Transcutaneous injection of triamcinolone acetonide for persistent glottic granulation after laser microsurgery

Abstract Objective The aim of study was to demonstrate that transcutaneous intralesional injection of Triamcinolone Acetonide (TA) under fibrolaryngoscopy could be an option for persistent granulation after Transoral Laser Microsurgery (TLM) in glottic cancer patients. Methods We recruited 32 patients, who had conservative treatment but failed. 20 patients accepted TA injection monthly until the granulation disappeared or did not shrink further. 12 patients chose to closely monitor. Results For the 20 patients, 17 (85.0%) patients' granulations completely disappeared. 3 (15.0%) patients' granulations had reduced 80%. For the 12 patients, 3 (25.0%) patients' granulations disappeared but 9 (75%) patients' granulations did not have an obvious change. Recurrence was not observed. Conclusion Our experience showed that transcutaneous intralesional TA injection for persistent granulation after TLM through cricothyroid membrane is an efficient, security, harmless and low recurrence method. Especially suitable for huge granulation which blocks the glottis and recur after a second operation.

Intramatricial injections for nail psoriasis: An open-label comparative study of triamcinolone, methotrexate, and cyclosporine

Background: One of the most effective options available for treating psoriatic fingernails is intramatricial injection of triamcinolone acetonide. Efficacies of intramatricial methotrexate and cyclosporine have not been comparatively evaluated to date. Methods: Ninety fingernails in 17 patients were assigned to three groups of thirty nails each, and treated with intramatricial injections of triamcinolone acetonide (10 mg/ml), methotrexate (25 mg/ml) and cyclosporine (50 mg/ml) respectively. Each nail was given two injections with a 6-week interval, and graded at 24 weeks using the Nail Psoriasis Severity Index. Results: In both triamcinolone acetonide and methotrexate groups, 15 (50%) nails out of 30 showed >75% improvement. In the cyclosporine group, only ten (33%) nails showed >75% improvement. Side effects were most in the nails treated with cyclosporine. Limitations: The limited follow-up period of 24 weeks may have been insufficient for detecting delayed remissions. The number of patients was small and there was no randomization or blinding. The lack of a placebo/ no- treatment arm can be considered a limitation. Conclusions: Amongst the three drugs studied, intramatricial methotrexate injection yielded the most improvement with minimum side effects, results being comparable to intramatricial triamcinolone acetonide injection. Cyclosporine was the least effective drug, with the most side effects. Intramatricial injection therapy is a safe, economical, simple and effective therapeutic modality in the management of nail psoriasis.

Intramatricial injections for nail psoriasis: An open-label comparative study of triamcinolone, methotrexate, and cyclosporine

Background: One of the most effective options available for treating psoriatic fingernails is intramatricial injection of triamcinolone acetonide. Efficacies of intramatricial methotrexate and cyclosporine have not been comparatively evaluated to date. Methods: Ninety fingernails in 17 patients were assigned to three groups of thirty nails each, and treated with intramatricial injections of triamcinolone acetonide (10 mg/ml), methotrexate (25 mg/ml) and cyclosporine (50 mg/ml) respectively. Each nail was given two injections with a 6-week interval, and graded at 24 weeks using the Nail Psoriasis Severity Index. Results: In both triamcinolone acetonide and methotrexate groups, 15 (50%) nails out of 30 showed >75% improvement. In the cyclosporine group, only ten (33%) nails showed >75% improvement. Side effects were most in the nails treated with cyclosporine. Limitations: The limited follow-up period of 24 weeks may have been insufficient for detecting delayed remissions. The number of patients was small and there was no randomization or blinding. The lack of a placebo/ no- treatment arm can be considered a limitation. Conclusions: Amongst the three drugs studied, intramatricial methotrexate injection yielded the most improvement with minimum side effects, results being comparable to intramatricial triamcinolone acetonide injection. Cyclosporine was the least effective drug, with the most side effects. Intramatricial injection therapy is a safe, economical, simple and effective therapeutic modality in the management of nail psoriasis.

Advances in the research of drug intralesional injection therapy in keloid / 中华烧伤杂志

Keloid is characterized by tumor-like invasive growth, high incidence, and low remission rate. The pathogenesis of keloid is still unknown. Keloids can not only affect appearance, but also cause severe itching and pain, which may affect physical and mental health of patients. Previous treatments for keloids include surgery, drugs, lasers and so on. Due to the high recurrence rate of surgical treatment accompanied by keloid enlargement, drug therapy has gradually become a hot topic. Among various methods of administration, intralesional injection is widely accepted as it can promote drug absorption to achieve better results. The progress of several drugs used in intralesional injection therapy for keloid is reviewed in this paper.

Effect of autologous platelet-rich plasma application on cutaneous wound healing in dogs

This study was conducted to identify the effectiveness of platelet-rich plasma (PRP) and efficacy of intralesional injection as a method of application to acute cutaneous wounds in dogs. Healthy adult beagles (n = 3) were used in this study. Autologous PRP was separated from anticoagulant treated whole blood in three dogs. Cutaneous wounds were created and then treated by intralesional injection of PRP in the experimental group, while they were treated with saline in the control group on days 0, 2 and 4. The healing process was evaluated by gross examination throughout the experimental period and histologic examination on day 7, 14 and 21. In PRP treated wounds, the mean diameter was smaller and the wound closure rate was higher than in the control. Histological study revealed that PRP treated wounds showed more granulation formation and angiogenesis on day 7, and faster epithelialization, more granulation formation and collagen deposition were observed on day 14 than in control wounds. On day 21, collagen deposition and epithelialization were enhanced in PRP treated groups. Overall, PRP application showed beneficial effects in wound healing, and intralesional injection was useful for application of PRP and could be a good therapeutic option for wound management in dogs.

Treatment of Nodular Fasciitis Occurring on the Face

BACKGROUND: Surgical excision is generally recommended for the treatment of nodular fasciitis (NF) to rule out sarcoma. However, in cases of NF occurring on the face, the reported recurrence rate is higher and the surgical approach may result in considerable aesthetic concern. OBJECTIVE: To describe our experience with NF occurring on the face and evaluate the outcomes of surgical and nonsurgical methods of treatment. METHODS: We performed a retrospective review of 16 patients with NF on the face. The patients were treated with surgical excision or nonsurgical methods such as triamcinolone intralesional injection (TA ILI) and pinhole method with a carbon dioxide (CO2) laser. RESULTS: Among the 16 patients, surgical treatment was performed in 9 and recurrence occurred in 7 of these 9 patients (77.8%). The recurred lesions showed regression after repeated TA ILI. On the other hand, five patients underwent nonsurgical treatment after the histologic exclusion of malignancy. Their lesions showed regression after repeated pinhole treatment and TA ILI. In one case, NF spontaneously regressed. On a visual analogue scale, the nonsurgical approach showed superior results. However, the values were not statistically significant (6.90+/-1.56 vs. 5.61+/-1.36; p=0.163). The satisfaction level was lower in patients who experienced recurrence after surgical excision. CONCLUSION: Surgical treatment for NF on the face showed a noticeable recurrence rate and resulted in scarring. Therefore, considering the possibility of spontaneous regression, the nonsurgical method can be considered as an alternative treatment option for NF on the face.

Subcutaneous intralesional Ksharodaka injection: A novel treatment for the management of Warts: A case series.

Warts are generally managed using cryosurgery, keratolytic ointments, curettage and electrodessication. Warts, vis‑a‑vis Charmakila, in Ayurvedic classical texts are classified into different types depending on the dominance of dosha. Ayurveda prescribes oral medications, topical use of Kshara (alkaline ash of herbs), Agni (thermal cautery) and Shastrakarma (surgery) for removal of Charmakila. Use of topical Kshara in the form of powder, aqueous solution i.e. Ksharodaka and Ksharasutra (thread smeared with Kshara) for warts has been reported. However, these methods necessitate multiple sittings and takea longer duration for removal of the warts. Herewith, we report a case series of different types of warts treated with intralesional infiltration of Apamarga Ksharodaka (AK), i.e. aqueous solution of Apamarga (Achyranthes aspera) Kshara. We observed that all these warts took a minimum of 2–6 days to shed off, leaving minor scars. There were no adverse reactions reported in any of these cases.

A Case of Intralesional Cidofovir Injection for Recurrent Lacrimal Sac Squamous Papilloma

PURPOSE: To report a case of treating a patient with intralesional cidofovir injection who had frequently recurring lacrimal sac squamous papilloma after several excision surgeries. CASE SUMMARY: A 59-year-old man who had mass excision surgery at a different clinic nine months previously, visited our clinic to treat a recurring erythematous protruding mass near his left medial canthus that developed two months prior. Orbit CT showed a 15 x 25 mm-sized large mass located on the lacrimal sac adherent to medial orbital wall. An excision biopsy was performed and the histopathologic examination showed typical findings of squamous papilloma. Because the tumor recurred six months after the second surgery, we decided to perform adjuvant therapy using the antiviral agent cidofovir. The patient was treated with a 5 mg/mL intralesional cidofovir injection every three weeks. A transient recurrence presented on the upper lid at the third intralesional cidofovir injection site two months after the surgery, but the recurrent lesion improved after repeated injections. During the 12 months of follow-up, there were no complications and no evidence of recurrence. CONCLUSIONS: Intralesional cidofovir injections can be a safe and effective treatment for the management of recurrent squamous papilloma of the orbit, especially after total excision.

Intralesional Methotrexate for the Treatment of Keratoacanthoma: Retrospective Study and Review of the Korean Literature

BACKGROUND: Although intralesional methotrexate (MTX) is an effective, nonsurgical treatment of keratoacanthoma (KA), there have not been many reports of on the MTX treatment for KA in Korea. OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy of the intralesional MTX for the treatment of KA in Korean patients. METHODS: We retrospectively studied seven patients with KA who received intralesional injection of MTX in our department. The efficacy was evaluated based on the physician assessment. Our review also included the cases of KA treated with intralesional MTX in Korean patients from the previous reports. We then analyzed the therapeutic regimens in the Korean patients by comparing them with the Caucasian patients. RESULTS: We identified 11 cases of Korean KA patients treated with an intralesional MTX, including seven from our institution and four from the Korean literature. Ten of the 11 patients (91%) showed a complete resolution with an intralesional MTX. No adverse events were observed during the treatment and the follow-up periods. No recurrence was found during the follow-up. In therapeutic analysis, the Korean patients required 2 to 7 injections (mean 4.6 injections) to achieve a tumor resolution with the mean time to clearing at 7.6 weeks. CONCLUSION: Intralesional MTX can be an effective and safe non-operative treatment modality for most Koreans with KA.

Three Cases of Classic Kaposi Sarcoma Treated with Pegylated Interferon Alpha 2a Intralesional Injection / 대한피부과학회지

Kaposi sarcoma (KS) is a multifocal proliferative vascular tumor often caused by human herpes virus 8. Among the four subtypes of KS, classic KS (CKS) is usually chronic, persisting over many years, but is not life threatening. Because the natural history of KS varies, many kinds of therapeutic option for CKS are available and their assessment may be difficult. We experienced three cases of CKS showing HHV-8 positive in biopsy, no history of immunosuppression and HIV infection, normal chest X-ray, no metastasis, and successfully treated with intralesional injection of Pegylated Interferon-alpha2a (Peg-IFN-alpha2a). After an intralesional Peg-IFN-alpha2a injection of 180 mcg/0.5 ml was administered once a week for 4 months, the size and induration of the lesions reduced greatly and the colors faded away. Histopathological examination of the resolved lesions did not show any evidence of KS with negative HHV-8 results. To the best of our knowledge, this is the first report in the literature for the treatment of CKS with intralesional Peg-IFN-alpha2a injection.

The Effects of Intralesional Steroid Injection for Chalazion According to the Concentrations of Triamcinolone Acetonide

PURPOSE: To compare the efficacy of an intralesional steroid injection in the treatment of chalazion according to triamcinolone acetonide (TA) concentrations. METHODS: A total of 108 patients with 120 chalazia received an intralesional injection of TA. Patients were divided into 3 groups according to the concentrations of TA: 5 mg/ml, 10 mg/ml, and 40 mg/ml. A regular follow-up was performed and the size of lesion and recurrence were evaluated. RESULTS: Success was defined as a minimum of 80% decrease in size with no recurrence. The success rate was 78.1% in the 5 mg/ml group, 76.2% in the 10 mg/ml group, and 78.4% in the 40 mg/ml group. These results were not statistically significant (p = 0.999, Fisher's exact test). Yellow deposits developed in 4 out of 37 lesions in the 40mg/ml group, and in 1 out of 42 lesions in the 10 mg/ml group. Skin depigmentation was observed in 1 case in the 5 mg/ml group. CONCLUSIONS: Intralesional TA injection is an effective treatment for chalazion. There is no significant difference in success rates according to the concentrations of TA. However, caution is advised in cases of high injection concentrations of TA to prevent yellow deposits.

A Comparison of the Corticosteroid Intralesional Injections Alone versus Corticosteroid Intralesional Injections with Cryotherapy on Hypertrophic Scars and Keloids after Thyroidectomy: A Split-scar Study / 대한피부과학회지

BACKGROUND: Various treatment modalities for hypertrophic scars and keloids have been used. However, there is no consensus as to what the optimum approach should be. Most common treatments are corticosteroid intralesional injection (ILI) and cryotherapy as well as combination of these two modalities. To this date, however, there are no prospectively comparative, scar-split studies between steroid ILI monotherapy and combination of steroid ILI and cryotherapy. OBJECTIVE: The purpose of this article is to investigate and compare the efficacy of steroid ILI monotherapy and the combination of steroid ILI and cryotherapy. METHODS: Eighteen women who had thyroid operation scars were recruited. Patients received steroid ILI with cryotherapy on the right half, and steroid ILI monotherapy on the left half of the scar. Patients were treated for four sessions with three weeks of intervals. Subjects were evaluated on their scar status with the modified Vancouver scar scale (MVSS) and scar redness by using colorimeter at baseline and every visit day. RESULTS: After four treatment sessions, MVSS was significantly improved on both sides of scar. Significant improvement was observed after one treatment session on the right half, and after two treatment sessions on the left half. There was no significant difference between left and right side after four sessions of treatment. The scar redness of both sides of scar showed no significant differences between the baseline and at the end of the study. CONCLUSION: Both corticosteroid ILI with cryotherapy and corticosteroid ILI monotherapy are effective treatment modalities for hypertrophic scars. However, the results of the present study suggest that a combination therapy might lead to more rapid improvements.

A Comparative Study on Recurrence of Earlobe Keloids after Postoperative Adjuvant Therapy / 대한피부과학회지

BACKGROUND: Earlobe keloids are a cosmetically and symptomatically bothersome clinical problem with frequent recurrence despite various treatments including surgical excision and intralesional injection of corticosteroids. OBJECTIVE: The aim of this study was to compare the results and recurrence of earlobe keloids after various postexcisional adjuvant therapies and to identify the most effective postoperation adjuvant therapy. METHODS: We retrospectively evaluated 36 patients with earlobe keloids (n=71) who underwent core excision and a suprakeloidal flap using photographs. One group did not have adjuvant therapy, one group was treated with adjuvant triamcinolone intralesional injection (TRA/ILI), and another group was treated with postoperative irradiation. RESULTS: Among treated 71 keloids, 18 lesions (25.4%) recurred; 42.9% (12/28) of the operation-only group and 19.4% (6/31) of TRA/ILI group showed recurrence. The adjuvant radiation therapy group had no recurrence. The difference in recurrence rate was statistically significant. CONCLUSION: Postexcisional adjuvant therapy was more effective than excision monotherapy for keloid treatment, and radiation therapy had more sustained effects than that of TRA/ILI.

Clinical Study on Hypopigmentation Induced by Intralesional Corticosteroid Injection / 대한피부과학회지

BACKGROUND: Several cases of hypopigmentation induced by intralesional corticosteroid injection have been reported. However, there is little information concerning the epidemiology and clinical characteristics of such cases. OBJECTIVE: To describe the epidemiology and clinical characteristics of hypopigmentation induced by intralesional corticosteroid injection. METHODS: A retrospective clinical study was performed on 22 patients with hypopigmentation induced by intralesional corticosteroid injection, during a period of January 2003 to December 2010. Investigated factors included sex, age, previous history of intralesional corticosteroid injection, clinical manifestations, treatment modalities and clinical course. RESULTS: Of the 22 patients, 21 were female and 1 were male with the mean age of 34.3+/-17.5 (range 4~68) years old. Twelve patients were treated with corticosteroid injection for the treatment of musculoskeletal diseases, whereas, 10 patients for treatment of skin diseases. Eight patients were injected by dermatologists, 3 patients by orthopedists and 11 patients by doctors of unknown specialty. The mean number of the times of corticosteroid injection was 1.9. On the average, hypopigmentation occurred 4.2 months after corticosteroid injection. Upper extremities were most frequently affected, followed by the scalp, face, lower extremities and trunk. Hypopigmentation in most patients were localized and accompanied with skin depression and telangiectasia. There was complete resolution of hypopigmentation within 3.7 months, on average. CONCLUSION: Intralesional injections of corticosteroid are performed not only as the treatment of various skin diseases, but also for the treatment of musculoskeletal diseases. Intralesional corticosteroid injection could cause hypopigmentation of the skin, and it could be confused with other skin diseases presented with hypopigmented patch. However, dermatologist could distinguish hypopigmentaion induced by intralesional corticosteroid injection from other skin diseases, such as vitiligo, by the presence of skin depression, telangiectasia and spontaneous resolution.

Effectiveness for Intralesional Triamcinolne Acetonide Injections for Chalazia in Pediatric Patients

PURPOSE: To evaluate the effectiveness of intralesional triamcinolone acetonide injection for chalazia in pediatric patients. METHODS: We performed a retrospective chart review of 58 patients (70 lesions) under fifteen years of age and 40 patients (50 lesions) aged fifteen and over, who underwent intralesional triamcinolone acetonide injections and performed follow-ups for at least three months between January 2007 and October 2008. Data regarding age, sex, lesion size, location, number of injections, treatment success, surgery, and complications were evaluated. RESULTS: Cumulative treatment success of TA was 64.3% with the first injection, 82.9% with a second injection, and 88.6% with a third injection in patients under fifteen years of age. The average number of TA injections was 1.67+/-1.03 in primary chalazia and 1.48+/-0.87 in recurrent chalazia, while the cumulative treatment success until third TA injection was 89.8% in primary chalazia and 85.7% in recurrent chalazia inpatients under fifteen years old. The average number of TA injections was 1.95+/-1.18 in primary chalazia and 1.80+/-1.14 in recurrent chalazia, while the cumulative treatment success until the third TA injection was 82.5% in primary chalazia and 70.0% in recurrent chalazia in patients aged fifteen and over. No complications were noted with TA injections. CONCLUSIONS: Intralesional triamcinolone acetonide injection in chalazia is an effective and safe treatment in pediatric patients.

Surgery and Perioperative Intralesional Corticosteroid Injection for Treating Earlobe Keloids: A Korean Experience

BACKGROUND: The aesthetic implications of ear keloids, which affect people of all races, are serious and the treatment of earlobe keloids is known to be difficult. The high rate of recurrence following excision alone has led to investigating various types of adjuvant therapy, including intralesional corticosteroid injection. OBJECTIVE: We evaluated the efficacy of excision combined with perioperative intralesional triamcinolone acetonide injection for treating earlobe keloids of Korean patients. METHODS: From 1997 to 2006, eighteen keloids on the earlobes of fifteen Korean patients were treated. The patient age ranged from 15 to 32 years (mean age: 24 years). All the patients were female and the keloids occurred after ear piercing. Preoperative intralesional triamcinolone acetonide (TA) injection was administered twice at a 1-month interval. Postoperative intralesional TA injections were given every 1 month for several months, depending on the patient's clinical progress. RESULTS: The follow-up period ranged from 4 to 42 months (mean: 18.5 months). After the surgery, TA intralesional injections were given 2 to 13 times (mean: 5.2 times). Of the treated keloids, eleven showed good results (61.1%) and three recurred (16.6%). No complications from the TA intralesional injection were observed. CONCLUSION: Among the various treatments for earlobe keloids, we suggest that excision with corticosteroid intralesional injection can be used as the first line therapy when considering its effect and economic advantage.

Use of corticosteroids in the treatment of localized langerhans cell histiocytosis of the mandible : Case report

Therapeutic Effect of Bleomycin Intralesional Injection on Keloids & Hypertrophic Scars / 대한피부과학회지

BACKGROUND: Keloids and hypertrophic scars are benign growths of dermal collagen that usually cause major physical, psychological, and cosmetic problems. Numerous treatment modalities have been used to treat keloids and hypertrophic scars, but the optimal treatment has not been established. OBJECTIVE: The purpose of this study is to investigate whether bleomycin intralesional injection has an therapeutic effect on both keloids and hypertrophic scars. METHODS: Thirteen patients with keloids or hypertrophic scars were administered with intralesional injection of bleomycin (1.5 IU/ml). Scar height was measured, and scar pliability and erythema were scored at baseline and then monthly during the treatment and follow-up period. Patient's self-assessments of subjective symptoms (pruritus and pain) were also scored. Pre- and post-treatment mean values for scar height, scar pliability, erythema, pruritus and pain were statistically compared. RESULTS: The clinical response was positive in all cases: highly significant flattening in one case, significant flattening in one case, moderate flattening in five cases and minimal flattening in six cases. The mean scores for pruritus and pain also improved. The observed side-effects were hyperpigmentation (two cases), hypopigmentation (one case) and skin infection (one case). No exacerbation was noted during follow-up period of 4 months. CONCLUSION: Bleomycin intralesional injecton may be one of the effective and safe method of treating keloids and hypertrophic scars.

Effect of Steroid Intralesional Treatment on Onychodystrophy / 대한피부과학회지

BACKGROUND: Onychodystrophy is a disorder which is still difficult to properly diagnose. Although onychodystrophy has many treatment modalities, such as systemic steroids, topical steroids, steroid intralesional injection, phototherapy, or calcitriol, no method has proven to be totally satisfactory. OBJECTIVE: The aim of our study was to evaluate the therapeutic effect of intralesional triamcinolone acetonide injection on onychodystrophy. METHODS: Retrospective analysis was undertaken by reviewing the clinical records of 43 patients who had been diagnosed with onychodystrophy between 1995 and 2005. They were treated with 10 mg/ml triamcinolone intralesional injection to the proximal or lateral nail fold. Intralesional injection was performed at 1~2 month intervals. Of the total 43 patients, 36 patients were scored against 4 grades: Grade 0 (no response), Grade 1 (less than 50% improvement), Grade 2 (less than 75% improvement), and Grade 3 (more than 75% improvement). RESULTS: Therapeutic effects were as follows; Of 36 patients, 4 (11%) were classified as Grade 1 (less than 50% improvement), 10 (27.8%) as Grade 2 (less than 75% improvement), and 17 (47.2%) as Grade 3 (more than 75% improvement). Trachyonychia was the most common percentage in our study classification. Trachyonychia responded well to treatment and by more than 72.8% more than compared to Grade 2. Furthermore, of the 31 (86.8%) patients who showed a Grade 1 to 3 effect, 14 (39.2%) had less than 4 TA injections in total. CONCLUSION: Intralesional injection of triamcinolone acetonide into onychodystrophy is a useful, efficacious treatment.

Mycobacterium fortuitum Infection Caused by a Nerve Block

With its nerve blocking effects, intralesional injection (ILI) is a treatment method commonly used for controlling inflammation and pain syndromes in zoster patients. We herein report a case of chronic subcutaneous disease in a 52-year-old female patient caused by Mycobacterium fortuitum. Clinically, the lesion was arranged in a linear fashion, coinciding with the previous zoster site where we performed an ILI. Incision and drainage of the individual abscess pockets, with subsequent ingestion of antibiotics, was effective in our patient.