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...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.展开更多
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...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.展开更多
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-...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.展开更多
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, simp...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 cm<sup>2</sup> (13.78 ± 17.57) cm<sup>2</sup>. The mean ±SD of surface area of lesions was decreased from 13.78 ± 17.57 cm<sup>2</sup> at baseline visit to 13.61 ± 17.48 cm<sup>2</sup> 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 cm<sup>2</sup> at the third visit and 12.01 ± 15.55 cm<sup>2</sup> 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.展开更多
Pretibial myxedema(PTM), an uncommon manifestation of Graves' disease(GD), is a local autoimmune reaction in the cutaneous tissue. The treatment of PTM is a clinical challenge. We herein report on a patient with P...Pretibial myxedema(PTM), an uncommon manifestation of Graves' disease(GD), is a local autoimmune reaction in the cutaneous tissue. The treatment of PTM is a clinical challenge. We herein report on a patient with PTM who achieved complete remission by multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application for a self-controlled study. A 53-year-old male presented with a history of GD for 3.5 years and a history of PTM for 1.5 years. Physical examination revealed slight exophthalmos, a diffusely enlarged thyroid gland, and PTM of both lower extremities. One milliliter of triamcinolone acetonide(40 mg) was mixed well with 9 mL of 2% lidocaine in a 10 mL syringe. Multipoint intralesional injections into the skin lesions of the right lower extremity were conducted with 0.5 mL of the premixed solution. A halometasone ointment was used once daily for PTM of the left lower extremity until the PTM had remitted completely. The patient's PTM achieved complete remission in both legs afteran approximately 5-mo period of therpy that included triamcinolone injections once a week for 8 wk and then once a month for 2 mo for the right lower extremity and halometasone ointment application once daily for8 wk and then once 3-5 d for 2 mo for the left lower extremity. The total dosage of triamcinolone acetonide for the right leg was 200 mg. Our experience with this patient suggests that multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application are safe, effective,and convenient treatments. However, the topical application of a glucocorticoid ointment is a more convenient treatment for patients with PTM.展开更多
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,...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.展开更多
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 th...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.展开更多
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 ...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.展开更多
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...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展开更多
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 aft...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.展开更多
基金supported by the National Nature Science Foundation of China (grant no. 82272288)。
文摘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.
基金supported by the National Natural Science Foundation of China(grant nos.81501678,81971848,and 82272287)Clinical Research Plan of Shanghai Hospital Development Center(grant nos.SHDC2020CR1019B and SHDC2020CR4029)+1 种基金Shanghai Municipal Key Clinical Specialty(grant no.shslczdzk00901)Innovative Research Team of High-Level Local University in Shanghai(grant no.SSMUZDCX20180700).
文摘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.
基金Pudong New District Science and Technology Development Fund People’s Livelihood Scientific Research Special Fund(No.PKJ2018-Y42)the Shanghai Pudong New District Health System Discipline Construction Project(No.PWZzk 2017-14)the School-level Scientific Research Project of Shanghai University of Medicine and Health Sciences Affiliated with Zhoupu Hospital(No.ZPXM-2019A-13).
文摘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.
文摘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 cm<sup>2</sup> (13.78 ± 17.57) cm<sup>2</sup>. The mean ±SD of surface area of lesions was decreased from 13.78 ± 17.57 cm<sup>2</sup> at baseline visit to 13.61 ± 17.48 cm<sup>2</sup> 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 cm<sup>2</sup> at the third visit and 12.01 ± 15.55 cm<sup>2</sup> 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.
文摘Pretibial myxedema(PTM), an uncommon manifestation of Graves' disease(GD), is a local autoimmune reaction in the cutaneous tissue. The treatment of PTM is a clinical challenge. We herein report on a patient with PTM who achieved complete remission by multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application for a self-controlled study. A 53-year-old male presented with a history of GD for 3.5 years and a history of PTM for 1.5 years. Physical examination revealed slight exophthalmos, a diffusely enlarged thyroid gland, and PTM of both lower extremities. One milliliter of triamcinolone acetonide(40 mg) was mixed well with 9 mL of 2% lidocaine in a 10 mL syringe. Multipoint intralesional injections into the skin lesions of the right lower extremity were conducted with 0.5 mL of the premixed solution. A halometasone ointment was used once daily for PTM of the left lower extremity until the PTM had remitted completely. The patient's PTM achieved complete remission in both legs afteran approximately 5-mo period of therpy that included triamcinolone injections once a week for 8 wk and then once a month for 2 mo for the right lower extremity and halometasone ointment application once daily for8 wk and then once 3-5 d for 2 mo for the left lower extremity. The total dosage of triamcinolone acetonide for the right leg was 200 mg. Our experience with this patient suggests that multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application are safe, effective,and convenient treatments. However, the topical application of a glucocorticoid ointment is a more convenient treatment for patients with PTM.
基金This study was supported by the Multi-Center Clinical Research Program(DLY201613)of Shanghai Ninth People’s Hospital.
文摘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.
基金the Shanghai Plastic Surgery Research Center(grant no.2023ZZ02023).
文摘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.
文摘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.
文摘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
文摘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.