9 wk; body weight: 1700-2500 g) were inoculated with VX2 hepatic tumor cells (104 cells/rabbit) via supraumbilical median laparotomy. On day 4 post-implantation, when the tumors were about 1 cm in diameter, the rabbits were randomly divided into the following groups (n = 8 each group) to assess early (24 h) and late (7 d) antineoplastic effects of intratumoral injection of 10% bicarbonate aspirin solution (experimental groups) in comparison to intratumoral injection of physiological saline solution (control groups): group 1, 24 h control; group 2, 24 h experimental; group 3, 7 d control; group 4, 7 d experimental. The serum biochemistry profile (measurements of glycemia, alkaline phosphatase, gamma-glutamyl transferase, aspartateaminotransferase, and alanine aminotransferase) and body weight measurements were obtained for all animals at the following time points: D0, before tumor implant; D4, day of treatment; D5, day of sacrifice for groups 1 and 2; D11, day of sacrifice for groups 3 and 4. Gross assessments of the abdominal and thoracic cavities were carried out upon sacrifice. The resected liver tissues, including hepatic tumors, were qualitatively (general morphology, signs of necrosis) and quantitatively (tumor area) assessed by histopathological analysis. RESULTS: Gross examination showed no alterations, besides the left hepatic lobe tumors, had occurred in the thoracic and abdominal cavities of any animal at any time point evaluated. However, the features of the tumor foci were distinctive between the groups. Compared to the control groups, which showed normal unabated tumor progression, the aspirin-treated groups showed imprecise but limited tumor boundaries and a general red-white coloration (indicating hemorrhaging) at 24 h post-treatment, and development of yellow-white areas of a cicatricial aspect at 7 d after treatment. At all time points evaluated, all except one biochemical parameters tested within the reference range (P > 0.05); a significant increase was detected in the alkaline phosphatase level of the control group 3 on D11 (P < 0.05). At 24 h post-treatment, the aspirintreated groups showed extensive coagulation necrosis accompanied by a remarkable absence of viable tumor foci; at 7 d after treatment, the tumors had completely disappeared in these animals and fibrous necrotic nod- ules had developed. In contrast, throughout the study course, the tumors of the control groups remained unchanged, showing tumor nodules without necrosis at the time point corresponding to 24 h post-treatment and increased amounts of tumor nodules at the time point corresponding to 7 d post-treatment. Quantitative analysis of the remaining tumor area revealed that the aspirin-treated groups had significantly smaller tumor foci at 24 h post-treatment (8.5% ± 0.7%) andat 7 d after treatment (11.0% ± 4.2%), compared to those in the control groups (24 h: 98.5% ± 1.5% and 7 d: 94.0% ± 2.7%; both,P < 0.005). CONCLUSION: Intralesional injection of a 10% aspirin solution causes destruction of VX2 hepatic tumors in rabbits without evidence of relapse at 7 d after treat- ment administration.

Management of Vascular Malformations in Dangerous Area of Oral Cavity: The Iranian Experience and Review of Treatment Modalities

Aim: To evaluate the effect of a highly potent corticosteroid (dexamethasone) in the treatment of vascular malformation when the location is difficult to reach and complications such as uncontrolled bleeding is predictable in surgery. Background: Vascular malformation is not a common lesion in oral cavity especially in alveolar ridge with extension to the pillar uvula. These lesions arise from capillary or venous malformations with various surgical or non-surgical treatment modalities. Case Description: We performed weekly intralesional injection of dexamethasone in a patient with a vascular malformation in alveolar ridge extending to the lingual side of alveolar ridge and posterior extension to the uvula. Complete resolution of lesion was observed after 6th injection. Conclusion: Intralesional injection of dexamethasone is a potentially curative method to treat oral vascular malformation. Clinical Significance: Injection of dexamethasone is a simple and cost-effective therapy that can be used as a safe treatment for vascular malformations prior to or as a substitute for surgery.

Recurrence Factors in Giant Cell Tumors of the Spine

Background： Giant cell tumors （GCTs） are benign, locally aggressive tumors. We exalnined the rate of local rectirrence of spinal GCTs and sought to identify recurrence factors in patients who underwent surgery. Methods： Between 1995 and 2014, 94 mobile spine GCT patients were treated at our hospital, comprising 43 male and 51 female patients with an average age of 33.4 years. Piecemeal intralesional spondylectomy and total en bloc spondylectomy （TES） were performed. Radiotherapy was suggested for recurrent or residual GCT cases. Since denosumab was not available before 2014 in our country, only interferon and/or zoledronic acid was suggested. Results： Of the 94 patients, four underwent conservative treatment and 90 underwent operations. Seventy-five patients （79.8%） were followed tip for a minimum of 24 months or until death. The median follow-up duration was 75.3 months. The overall recurrence rate was 37.3%. Ten patients （13.3%） died before the last follow-up （rnedian： 18.5 months）. Two patients （2.6%） developed osteogenic sarcoma. The local recurrence rate was 80.0% （24/30） in patients who underwent intralesional curettage, 8.8% （3/34） in patients who underwent extracapsular piecemeal spondylectomy,and 0 （0/9） in patients who underwent TES. The risk factors for local recurrence were lesions located in the cervical spine （P = 0.049）, intralesional curettage （P 〈 0.001 ）, repeated surgeries （P 0.014）, and malignancy （P 〈 0.001 ）. Malignant transformation was a significant risk factor for death （P 〈 0.001 ）. Conclusions： Cervical spinal tumors, curettage, and nonintact tumors were risk l;actors for local recurrence. Intralesional curettage and malignancy were the most important significant factors for local rectirrence and death, respectively.