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Pascual JC, Hernández-Quiles R, Sánchez-García V, Viudez-Martínez A, Belinchón Romero I, Sivera Mascaró F. Topical and Intralesional Therapies for Hidradenitis Suppurativa: A Systematic Literature Review. Actas Dermosifiliogr 2024; 115:T433-T448. [PMID: 38423507 DOI: 10.1016/j.ad.2024.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/29/2023] [Accepted: 12/04/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS. MATERIALS AND METHODS We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and Embase databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study. RESULTS We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs. CONCLUSION The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.
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Affiliation(s)
- J C Pascual
- Servicio de Dermatología. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España.
| | - R Hernández-Quiles
- Servicio de Dermatología. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España
| | - V Sánchez-García
- Servicio de Dermatología. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España
| | - A Viudez-Martínez
- Servicio de Farmacia. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España
| | - I Belinchón Romero
- Servicio de Dermatología. Hospital General Universitario Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante (Isabial), Alicante, España; Departamento de Medicina Clínica. Universidad Miguel Hernández, Alicante, España
| | - F Sivera Mascaró
- Departamento de Medicina Clínica. Universidad Miguel Hernández, Alicante, España; Servicio de Reumatología. Hospital General Universitario de Elda, Alicante, España
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Pascual JC, Hernández-Quiles R, Sánchez-García V, Viudez-Martínez A, Belinchón I, Sivera F. Topical and Intralesional Therapies for Hidradenitis Suppurativa: A Systematic Literature Review. Actas Dermosifiliogr 2024; 115:433-448. [PMID: 38159839 DOI: 10.1016/j.ad.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/29/2023] [Accepted: 12/04/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS. MATERIALS AND METHODS We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and EMBASE databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study. RESULTS We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs. CONCLUSION The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.
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Affiliation(s)
- J C Pascual
- Department of Dermatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
| | - R Hernández-Quiles
- Department of Dermatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - V Sánchez-García
- Department of Dermatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - A Viudez-Martínez
- Department of Pharmacy, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - I Belinchón
- Department of Dermatology, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain; Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| | - F Sivera
- Department of Rheumatology, General University Hospital of Elda, Alicante, Spain; Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
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Ricardo JW, Qiu Y, Lipner SR. Optimizing intralesional triamcinolone acetonide treatment for isolated nail psoriasis: a pilot, intra-subject randomized controlled trial. Arch Dermatol Res 2024; 316:113. [PMID: 38526737 DOI: 10.1007/s00403-024-02849-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 11/17/2023] [Accepted: 12/05/2023] [Indexed: 03/27/2024]
Affiliation(s)
- Jose W Ricardo
- Department of Dermatology, Weill Cornell Medicine, New York, NY, United States
| | - Yuqing Qiu
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
| | - Shari R Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, United States.
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Shiari R, Khalili M, Zeinali V, Shashaani N, Samami M, Moghaddamemami FH. Local injection of infliximab into calcinosis lesions in patients with juvenile dermatomyositis (JDM): a clinical trial. Pediatr Rheumatol Online J 2024; 22:2. [PMID: 38166943 PMCID: PMC10759742 DOI: 10.1186/s12969-023-00941-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Juvenile Dermatomyositis (JDM) is a rare autoimmune disorder that primarily affects muscles and skin. One of the severe complications associated with JDM is calcinosis, and treating this condition presents significant challenges. This study aimed to evaluate the efficacy and safety of local injection of infliximab into calcinosis lesions in patients with JDM. METHODS In this clinical trial, five patients diagnosed with JDM and calcinosis lesions were enrolled. The primary treatment consisted of weekly infliximab injections for 16 weeks, targeting all four sides of each lesion. Lesion dimensions, including length and width, were documented and monitored weekly. Before the intervention, patients underwent radiographic imaging. After the final injection in week 16, a follow-up radiographic assessment was performed. Data were analyzed using the Generalized Estimating Equation (GEE) method. RESULTS The lesions' size significantly decreased in both length and width during each visit. On average, the lesion length reduced by 2.66%, and the width shrank by 3.32% per visit. Based on radiographic findings, the average length and width of lesions at the initial visit were 12.09 ± 5.05 mm (range: 6.00-25.50 mm) and 6.35 ± 3.00 mm (range: 2.00-16.00 mm), respectively. The average length and width at the last visit were 5.59 ± 7.05 mm (range: 0-23.00 mm) and 3.41 ± 4.05 mm (range: 0-13.00 mm), respectively. No specific side effects related to the treatment were reported. CONCLUSIONS The results suggest that the direct administration of infliximab into the calcinosis lesions of patients with JDM could be a safe and effective treatment approach. TRIAL REGISTRATION Name of the registry: The effect of infliximab injection into calcinosis lesions on patients with juvenile dermatomyositis (JDM), Trial registration number: IRCT20210808052107N1, Registration date: 2022-07-22, URL of trial registry record: https://en.irct.ir/trial/58329 .
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Affiliation(s)
- Reza Shiari
- Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mitra Khalili
- Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Vahide Zeinali
- Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Shashaani
- Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Samami
- Dental Sciences Research Center, Department of Oral and Maxillofacial Medicine, School of Dentistry, Guilan University of Medical Sciences, Rasht, Iran
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Guo L, Wang M, Song D, Sun J, Wang C, Li X, Wang L. Additive value of single intralesional bleomycin injection to propranolol in the management of proliferative infantile hemangioma. Asian J Surg 2024; 47:154-157. [PMID: 37328380 DOI: 10.1016/j.asjsur.2023.05.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/08/2023] [Accepted: 05/31/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND /Objective: We aimed to evaluate whether additional intralesional bleomycin injections benefit children with proliferative infantile hemangiomas (IHs). METHODS In this retrospective case-control study, we examined the medical records of 216 infants who were followed up for proliferative IH. Patients in group 1 were treated with propranolol orally at 2 mg/kg/day. Group 2 was treated with oral propranolol combined with intralesional bleomycin injections. RESULTS We retrospectively reviewed 95 and 121 patients in groups 1 and 2, respectively. No significant differences were observed between both groups regarding visiting age, sex, lesion thickness, or risk site. The overall cure rates in groups 1 and 2 were 77.89% (74/95) and 84.30% (102/121), respectively. The overall distribution of the length of cure significantly differed between both groups (P = 0.035). From the survival analysis (P = 0.026), the median survival time was 198 days (95% confidence interval (CI) 174.46-221.54) for group 1 and 139 days (95% CI 114.58-163.42) for group 2. The effect of treatment modality (hazard ratio (HR) = 1.41, P = 0.031) and risk site on survival time (HR = .54, P < 0.001) was significant. CONCLUSION No significant differences were observed in the resolution of proliferative IH; however, intralesional bleomycin injection with systemic propranolol for proliferative IH treatment may provide a more rapid resolution.
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Affiliation(s)
- Lei Guo
- Department of Vascular Anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China; Department of Vascular Anomalies and Interventional Radiology, Ji'nan Children's Hospital, Jinan, China.
| | - Ming Wang
- Department of Hospital Office, QiLu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, China.
| | - Dan Song
- Department of Vascular Anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China; Department of Vascular Anomalies and Interventional Radiology, Ji'nan Children's Hospital, Jinan, China.
| | - Jiali Sun
- Department of Vascular Anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China; Department of Vascular Anomalies and Interventional Radiology, Ji'nan Children's Hospital, Jinan, China.
| | - Changfeng Wang
- Department of Vascular Anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China; Department of Vascular Anomalies and Interventional Radiology, Ji'nan Children's Hospital, Jinan, China.
| | - Xiaojuan Li
- Department of Hospital Office, QiLu Hospital of Shandong University Dezhou Hospital (Dezhou People's Hospital), Dezhou, China.
| | - Liang Wang
- Department of Vascular Anomalies and Interventional Radiology, Children's Hospital Affiliated to Shandong University, Jinan, China; Department of Vascular Anomalies and Interventional Radiology, Ji'nan Children's Hospital, Jinan, China.
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Rimmer SN, Chandy RJ, Khan D, Feldman SR. Recurrence rates in the treatment of keloids and hypertrophic scars with intralesional triamcinolone combined with other intralesional agents. Arch Dermatol Res 2023; 315:2757-2767. [PMID: 37432467 DOI: 10.1007/s00403-023-02662-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/10/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
Hypertrophic scars (HTS) and keloids are pathologic scars that are products of a wound healing pathway error attributed to genetic and inflammatory causes (Leventhal et al., Arch Facial Plast Surg 8(6):362-368. https://doi.org/10.1001/archfaci.8.6.362 , 2006). Methods of pathologic scar treatment include intralesional agents, cryotherapy, surgical excision, pressure dressings, topical agents, laser resurfacing, radiotherapy, and other investigational therapies (Leventhal et al. 2006). The recurrence of pathologic scar is high across all treatment modalities, including the use of intralesional agents (Trisliana Perdanasari et al., Arch Plast Surg 41(6):620-629. https://doi.org/10.5999/aps.2014.41.6.620 , 2014). In the treatment of pathologic scar, combination approaches using intralesional agents, such as triamcinolone (TAC), 5-fluorouracil (5FU), verapamil (VER), bleomycin (BLM), and botulinum toxin (BTX), are superior therapies when compared to monotherapy (Yosipovitch et al., J Dermatol Treat 12(2):87-90. https://doi.org/10.1080/095466301317085363 , 2001; Yang et al., Front Med 8:691628. https://doi.org/10.3389/fmed.2021.691628 , 2021; Sun et al., Aesthetic Plast Surg 45(2):791-805. https://doi.org/10.1007/s00266-019-01570-8 , 2021). This review assesses recurrence and the reporting of recurrence in pathologic scar after treatment with intralesional triamcinolone (TAC) in combination with another intralesional agent. A literature review was conducted using research journals from PubMed using the following search terms: [(keloid) AND (triamcinolone) AND (combination) AND (intralesional)], as well as [(keloid) AND (triamcinolone) AND (combination)]. Articles were reviewed and included if the article analyzed or compared intralesional agents for pathologic scar treatment within the last 10 years. The average follow-up period of included articles (n = 14) that utilized combination intralesional therapy (TAC-X) was approximately 11 months (range 1-24 months). Consistent recurrence rate reporting across studies was lacking. The combination agent with the highest recurrence rate was TAC-5FU (23.3%). The range of reported recurrence rates was 7.5-23.3%. Six studies using various intralesional combination regimens reported 0% recurrence over the follow-up period (TAC-5FU, TAC-BTX, TAC-BLM, TAC-CRY). Three studies did not report recurrence rates. While the efficacy of combination therapy is typically assessed via scar scales, the assessment of recurrence across studies of combination therapy is inconsistent and inadequate, with truncated follow-up periods. While scar recurrence can take place during 1-year post-treatment, long-term follow-up (18-24 months) is needed to characterize recurrence in the treatment of pathologic scar using various intralesional agents. Long-term follow-up periods allow patients to receive accurate prognostic information regarding recurrence after combination intralesional therapy. There are limitations to this review in that comparisons were made across studies with varying outcome variables, including scar size, injection concentration and interval, and follow-up period. Standardized follow-up periods and recurrence rate reporting are integral to furthering the understanding of these therapies and enhancing patient care.
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Affiliation(s)
- Sarah N Rimmer
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Rithi J Chandy
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Danyaal Khan
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Steven R Feldman
- Department of Dermatology, Center for Dermatology Research, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
- Department of Dermatology, University of Southern Denmark, Odense, Denmark
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Worley B, Kim K, Jain-Poster K, Reynolds KA, Merkel EA, Kang BY, Dirr MA, Anvery N, Christensen RE, Hisham FI, Ibrahim SA, Asadbeigi SN, Poon E, Alam M. Treatment of traumatic hypertrophic scars and keloids: a systematic review of randomized control trials. Arch Dermatol Res 2023; 315:1887-1896. [PMID: 36781457 DOI: 10.1007/s00403-023-02535-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/08/2022] [Accepted: 01/12/2023] [Indexed: 02/15/2023]
Abstract
Exaggerated healing and remodeling after skin injury may cause hypertrophic and keloidal scars, which are associated with functional and quality of life impairment. There is limited guidance available regarding the relative effectiveness of therapies for hypertrophic scars and keloids. In this review, we aim to compare the effectiveness of treatments for hypertrophic scars and keloids. MEDLINE, Embase, Scopus, and the Cochrane Collaboration database were searched from inception to March 2019 for randomized control trials of treatments for hypertrophic and keloid scars that included 20 or more patients. Outcomes evaluated included the standardized mean reduction in scarring and adverse events. The type of scar and the demographic features were analyzed for their effect on clinical outcome. Based on 25 included clinical trials, intralesional injection (64.1% [95% CI 60.8-67.5%]) may be more effective than physical (29.9% [95% CI 28.9-30.9%]) or topical treatments (34% [95% CI 31.8-36.8%]). Combination of 5-fluorouracil and triamcinolone (9:1 dilution) appeared superior among intralesional treatments for keloids. Ablative laser and pulsed-dye laser were the most useful laser treatments. Regression modeling showed laser treatment response was linked to Fitzpatrick skin type (p = 0.002). Adverse events were uncommon for all treatments and mostly transient. Intralesional treatments for keloid and hypertrophic scars may be the most reliable treatment option to improve pathologic scars, while laser treatment may have specific benefits for Fitzpatrick skin types I-III over types IV-VI. Management of pathological scars is an area of critical need, where appropriate treatment can have a significant impact on quality of life.
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Affiliation(s)
- Brandon Worley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Kathyrn Kim
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Ketan Jain-Poster
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Kelly A Reynolds
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily A Merkel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - McKenzie A Dirr
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Noor Anvery
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Rachel E Christensen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Farhana Ikmal Hisham
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Sepideh Nikki Asadbeigi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA.
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Anggawirya BY, Wardhani PH, Indramaya DM, Listiawan MY. Combination of Fractional Er:YAG Laser, Pulsed Dye Laser, and Intralesional Triamcinolone With 5-Fluorouracil for Keloid Treatment. J Lasers Med Sci 2023; 14:e30. [PMID: 37744013 PMCID: PMC10517570 DOI: 10.34172/jlms.2023.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/05/2023] [Indexed: 09/26/2023]
Abstract
Introduction: Benign fibroproliferative scars that are larger than the initial lesion are called keloids. Keloids treatment in clinical practice is still difficult. Although there are various therapy choices, none is embraced by everyone or is relapse-free. Various treatment modalities such as intralesional corticosteroid injection with 5-fluorouracil (5-FU), fractional Er:YAG laser, pulsed dye laser (PDL), and others can be used either as monotherapies or combined therapies. Therefore, efforts should be made to select the treatment that will provide the best results. Case Presentation: A 6-year-old boy with keloids on the lower lips extending to the chin was successfully treated with a 2940-nm fractional Er:YAG laser alternated with a 595-nm long-PDL followed by the combined intralesional injection of corticosteroid and 5-FU. The patient was followed up for 1 year with no lesion recurrence. Conclusion: Our case supports a combined therapy to successfully treat a patient with a keloid on the chin. Therapy using a combination of these four modalities seems safe and effective and may have a synergistic effect with minimal downtime.
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Affiliation(s)
- Bonnie Yudistha Anggawirya
- Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Putri Hendria Wardhani
- Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Diah Mira Indramaya
- Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Muhammad Yulianto Listiawan
- Department of Dermatology and Venereology, Faculty of Medicine, Airlangga University, Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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Guragain R, Gyawali BR. Intralesional Bevacizumab as Adjuvant Therapy for Juvenile Onset Recurrent Respiratory Papillomatosis: A Systematic Review. Indian J Otolaryngol Head Neck Surg 2023; 75:1296-1301. [PMID: 37275063 PMCID: PMC10235305 DOI: 10.1007/s12070-022-03204-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/23/2022] [Indexed: 11/08/2022] Open
Abstract
Background: Respiratory papillomatosis is one of the common benign lesions of the airway that is often difficult to treat and carries significant morbidity. Bevacizumab is a monoclonal antibody that acts upon vascular endothelial growth factor receptor and is known to have an effect in respiratory papillomatosis. This study aims to systematically review the literature on efficacy of intralesional Bevacizumab in juvenile onset respiratory papillomatosis. Materials and methods. A systematic search of literature in various databases was conducted. The search was restricted to the English language, however, no restrictions were made regarding the date of publication keeping December 31st, 2020 as the last date of publication. We strictly complied with the PRISMA guidelines. Results. Of 145 articles analyzed, only 3 were selected as eligible and a total of twenty-one cases were evaluated. There was improvement in anatomic Derkay score after initiating intralesional Bevacizumb with reduction in the number of surgeries. Where reported, voice related functional outcomes also were also improved. No adverse effect related to the drug was reported. Conclusion: Intralesional Bevacizumab can be a promising efficacious, and safe adjuvant in the management of JORRP. Well-designed studies are further required in the future to prove its efficacy and safety over other adjuvants available.
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Affiliation(s)
- Rajendra Guragain
- Department of ENT-HNS Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
| | - Bigyan Raj Gyawali
- Department of ENT-HNS Maharajgunj Medical Campus, Institute of Medicine, Kathmandu, Nepal
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10
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Gil-Lianes J, Morgado-Carrasco D. RF - Intralesional 5-Fluorouracil in the Treatment of Nonmelanoma Skin Cancer. Actas Dermosifiliogr 2023; 114:255-6. [PMID: 36113608 DOI: 10.1016/j.ad.2021.07.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/28/2021] [Indexed: 10/14/2022] Open
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Gil-Lianes J, Morgado-Carrasco D. [Translated article] RF - Intralesional 5-Fluorouracil in the Treatment of Nonmelanoma Skin Cancer. Actas Dermosifiliogr 2023; 114:T255-T256. [PMID: 36720361 DOI: 10.1016/j.ad.2021.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/28/2021] [Indexed: 01/31/2023] Open
Affiliation(s)
- J Gil-Lianes
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain.
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Youssef EMK, Eissa MAA, Bakr RM. Intralesional Candida albicans antigen versus intralesional zinc sulfate in treatment of cutaneous warts. Arch Dermatol Res 2022; 315:1305-1314. [PMID: 36567351 DOI: 10.1007/s00403-022-02499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/16/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
Immunotherapy represents a promising therapeutic option for treatment of warts. Different concentrations of Candida antigen (1/100 and 1/1000) and zinc sulfate 2% were not previously compared regarding their efficacy in treatment of cutaneous warts. The present study compared the safety and efficacy of intralesional candida antigen versus intralesional 2% zinc sulfate for treatment of cutaneous warts. This prospective controlled clinical trial included one hundred and five patients presented with common, plantar, and plane warts. Patients were divided randomly into three groups, each group included 35 patients. Group 1 were treated with intralesional candida antigen (Ag) 1/100, Group 2 were treated with intralesional candida Ag 1/1000, and Group 3 were treated with intralesional zinc sulfate 2%. This study found that target warts of group 1 displayed higher rate of complete clearance compared to group 2 and group 3 (94.3%, 77.1, 74.2%), respectively. The present study concluded that intralesional immunotherapy with Candida antigen was more effective than Intralesional 2% zinc sulfate in treatment of cutaneous warts and less painful. Clinical trial registration number is (Clinical Trials.gov Identifier: NCT03158168).
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Affiliation(s)
- Eman M Kamal Youssef
- Department of Dermatology, Faculty of Medicine, Assiut University, Asyût, Egypt.
| | | | - Radwa M Bakr
- Department of Dermatology, Faculty of Medicine, Assiut University, Asyût, Egypt
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Verma PK, Rana AK, Tripathi S, Kumar S, Upadhyay D. Evaluation of Clinical Profile and Various Treatment Modalities in Oral Sub Mucous Fibrosis in North India: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:6313-6320. [PMID: 36742589 PMCID: PMC9895579 DOI: 10.1007/s12070-021-03049-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
Oral submucous fibrosis is a chronic disease affecting oral cavity and sometimes the pharynx. Etiology seems to be local irritants such as capsaicin, tobacco, areca nut and spicy foods. The main concern in this is the management of trismus and burning sensation of the oral mucosa. The aim of this study was to compare various medical treatment protocol of OSMF. 210 patients were divided randomly in 3 groups. In Group A, patients were given biweekly intralesional Hyaluronidase/Dexamethasone for 6 weeks. Group B patients were given tablet Pentoxifylline 400 mg TDS.Group C patients were given Eprisone hydrochloride. All three groups were given Lycopene 10,000 mcg for period of 6 weeks. All patients were given topical Triamcelone for local application. The examinations for mouth opening were repeated at weekly intervals for a period of 6 weeks.The most common complaint was burning sensation in 75.98% cases, difficulty in mouth opening in77.45% and difficulty in swallowing food in 61.76% cases. Group A showed improvement in 41.17% cases presenting with burning sensation followed by decreased mouth opening 39.70%. Group B showed improvement in 45.58% burning sensation, 17.64% with decreased mouth opening. Group C showed improvement in 48.52% patients having pain with spicy food, 32.35% with decreased mouth opening and 17.64% with difficulty in swallowing. We conclude that patients which received intralesional dexamethasone and hyaluronidase along with oral Lycopene showed better clinical and symptomatic improvement, and at present appears to be best non-surgical treatment.
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Affiliation(s)
- Pankaj Kumar Verma
- Department of ENT, Integral Institute of Medical Sciences & Research, Lucknow, Uttar Pradesh India
| | - Amit Kumar Rana
- Department of Otolaryngology and Head Neck Surgery, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh India
| | - Swati Tripathi
- Department of Pedodontics, Career Post Graduate Institute of Dental Sciences and Hospital, Lucknow, Uttar Pradesh India
| | - Shivesh Kumar
- Department of ENT, Career Institute of Medical Sciences, Lucknow, Uttar Pradesh India
| | - Deepak Upadhyay
- Department of Community Medicine, Rohilkhand Medical College & Hospital, Bareilly, Uttar Pradesh India
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Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022; 10:409-420. [PMID: 35772849 DOI: 10.1016/j.sxmr.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Across many cultures, penis size has been associated with virility, and concerns about penile length are commonplace. Peyronie's disease (PD) is a known acquired cause of penile shortening. OBJECTIVES This paper describes the psychosocial impacts of penile length on men and their partners, both generally and in men with PD, and evaluates the effect of PD treatments (eg, collagenase clostridium histolyticum , surgery, mechanical therapy) on this outcome measure. METHODS A PubMed database search was performed for English language articles through July 2021. Main outcome measures were association of penile length with emotional well-being, selfesteem, and relationship satisfaction in men with PD, and change from baseline penile length after treatment. RESULTS Shortened penile length caused by PD can negatively impact patient and partner quality of life, including effects on body image, emotional well-being, sexual function, and interpersonal relationships. In men with PD, studies have demonstrated an association between loss of penile length and emotional problems, reduced satisfaction with sexual performance, poor self-esteem, depression, and relationship difficulties. Loss of penile length can frequently occur after surgery for PD (including plication, plaque incision/excision with grafting, and penile implant). Advanced surgical techniques may preserve/increase penile length, but the increased risks associated with these complex procedures must be carefully considered. Treatment with collagenase clostridium histolyticum does not appear to negatively impact penile length, and 5-year follow-up data suggest potential longterm posttreatment improvements in this outcome measure. Penile traction therapy, either alone or as adjunctive therapy, may increase penile length in men with PD, but nonadherence may limit improvement. CONCLUSION Changes in penile length are important to many men, particularly those with PD, and should be considered during PD treatment selection. Penile length should be measured objectively before and after treatment for PD and should be included as an outcome measure in future studies on treatment effectiveness. Goldstein I, Gelbard MK, Lipshultz LI. Clinical Significance of Shortened Penile Length and Alterations in Penile Length Following Treatment for Peyronie's Disease. Sex Med Rev 2022;10:409-420.
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Saha A, Bahalia I, Agarwal S, Banerjee A, Bandyopadhyay D. Comparison of Effectiveness and Safety of Immunotherapy of Warts with Intralesional Versus Subcutaneous MMR Vaccine: An Open Label Randomized, Parallel Group, Clinical Trial. Indian J Dermatol 2022; 67:99-108. [PMID: 36092192 PMCID: PMC9455138 DOI: 10.4103/ijd.ijd_960_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Common wart, also known as verruca vulgaris is characterized by focal proliferation of keratinocytes caused by multiple strains of human papilloma virus (HPV). Conventional treatments like chemical cautery, cryotherapy, electro-cautery, etc often fail to cure verruca satisfactorily. The present work was a randomized, parallel-group, non-inferiority clinical trial with an objective of comparing the effectiveness and safety of subcutaneous MMR versus intralesional MMR vaccine in the treatment of multiple warts. Method Consenting patients of both sexes of 18-65 years age, who have viral warts and did not receive anti-wart treatment in the last 4 weeks and devoid of any active bacterial or viral skin diseases were included in the study. Interventions Eligible patients were randomized into either group A (receiving 0.3 ml of intralesional MMR) or group B (receiving 0.5 ml of subcutaneous MMR). A total of three injections were administered at two weeks interval. Outcome Measure The response was considered complete if there was disappearance of the wart(s) and return of the normal skin markings, partial if the wart(s) was regression in size by 50-99% and no response if there was be 0-49% decrease in wart size. Results Thirty patients were recruited in each group; 5 of group A and 3 of group B were lost to follow up. Modified intention to treat analysis was performed, so, the last observation of such patients was carried forward and all 60 participants were analysed. Number of warts and size of the largest wart were declined significantly (P < 0.001 and P = 0.001 respectively) in both the treatment arms. No significant difference between two groups were seen. Complete clearance including distant lesions was achieved in 22 patients; 12 (48%) in group A and 10 (37.04%) in group B, but the final outcome at the end of the study showed no significant difference between the two t groups. (P = 0.64). Adverse Events Only one patient had developed mild fever with tender, enlarged parotid gland after first injection of subcutaneous MMR which resolved within two weeks. Conclusion Efficacy and safety profile of Subcutaneous and intralesional MMR were almost same. Both can be considered as safe and cost effective treatment of warts while the subcutaneous route may be easier to administer.
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Affiliation(s)
- Abanti Saha
- From the Department of Dermatology, Medical College, Kolkata, West Bengal, India,Address for correspondence: Dr. Abanti Saha, Department of Dermatology, Medical College, Kolkata, West Bengal, India. Shri Bishnu Apartment. 37, Bosepukur Purbapara. Flat No 8. Kolkata - 700 107, West Bengal, India. E-mail:
| | - Indrajit Bahalia
- Department of Dermatology, Islampur Subdivision Hospital, West Bengal, India
| | - Sristi Agarwal
- Department of Dermatology, Imambara Sadar Hospital, West Bengal, India
| | - Arini Banerjee
- Department of Dermatology, Burdwan Medical College and Hospital, West Bengal, India
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Zakria D, Patrinely JR, Dewan AK, Albers SE, Wheless LE, Simmons AN, Drolet BC. Intralesional corticosteroid injections are less painful without local anesthetic: a double-blind, randomized controlled trial. J DERMATOL TREAT 2021; 33:2034-2037. [PMID: 33760691 DOI: 10.1080/09546634.2021.1906842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Corticosteroid injections are a commonly used treatment for dermatologic pathologies. Although the injectable is often prepared with a local anesthetic, we hypothesize that patients receiving an injection with anesthetic will experience no decrease in pain at the time of injection. METHODS Patients requiring a corticosteroid injection were prospectively randomized into two cohorts to receive a corticosteroid (triamcinolone acetonide) combined with either lidocaine with epinephrine 1:100 000 (anesthetic) or bacteriostatic normal saline. Both patient and clinician were blinded to the treatment arm. The primary outcome was pain associated with the injection measured using a Visual Analog Scale (VAS) immediately following the injection. RESULTS Thirty-one patients were enrolled with 18 in the saline group and 13 in the lidocaine with epinephrine group. Pain scores were significantly higher for injections containing lidocaine with epinephrine versus saline (VAS 5.0 vs 2.0, p = .0056). CONCLUSIONS For various dermatologic pathologies, corticosteroid injections are effective and have relatively little associated pain. Counterintuitively, we found that there is more injection-associated pain when lidocaine with epinephrine is included with the corticosteroid. Therefore, clinicians should omit this anesthetic or dilute corticosteroids with normal saline, rather than with lidocaine and epinephrine. This will minimize injection pain as well as decrease the risk of pharmacologic adverse reactions from an unnecessary additional medication. Due to the small sample size, additional research may be necessary for generalization to other indications. Clinicaltrials.gov listing: NCT03630198.
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Affiliation(s)
- Danny Zakria
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | | | - Anna K Dewan
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sharon E Albers
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lee E Wheless
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aleta N Simmons
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian C Drolet
- Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Herz-Ruelas ME, Álvarez-Villalobos NA, Millán-Alanís JM, de León-Gutiérrez H, Ocampo-Garza SS, Gómez-Flores M, Grimalt R. Efficacy of Intralesional and Oral Dutasteride in the Treatment of Androgenetic Alopecia: A Systematic Review. Skin Appendage Disord 2020; 6:338-345. [PMID: 33313048 DOI: 10.1159/000510697] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022] Open
Abstract
Androgenetic alopecia is the most common cause of hair loss [Br J Dermatol. 2011 Jan;164(1):5-15]. Finasteride and minoxidil are the only approved treatments [J Am Acad Dermatol. 2008 Oct;59(4):547-8 and J Eur Acad Dermatology Venereol. 2018 Jan;32(1):11-22]. Dutasteride is more potent than finasteride due to its ability to inhibit both 5-α-reductase type I and II [Our Dermatol Online. 2017 Sep;9(1):75-9] though its adverse effects and long half-life contribute to the reluctance on its oral use. Mesotherapy could be a feasible alternative to avoid systemic exposure and side effects [J Pan-Arab League Dermatologist. 2009 Feb;20(1):137-45]. We aim to perform a systematic review to analyze scientific literature with the purpose of comparing efficacy and adverse effects of both administration routes. Five clinical trials using oral route and 3 intralesional in comparison with placebo met criteria for inclusion. Regarding intralesional dutasteride, only one study [Clin Dermatol. 2001 Mar;19(2):149-54] reported the mean change in hair count. Although both interventions favor over placebo, there are not enough data to reliably compare outcomes obtained between both routes. Mean increase in hair count observed with oral dutasteride was higher (MD: 15.92 hairs [95% CI: 9.87-21.96]; p = <0.00001; I 2 = 90%) compared to intralesional dutasteride in Abdallah's study (MD: 7.90 hairs [95% CI: 7.14-8.66]; p = <0.00001). Future studies are required to assess the therapeutic efficacy of both treatment routes, including head-to-head treatments before well-supported conclusions can be established.
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Affiliation(s)
| | | | - Juan Manuel Millán-Alanís
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Sonia Sofía Ocampo-Garza
- Servicio de Dermatología, Hospital Universitario "Dr. José Eleuterio González", U.A.N.L, Monterrey, Mexico
| | - Minerva Gómez-Flores
- Servicio de Dermatología, Hospital Universitario "Dr. José Eleuterio González", U.A.N.L, Monterrey, Mexico
| | - Ramón Grimalt
- Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain
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Singal A, Grover C. Efficacy and Safety of Intralesional Bleomycin in the Management of Ungual Warts. Skin Appendage Disord 2020; 6:346-350. [PMID: 33313049 DOI: 10.1159/000510989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/15/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Ungual warts are common fibroepithelial tumours of the nail unit caused by human papillomavirus. Although various treatment modalities are available, their management is challenging due to high potential for recurrence and treatment-related nail dystrophy. OBJECTIVE This study evaluates the efficacy and safety of intralesional bleomycin injections in the treatment of ungual warts. METHODS Medical records of 80 patients with ungual warts, treated by us from 2015 to 2019, were analysed retrospectively with respect to the number of warts, site, morphology, and treatment outcome. Children <5 years of age, and pregnant and lactating women were excluded. All ungual warts were treated with intralesional injections of bleomycin 3 Units/mL, given at 3-4 weeks interval. RESULTS AND CONCLUSIONS A total of 250 periungual and subungual warts were treated in 80 patients. An average of 2.61 sessions per patient was required for complete resolution. Moderate pain was reported by 65 patients (81.2%), and transitory perilesional hyperpigmentation was observed in 155 lesions (62%). Severe pain and necrosis developed in 3 lesions (1.2%) that were reversible without any residual scarring and deformity. We conclude that intralesional bleomycin is an effective and safe therapeutic modality for ungual warts.
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Affiliation(s)
- Archana Singal
- Department of Dermatology and STD, University College of Medical Sciences and G.T.B. Hospital, University of Delhi, New Delhi, India
| | - Chander Grover
- Department of Dermatology and STD, University College of Medical Sciences and G.T.B. Hospital, University of Delhi, New Delhi, India
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Searle T, Ali FR, Al-Niaimi F. Intralesional methotrexate in dermatology: Diverse indications and practical considerations. Dermatol Ther 2020; 34:e14404. [PMID: 33044042 DOI: 10.1111/dth.14404] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 01/25/2023]
Abstract
Intralesional methotrexate (IL-MTX) is a long-established treatment, which is arguably underutilized by dermatologists. We describe the underlying evidence base and practical considerations for its broad range of cutaneous indications, including in cutaneous oncology (keratoacanthomas, squamous cell carcinomas, lymphomas), inflammatory dermatology (nail psoriasis, plaque psoriasis, pyoderma gangrenosum, cutaneous Crohn's disease, amyloidosis), cutaneous infections (viral warts) and for treatment of filler complications. In certain circumstances, IL-MTX can be more efficacious and less invasive than other treatments, with fewer adverse effects. Dermatologists should consider using IL-MTX for a range of recalcitrant cutaneous conditions, particularly for those patients not amenable to surgery or systemic therapy.
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Affiliation(s)
| | - Faisal R Ali
- Department of Dermatology, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Dermatology, Vernova Healthcare Community Interest Company, Macclesfield, UK
| | - Firas Al-Niaimi
- Department of Dermatology, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
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Wohlgemuth WA, Müller-Wille R, Meyer L, Wildgruber M, Guntau M, Heydt SV, Pech M, Zanasi A, Flöther L, Brill R. Bleomycin electrosclerotherapy in therapy-resistant venous malformations of the body. J Vasc Surg Venous Lymphat Disord 2021; 9:731-9. [PMID: 33045393 DOI: 10.1016/j.jvsv.2020.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Bleomycin is one of the most commonly used agents in sclerotherapy for slow-flow vascular malformations worldwide. However, its efficiency remains unknown. The objective of the present study was to assess whether reversible electroporation combined with bleomycin would increase the sclerotherapy effect in patients with previously unsuccessfully treated venous malformations (VMs). METHODS We performed, to the best of our knowledge, the first retrospective observational case series from January 2019 to January 2020 of 17 patients (20 lesions) with symptomatic VMs, who had previously undergone at least two unsuccessful invasive treatments. Reversible electroporation was performed with various electrodes and directly injected bleomycin. All patient records, magnetic resonance imaging data, documentation of previous treatments, and data regarding the intervention, complications, and clinical symptoms were analyzed. RESULTS The 17 VM patients (mean age, 20.8 ± 8.2 years; 9 females) had previously undergone an average of 4.2 invasive treatments. These patients had subsequently undergone 22 electrosclerotherapy sessions of 20 lesions. The median dose of bleomycin was 3 mg. The median magnetic resonance imaging-derived lesion volume before treatment was 24.9 cm3, which had decreased by 86% to 3.5 cm3 after treatment. After 3.7 months, eight patients were asymptomatic without residual symptoms and nine patients showed improvement. CONCLUSIONS Bleomycin electrosclerotherapy appears to be an effective therapy for patients with VMs resistive to previous invasive therapy. Because of the small sample size and short follow-up period, our results should be examined further using a larger patient population.
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Rafei-Shamsabadi D, Lehr S, von Bubnoff D, Meiss F. Successful combination therapy of systemic checkpoint inhibitors and intralesional interleukin-2 in patients with metastatic melanoma with primary therapeutic resistance to checkpoint inhibitors alone. Cancer Immunol Immunother 2019; 68:1417-1428. [PMID: 31422446 DOI: 10.1007/s00262-019-02377-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 08/09/2019] [Indexed: 12/19/2022]
Abstract
Systemic immunotherapy with PD-1 inhibitors is established in the treatment of metastatic melanoma. However, up to 60% of patients do not show long-term benefit from a PD-1 inhibitor monotherapy. Intralesional treatments with immunomodulatory agents such as the oncolytic herpes virus Talimogene Laherparepvec and interleukin-2 (IL-2) have been successfully used in patients with injectable metastases. Combination therapy of systemic and local immunotherapies is a promising treatment option in melanoma patients. We describe a case series of nine patients with metastatic melanoma and injectable lesions who developed progressive disease under a PD-1 inhibitor monotherapy. At the time of progressive disease, patients received intratumoral IL-2 treatment in addition to PD-1 inhibitor therapy. Three patients showed complete, three patients partial response and three patients progressive disease upon this combination therapy. IHC stainings were performed from metastases available at baseline (start of PD-1 inhibitor) and under combination therapy with IL-2. IHC results revealed a significant increase of CD4+ and CD8+ T cells and a higher PD-1 expression in the inflammatory infiltrate of the tumor microenvironment in metastases from patients with subsequent treatment response. All responding patients further showed a profound increase of the absolute eosinophil count (AEC) in the blood. Our case series supports the concept that patients with initial resistance to PD-1 inhibitor therapy and injectable lesions can profit from an additional intralesional IL-2 therapy which was well tolerated. Response to this therapy is accompanied by increase in AEC and a strong T cell-based inflammatory infiltrate.
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Affiliation(s)
- David Rafei-Shamsabadi
- Department of Dermatology and Venereology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 7, 79104, Freiburg, Germany
| | - Saskia Lehr
- Department of Dermatology and Venereology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 7, 79104, Freiburg, Germany
| | - Dagmar von Bubnoff
- Department of Dermatology and Venereology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 7, 79104, Freiburg, Germany
| | - Frank Meiss
- Department of Dermatology and Venereology, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Hauptstrasse 7, 79104, Freiburg, Germany.
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de Mendonça RP, Mitre GP, Real FH, da Silva Kataoka MS, de Melo Alves Júnior S, Vianna P, Da Silva Júnior NG, de Jesus Viana Pinheiro J. Central Giant Cell Granuloma Treated with Intralesional Corticosteroid Injections and Bisphosphonates: A Long-Term Follow-Up Case Study. Head Neck Pathol 2019; 14:497-502. [PMID: 31297738 PMCID: PMC7235135 DOI: 10.1007/s12105-019-01053-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 07/06/2019] [Indexed: 12/11/2022]
Abstract
Central giant cell granuloma (CGCG) is a benign intraosseous lesion of the head and neck with potential for aggressive and locally destructive behaviour. Lesions of the maxilla tend to expand more than those of the mandible due to the thinner cortices and spongy tissue of this location. Surgical removal is the most common treatment; however, it may be disfiguring in aggressive cases, especially for lesions located in the maxilla. Alternative treatments, such as intralesional corticosteroid injections, have been performed with satisfactory results. We report a case of a 12-year-old female patient with a CGCG of the left maxilla that was treated with 40 doses of intralesional triamcinolone acetonide infiltrations combined with alendronate sodium and calcium carbonate. Clinical and imaging follow-up over 12 years demonstrates improvement in the patient's condition.
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Affiliation(s)
- Raíssa Pinheiro de Mendonça
- Department of Oral Pathology, School of Dentistry, Federal University of Ceara, Rua Monsenhor Furtado, Fortaleza, Ceara 60430-355 Brazil
| | - Geovanni Pereira Mitre
- Department of Oral Pathology, School of Dentistry, Federal University of Para, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | - Flavio Henrique Real
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Para, Avenida Augusto Correa, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | - Maria Sueli da Silva Kataoka
- Department of Oral Pathology, School of Dentistry, Federal University of Para, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | - Sérgio de Melo Alves Júnior
- Department of Oral Pathology, School of Dentistry, Federal University of Para, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | | | - Newton Guerreiro Da Silva Júnior
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Federal University of Para, Avenida Augusto Correa, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
| | - João de Jesus Viana Pinheiro
- Department of Oral Pathology, School of Dentistry, Federal University of Para, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
- Cell Culture Laboratory, Department of Oral Pathology, School of Dentistry, Federal University of Para - UFPA - Institute of Health Sciences, Avenida Augusto Correa, 01, Belem, Para 66075-110 Brazil
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de Oliveira Duque MC, Quintão Silva JJ, Soares PAO, Magalhães RS, Horta APA, Paes LRB, Rosandiski Lyra M, Pimentel MIF, de Fátima Antonio L, de Camargo Ferreira e Vasconcellos É, Saheki MN, de Almeida Marzochi MC, Valete-Rosalino CM, de Oliveira Schubach A. Comparison between systemic and intralesional meglumine antimoniate therapy in a primary health care unit. Acta Trop 2019; 193:176-182. [PMID: 30851256 DOI: 10.1016/j.actatropica.2019.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/27/2022]
Abstract
Cutaneous leishmaniasis (CL) is not a life-threatening condition. However, its treatment can cause serious adverse effects and may sometimes lead to death. Recently, safer local treatments have been included among therapies acceptable to New World CL cases, but the use of intralesional meglumine antimoniate (IL-MA) is recommended to be performed in reference centers, for patients with single cutaneous lesions <3 cm in diameter at any location except the head and periarticular regions; the volume of injected MA should not exceed 5 mL. In this study we compared two groups of patients with CL treated with MA in a primary health care unit in Brazil. Patients were treated with systemic MA (n = 76) or IL-MA (n = 30). In the IL-MA group, 93% of patients had one or more of the following lesion characteristics: two or more lesions, lesions >3 cm in diameter, lesions located in the head or in periarticular regions, or had been administered IL-MA volumes >5 mL. Patients responded well (68.4% and 66.7% for the MA and IL-MA groups, respectively). When a second cycle of treatment was necessary, the responses were 72.4% and 90%, respectively. There were no significant differences between groups. In the IL-MA group, 43% had mild to moderate adverse effects, without needing treatment discontinuation. Results suggest that the treatment of CL lesions with IL-MA is simple, efficient, and safe.
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Abstract
INTRODUCTION Keloid scars are a particularly challenging clinical entity and a variety of management approaches have been described in the literature including intralesional surgery. The current literature lacks a summative review to ascertain the evidence base behind this surgical approach. METHODS A comprehensive English literature database search was performed using PubMed Medline, EMBASE and Web of Science from their individual dates of inception to March 2018. We present the different rationales proposed for the use of this technique, the clinical outcomes reported in the literature as well as the scientific basis for intralesional excision of keloid scars. DISCUSSION A number of arguments have been proposed to support intralesional excision including avoiding injury to neighbouring non-keloidal skin and the deep layer of the dermis, removal of the most proliferative fibroblastic group as well as debulking to facilitate the administration of injectable steroid. The most current literature does not provide sufficient support for the adoption of intralesional excisions based on data emerging from basic science as well as clinical outcome studies. CONCLUSION Emerging evidence supports the extralesional excision of keloid scars based on current mechanobiological, histological as well as clinical outcome data. Further trials comparing extralesional and intralesional surgical practices are eagerly awaited to ascertain the role of intralesional excisions in the keloid management arena.
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Affiliation(s)
- Ioannis Goutos
- Centre for Cutaneous Research, Blizard Institute,
London, UK
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25
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Suárez Valladares MJ, Vega J, Rodríguez Prieto MA. Comparison of treatment of basal cell carcinoma between surgery and intralesional photodynamic therapy: A cross-sectional study. Photodiagnosis Photodyn Ther 2018; 21:312-315. [PMID: 29309849 DOI: 10.1016/j.pdpdt.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Surgery is the treatment of choice in basal cell carcinoma (BCC), but new less invasive techniques are in development such as photodynamic therapy. The main problem of this technique is the limited depth penetration of topical photosensitizers. The use of an intralesional photosensitizer plus an irradiation with a 630 nm laser should increase this penetration. OBJETIVES To compare the effectiveness in treatment of BCC between surgery and intralesional photodynamic therapy (I-PDT). To identify the clearance rate differences between intralesional or external irradiation in I-PTD group. METHODS A retrospective study of 102 patients with different histological types of BCC (mean depth of 2.44 mm) was performed. A total of 51 patients were treated with surgery and 51 with I-PDT, injecting 5-aminolevulinic acid 1% in the tumor and later irradiated with a 630 nm laser (intralesionally or externally: 25 and 26 patients respectively). Histological samples were obtained before and after treatment. RESULTS A total of 41/51 Patients in the surgery group vs 42/51 patients in I-PDT group achieved a complete clearance after treatment (p 0.79). There were no differences in success rates between intralesional vs external irradiation in I-PDT group (p 0.46). LIMITATIONS Small sample size and retrospective study. CONCLUSION I-PDT achieved high clearance rates in the treatment of BCC similar to surgery. There were no differences in success rates between intralesional vs external irradiation in I-PDT group. PDT might be an interesting option of treatment where surgery it is not possible.
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Affiliation(s)
- M J Suárez Valladares
- Department of Dermatology, Complejo Asistencial Universitario de León, Spain; University of León, Spain.
| | - J Vega
- Department of Dermatology, Hospital Río Hortega de Valladolid, Spain
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Sukhumthammarat W, Putthapiban P, Sriphrapradang C. Local Injection of Triamcinolone Acetonide: A Forgotten Aetiology of Cushing's Syndrome. J Clin Diagn Res 2017; 11:OR01-OR02. [PMID: 28764237 DOI: 10.7860/jcdr/2017/27238.10091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022]
Abstract
Many different non systemic corticosteroid administrations can cause iatrogenic Cushing's Syndrome (CS). We herein report a case series of iatrogenic CS from keloid scars treatment and aesthetic regimen called mesotherapy. Our first patient developed CS after having exceeded recommended dose of intralesional injection of Triamcinolone Acetonide (TAC). Second case presented with CS followed by unidentified mesotherapy treatment for local fat reduction. Subcutaneous injections of dexamethasone were found to be the part of mesotherapy regimen in one case. Physicians should be insightful in prescribing TAC especially in those patients who have high predisposing factors for developing CS. In the same way, off-label mesotherapy combine with corticosteroid can lead to iatrogenic CS and Hypothalamic-Pituitary-Adrenal (HPA) axis suppression. Currently, there are no standard guidelines for mesotherapy treatment. Therefore, further clinical trials on dosage, duration and effective combination of mesotherapy regimens are needed to increase safety uses.
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Affiliation(s)
- Weera Sukhumthammarat
- Research Fellow, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Prapaipan Putthapiban
- Research Fellow, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chutintorn Sriphrapradang
- Assistant Professor, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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27
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Weide B, Neri D, Elia G. Intralesional treatment of metastatic melanoma: a review of therapeutic options. Cancer Immunol Immunother 2017; 66:647-656. [PMID: 28078357 DOI: 10.1007/s00262-016-1952-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/22/2016] [Indexed: 02/07/2023]
Abstract
Intralesional therapy of melanoma patients with locally advanced metastatic disease is attracting increasing interest, not least due to its ability to lead to both direct tumor cell killing and the stimulation of both a local and a systemic immune response. An obvious pre-requisite for this type of approach is the presence of accessible metastases that are amenable to direct injection with the therapeutic agent of interest. Patients who present with these characteristics belong to stages IIIB/C or IV of the disease. Surgical resection with intention to cure is the standard of care for patients with limited tumor burden and confined spread of disease (resectable patients). However, this category of patients is at a high risk of further recurrences until the disease becomes inoperable (unresectable) or progresses to a more advanced stage with visceral organ involvement, after which the prognosis is particularly grim. Most of the intralesional treatments tested so far, including the recently approved oncolytic virus talimogene laherparepvec, target the subpopulation of patients with unresectable disease, but the possibility to use the intralesional treatment in a neoadjuvant setting for fully resectable patients is attracting considerable interest. The present article reviews approved products and advanced stage pharmaceutical agents in development for the intralesional treatment of melanoma patients.
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Affiliation(s)
- Benjamin Weide
- Department of Dermatology, University Medical Center Tübingen, Tübingen, Germany
| | - Dario Neri
- Department of Chemistry and Applied Biosciences, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Giuliano Elia
- Philochem AG, Libernstrasse 3, 8112, Otelfingen, Switzerland.
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28
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van Leeuwen MCE, Bulstra AEJ, van der Veen AJ, Bloem WB, van Leeuwen PAM, Niessen FB. Comparison of two devices for the treatment of keloid scars with the use of intralesional cryotherapy: An experimental study. Cryobiology 2015; 71:146-50. [PMID: 25920961 DOI: 10.1016/j.cryobiol.2015.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/14/2015] [Accepted: 04/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intralesional (IL) cryotherapy is a new technique for the treatment of keloid scars, in which the scar is frozen from inside. Two cryodevices are available, which were recently evaluated. Both devices showed promising results, but differed in clinical outcome. To explain these differences, more understanding of the working mechanism of both devices is required. OBJECTIVE This experimental study was designed to investigate and compare the thermal behavior of an argon gas- and a liquid nitrogen-based device. Thermal behavior constitutes: (1) minimum tissue temperature (°C), (2) the freezing rate (°C/min). The thermal behavior was measured inside and on the outer surface of the scar. Both devices were tested ex vivo and in vivo. RESULTS Ex vivo, when determining the maximum freezing capacity, the argon gas device showed a higher end temperature compared to the liquid nitrogen device (argon gas: -120°C, liquid nitrogen: -140°C) and a faster freezing rate (argon gas: -1300°C/min, liquid nitrogen: -145°C/min). In vivo, measured inside the keloid, the argon gas device showed a lower end temperature than the liquid nitrogen device (argon gas: -36.4°C, liquid nitrogen: -8.1°C) and a faster freezing rate (argon gas: -14.7°C/min, liquid nitrogen: -5°C/min). The outer surface of the scar reached temperatures below -20°C with both devices as measured with the thermal camera. CONCLUSION In conclusion, the argon gas device displayed a lower end temperature and a faster freezing rate in vivo compared to the liquid nitrogen device. Although this resulted in lower recurrence rates for the argon gas device, more hypopigmentation was seen compared to the liquid nitrogen device following treatment. Finally, the low outer surface temperatures measured with both devices, suggest that some hypopigmentation following treatment is inevitable.
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Affiliation(s)
- Michiel C E van Leeuwen
- Department of Plastic and Reconstructive Surgery, VU University Medical Center, Amsterdam, The Netherlands.
| | - Anne Eva J Bulstra
- Department of Plastic and Reconstructive Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - A J van der Veen
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - W B Bloem
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
| | - P A M van Leeuwen
- Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - F B Niessen
- Department of Plastic and Reconstructive Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Farajzadeh S, Hakimi Parizi M, Haghdoost AA, Mohebbi A, Mohammadi S, Pardakhty A, Eybpoosh S, Heshmatkhah A, Vares B, Saryazdi S, Fekri AR, Mohebbi E. Comparison between intralesional injection of zinc sulfate 2 % solution and intralesional meglumine antimoniate in the treatment of acute old world dry type cutaneous leishmaniasis: a randomized double-blind clinical trial. J Parasit Dis 2014; 40:935-9. [PMID: 27605813 DOI: 10.1007/s12639-014-0609-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/01/2014] [Indexed: 10/24/2022] Open
Abstract
Zinc sulfate (ZS) has been used for the treatment of acute cutaneous leishmaniasis (CL) in both forms of in vivo and in vitro recently. The aim of the present study was to compare the efficacy of intralesional injection of ZS 2 % solution with intralesional glucantime in the treatment of acute CL. In this double-blind randomized clinical trial, 80 cases with acute old world dry type CL were enrolled in the study. The treatment protocol in the first group consisted of intralesional injection of ZS 2 % vials once a week for 10 weeks or sooner in case of complete resolution of the lesions. In the second group, intralesional glucantime once a week for 10 weeks or sooner in case of complete resolution of the lesions were used. In both groups cryotherapy was performed once every other week for 10 weeks. In ZS versus second group, partial and complete clinical response was observed with fewer injections although this difference was not statistically significant. In addition, we found that the trend of treatment in second group was faster but again it was not significant [partial treatment: hazard ratio (HR) 1.4, 95 % CI 0.7-2.9; complete treatment: HR 1.3, 95 % CI 0.6-2.8]. The results of this study showed that the intralesional injection of ZS 2 % solution was as effective as glucantime on the healing of the acute old world dry type CL.
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Affiliation(s)
- Saeedeh Farajzadeh
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Maryam Hakimi Parizi
- Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Akbar Haghdoost
- Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Azadeh Mohebbi
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Saman Mohammadi
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Abbas Pardakhty
- Pharmaceutics Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Sana Eybpoosh
- Research Center for Social Determinants of Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Amireh Heshmatkhah
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Behrooz Vares
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Simin Saryazdi
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Reza Fekri
- Department of Dermatology, Kerman University of Medical Sciences, Kerman, Iran
| | - Elham Mohebbi
- Research Center for Modeling in Health, Institute of Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Durvasula VS, Richter GT. Intralesional cidofovir as adjuvant for the successful management of aggressive respiratory papillomatosis in an infant. Int J Pediatr Otorhinolaryngol 2013; 77:1912-5. [PMID: 24063771 DOI: 10.1016/j.ijporl.2013.08.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 08/26/2013] [Accepted: 08/29/2013] [Indexed: 11/23/2022]
Abstract
Recurrent respiratory papillomatosis (RRP) in young children is frequently characterized by a recalcitrant course and need for multiple surgeries. Periodic surgical debulking and ablation is the mainstay of therapy as a cure for RRP rarely occurs. Benefits of adjuvant treatment with local injection of cidofovir in aggressive cases of RRP have been reported in both children and adults. However, a consensus on initiation, dosage, or scheduling of this drug has not been established in the very young patient. Literature on successful remission in children less than 1 year of age is not available. One such case of an infant with aggressive RRP treated with local adjuvant cidofovir is described herein.
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