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Bekkers VZ, Bik L, van Huijstee JC, Wolkerstorfer A, Prens EP, van Doorn MBA. Efficacy and safety of needle-free jet injector-assisted intralesional treatments in dermatology-a systematic review. Drug Deliv Transl Res 2023; 13:1584-1599. [PMID: 36884194 PMCID: PMC10126042 DOI: 10.1007/s13346-023-01295-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 03/09/2023]
Abstract
Needle-free jet injectors are used for the intralesional treatment of various dermatological indications. However, a systematic review that evaluates the efficacy and safety of these treatments has not been published. The objectives of this study are to evaluate the efficacy and safety of needle-free jet injections for dermatological indications and to provide evidence-based treatment recommendations. An electronic literature search was conducted in April 2022. Two reviewers independently selected studies based on predefined criteria and performed a methodological quality assessment using the Cochrane Collaborations risk-of-bias 2.0 assessment tool and Newcastle-Ottawa Scale. Thirty-seven articles were included, involving 1911 participants. Dermatological indications included scars, alopecia areata, hyperhidrosis, nail diseases, non-melanoma skin cancer, common warts, local anesthesia, and aesthetic indications. Keloids and other types of scars (hypertrophic, atrophic, and burn scars) were investigated most frequently (n = 7). The included studies reported favorable efficacy and safety outcomes for intralesional jet injector-assisted treatment with triamcinolone acetonide/hexacetonide, 5-fluorouracil, bleomycin, or hyaluronic acid. Two high-quality studies showed good efficacy and tolerability of intralesional jet injections with a combination of 5-fluorouracil and triamcinolone acetonide in hypertrophic scars and with saline in boxcar and rolling acne scars. No serious adverse reactions and good tolerability were reported in the included studies. Overall, the methodological quality of the included studies was low. Limited evidence suggests that needle-free jet injector-assisted intralesional treatment is efficacious and safe for hypertrophic and atrophic acne scars. More well-powered RCTs investigating the efficacy and safety of jet injector treatment in dermatology are warranted to make further evidence-based recommendations.
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Affiliation(s)
| | - Liora Bik
- Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Center, Location AMC, Amsterdam, the Netherlands
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Bik L, Wolkerstorfer A, Bekkers V, Prens EP, Haedersdal M, Bonn D, van Doorn MBA. Needle-free jet injection-induced small-droplet aerosol formation during intralesional bleomycin therapy. Lasers Surg Med 2021; 54:572-579. [PMID: 34931319 PMCID: PMC9303553 DOI: 10.1002/lsm.23512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/14/2021] [Accepted: 12/04/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Needle-free jet injectors are frequently used in dermatological practice. Injection-generated small-droplet aerosols could be harmful upon inhalation when chemotherapeutics, like bleomycin, are used. Here, we aim to explore jet injector-induced small-droplet aerosol formation of bleomycin in relation to air ventilation and to provide safety measures for clinical practice. MATERIALS AND METHODS With a professional particle sensor, we measured airborne aerosol particles (0.2-10.0 µm) after electronic pneumatic injection (EPI), spring-loaded jet injection (SLI), and needle injection (NI) of bleomycin and saline (100 μl) on ex vivo human skin. Three levels of air ventilation were explored: no ventilation, room ventilation, and room ventilation with an additional smoke evacuator. RESULTS EPI and SLI induced significant small-droplet aerosol formation compared with none after NI (0.2-1.0 µm; no ventilation). The largest bleomycin aerosol generation was observed for the smallest particles (0.2-1.0 µm) with 673.170 (528.802-789.453) aerosol particles/liter air (EPI; no ventilation). Room ventilation and smoke evacuation led to a reduction of ≥99% and 100% of measured aerosols, respectively. CONCLUSION Jet injectors generate a high number of small-droplet aerosols, potentially introducing harmful effects to patients and healthcare personnel. Room ventilation and smoke evacuation are effective safety measures when chemotherapeutics are used in clinical practice.
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Affiliation(s)
- Liora Bik
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam UMC Medical Center, Amsterdam, The Netherlands
| | - Vazula Bekkers
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg hospital, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Bonn
- Van der Waals-Zeeman Institute, Institute of Physics, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn B A van Doorn
- Department of Dermatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Oliveira GV, Metsavaht LD, Kadunc BV, Jedwab SKK, Bressan MS, Stolf HO, Castro RG, Bezerra SMFMC, Calil DA, Addor FAZ, Fraga JCS, Reis CMS, Reis-Filho E, Silva MR, Ramos-E-Silva M, Hexsel DM. Treatment of keloids and hypertrophic scars. Position statement of the Brazilian expert group GREMCIQ. J Eur Acad Dermatol Venereol 2021; 35:2128-2142. [PMID: 34263958 DOI: 10.1111/jdv.17484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/31/2021] [Indexed: 12/23/2022]
Abstract
Keloids (K) and hypertrophic scars (HS) are abnormal responses to wound healing that occur as the result of dermal inflammation. Despite the advances on their treatment, many patients still suffer from the negative effects of excessive scarring; its approach is impaired by the lack of objective data on different treatments and the large genetic variability among patients and the difficulties in producing multicentre studies. Their incidence among the Brazilian population is high, as the result of an admixture of Amerindians, Europeans and Africans ancestral roots. With the aim of producing multicentre studies on K and HS, a panel of senior Brazilian dermatologists focused on their treatment was invited to contribute with the K and HS Treatment Brazilian Guidelines. In the first part of this study, different treatment modalities for keloids and HS are fully reviewed by the panel. The second part of the study presents a consensus recommendation of treatment for different types of lesions. More than a literature review, this article aims to show the pitfalls and pearls of each therapeutic option, as well as a therapeutic approach by the Panel of Experts on keloids and Scars on a highly mixed population, providing simple guidelines.
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Affiliation(s)
- G V Oliveira
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Mario Penna/Luxemburgo Hospital, Keloids and Scars Ambulatory, Belo Horizonte, Brazil
| | - L D Metsavaht
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Santa Casa de Misericórdia, Rio de Janeiro, Brazil
| | - B V Kadunc
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Surgical and Cosmetic Dermatology, São Paulo, Brazil
| | - S K K Jedwab
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Skinlaser Director, São Paulo, Brazil
| | - M S Bressan
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Maura Bressan Dermatology, Campinas, Brazil
| | - H O Stolf
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,UNICAMP, Campinas, Brazil
| | - R G Castro
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Brazil
| | - S M F M C Bezerra
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Federal University of Pernambuco, Recife, Brazil
| | - D A Calil
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Brazilian Society of Dermatology, São Paulo Session, São Paulo, Brazil
| | - F A Z Addor
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Albert Einstein Hospital, São Paulo, Brazil
| | - J C S Fraga
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Military Hospital, Belo Horizonte, Brazil
| | - C M S Reis
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Dermatology Residency Program, ESCS-DF, Brasilia, Brazil
| | - E Reis-Filho
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Dermatology Residency Program, ESCS-DF, Brasilia, Brazil
| | | | - M Ramos-E-Silva
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,Dermatology Residency Program, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - D M Hexsel
- Brazilian Society of Dermatology and Dermatologic Surgery and GREMCIQ, Rio de Janeiro, Brazil.,International Society for Dermatologic Surgery (ISDS), Hexsel Dermatology Clinics and Brazilian Center for Studies in Dermatology, Porto Alegre, Brazil
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de Oliveira GV, Gold MH. Hydrocolloid dressings can be used to treat hypertrophic scars: An outpatient dermatology service devoted to treat keloids and challenging scars. J Cosmet Dermatol 2020; 19:3344-3348. [PMID: 33103841 DOI: 10.1111/jocd.13792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
Abstract
Since we first described the rationale for the use of hydrocolloid dressings to treat keloids and hypertrophic scars, this technique has been used as an occlusive therapy alternative to the use of silicone sheets in our outpatient clinic. In this paper, we describe the use of these dressings on two patients with challenging scars: a large postburn hypertrophic scar on a young patient's hand and arm, with a growing keloid on the wrist, and a progressive scar on the lower eyelid, developing after a complication of a cosmetic blepharoplasty procedure, leading to ectropium. The methods on the proper use of these dressings are reviewed here in detail. Larger clinical trials are needed to further evaluate this technique in the treatment of hypertrophic scars and keloids.
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Affiliation(s)
- Gisele Viana de Oliveira
- Ambulatory of Keloids and Hypertrophic scars treatment, Mario Penna/Luxemburgo Hospitals-, Belo Horizonte, MG, Brazil
| | - Michael H Gold
- Gold Skin Care Center, Tennessee Clinical Research Center, Nashville, TN, USA
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Abstract
This review article addresses the principles and controversies associated with thermal injury to the hand and upper limb. Accepted principles are outlined and areas of controversy are discussed in a balanced manner. The importance of hand burns is described functionally and epidemiologically. Burns appropriate to outpatient care are defined and treatment discussed, including debridement, topical therapy, rehabilitation and follow-up. The general principles of inpatient management are given, including the controversial issue to timing of surgery and treatment of the exposed tendon or joint. The extent of surgery, methods of wound closure and difficult problem of palm burns are also discussed. Reconstructive principles are outlined and a problem oriented approach to the most common reconstructive problems given.
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Affiliation(s)
- M A Smith
- Baltimore Regional Burn Center, Johns Hopkins University, School of Medicine, MD 21224, USA
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