Excision and adjuvant treatment to prevent keloid recurrence. - a systematic review of prospective, clinical, controlled trials.

Keloids are defined as the formation of collagen-rich scar tissue extending beyond the original lesion. Not all keloids respond to conventional treatment with intralesional triamcinolone injections. Recurrence of keloids after primary excision is reported in almost 100% of cases and should therefore always be followed by adjuvant treatment. Currently, consensus on preferred adjuvant treatment in relation to keloid excision is lacking. This study seeks to systematically review evidence on the efficacy of adjuvant treatments in relation to keloid excision. A systematic literature review was conducted on PubMed. Titles, abstracts, and articles were screened and sorted according to defined inclusion- and exclusion criteria. Each study was evaluated according to the Oxford Centre for Evidence-Based Medicine, OCEBM, Levels of Evidence by two independent authors. Seven studies were eligible. Adjuvant treatment methods included intralesional triamcinolone injection, radiotherapy, silicone gel, pressure therapy, verapamil hydrochloride and 5-fluorouracil. While all the included studies reported promising results, two studies showed that minimizing dosages when treating with radiotherapy or triamcinolone should be considered to avoid adverse events. However, a high risk of bias was found in all the included studies.

The Comparative Effects of Rhus Coriaria and Triamcinolone in Patients with Recurrent Aphthous Stomatitis: A Single-Blinded Randomized Controlled Clinical Trial.

Background: Recurrent aphthous stomatitis (RAS) is a common oral lesion with unknown etiology. Several treatment strategies are introduced for the treatment of RAS. In this regard, the therapeutic effects of Rhus coriaria, as one of the potential treatments, have recently caught attention. Since the clinical efficacy of Rhus coriaria has not been examined adequately. This study aims at evaluating the therapeutic effects of Rhus coriaria among patients with RAS. Method: s. Twenty-two patients with RAS were divided into two groups (n = 11). The experimental group received three pills of Rhus coriaria daily for 6 days, while the control group received triamcinolone (oral paste) three times a day for 6 days. The pain and size of the lesion were measured on the 1st, 2nd, 3rd, 4th, 5th, and 6th days. The data were analyzed by SPSS 16. In this regard, Student's t-test and Sidak pairwise tests were used for assessment of inter and intragroup comparisons of the pain and the size of the lesion, respectively. Results: Intergroup comparisons indicate that there is no difference between the experimental and the control group (p > 0.05). Whereas, the intragroup analysis of the pain revealed significant changes (p < 0.05) in most of the time points for both groups. Besides, the intragroup analysis of the lesion size, showed significant changes in all the time points in the experimental group (p < 0.05). The results in the control group exhibited the same pattern, except on 1-5, 1-6, 2-6, and 3-6 intervals in the control group. Conclusions: The application of Rhus coriaria could significantly reduce lesion size and pain in patients with RAS. Accordingly, Rhus coriaria can be an effective medication for RAS treatment.

Ultrasound-guided 5% dextrose prolotherapy versus corticosteroid injection in carpal tunnel syndrome: a randomized, controlled clinical trial.

Aim: The main assessment of this study is to analyze the efficiency of ultrasound-guided dextrose prolotherapy against corticosteroid injections for the treatment of carpal tunnel syndrome. Materials & methods: A total of 54 patients with carpal tunnel syndrome were included. Patients who were assigned into the prolotherapy group were injected with 5cc 5% dextrose water under ultrasound guidance. Patients in the corticosteroid group received ultrasound-guided 1 ml triamcinolone 40 mg/ml injection. Results: The inter-group analysis revealed that dextrose prolotherapy has a similar efficacy as corticosteroid for improving pain intensity, functional limitation in daily life, electrophysiologic parameters and ultrasonographic outcomes. No remarkable difference was found between the two treatments until 3 months of follow-up. Conclusion: Dextrose 5% has similar efficacy as triamcinolone for improving pain intensity, functional limitation in daily life, electrophysiologic parameters and ultrasonographic outcomes.

Oral lichen planus: comparative efficacy and treatment costs-a systematic review.

OBJECTIVE: To compare the reported efficacy and costs of available interventions used for the management of oral lichen planus (OLP). MATERIALS AND METHODS: A systematic literature search was performed from database inception until March 2021 in MEDLINE via PubMed and the Cochrane library following PRISMA guidelines. Only randomized controlled trials (RCT) comparing an active intervention with placebo or different active interventions for OLP management were considered. RESULTS: Seventy (70) RCTs were included. The majority of evidence suggested efficacy of topical steroids (dexamethasone, clobetasol, fluocinonide, triamcinolone), topical calcineurin inhibitors (tacrolimus, pimecrolimus, cyclosporine), topical retinoids, intra-lesional triamcinolone, aloe-vera gel, photodynamic therapy, and low-level laser therapies for OLP management. Based on the estimated cost per month and evidence for efficacy and side-effects, topical steroids (fluocinonide > dexamethasone > clobetasol > triamcinolone) appear to be more cost-effective than topical calcineurin inhibitors (tacrolimus > pimecrolimus > cyclosporine) followed by intra-lesional triamcinolone. CONCLUSION: Of common treatment regimens for OLP, topical steroids appear to be the most economical and efficacious option followed by topical calcineurin inhibitors. Large-scale multi-modality, prospective trials in which head-to-head comparisons interventions are compared are required to definitely assess the cost-effectiveness of OLP treatments.

Evaluating outcomes of pulsed dye laser therapy combined with intralesional triamcinolone injection after surgical removal of hypertrophic cesarean section scars.

BACKGROUND: Recently, pulsed dye laser (PDL) combined with triamcinolone intralesional injection (TAILI) has been introduced for surgical scar prevention. However, little is known about this procedure's effectiveness in preventing hypertrophic scar following surgical scar removal. OBJECTIVES: This study aimed to evaluate the outcome of early intervention using PDL combined with TAILI after surgical removal of hypertrophic cesarean section (CS) scars. METHODS: The medical records of 35 patients who underwent early intervention using PDL and TAILI after removal of hypertrophic CS scars were retrospectively reviewed. The scars' average Vancouver Scar Scale (VSS) scores before scar removal and 3 months after the final treatment were compared. RESULTS: The patients received 4.23 treatments on average and were followed up for a mean period of 7.74 months. The mean final VSS was 3.11 ± 1.52 and was significantly lower than that of the previous VSS (9.29 ± 1.74, p = 0.000). VSS of the previous CS scar, and the presence or absence of keloid formation in other areas, was associated with treatment outcome (p = 0.003 and 0.008, respectively). CONCLUSIONS: Early intervention using PDL combined with TAILI could prevent the recurrence or progression of hypertrophic CS scarring after surgical scar removal.

Optimal management of functional anorectal pain: a systematic review and network meta-analysis.

Functional anorectal is idiopathic and characterised by severe and potentially intractable anorectal pain. The current review aims to appraise available evidence for the management of functional anorectal pain and synthesise reported outcomes using network meta-analysis. PubMed, CENTRAL and Web of Science databases were searched for studies investigating treatments for functional anorectal pain. The primary outcome was clinical improvement of symptoms and the secondary outcome was pain scores reported during follow-up. A Bayesian network meta-analysis of interventions was performed. A total of 1538 patients were included from 27 studies. Intramuscular injection of triamcinolone, sacral neuromodulation (SNM) and biofeedback were most likely to be associated with improvement in symptoms [SUCRA (triamcinolone) = 0.79; SUCRA (SNM) = 0.74; SUCRA (Biofeedback) = 0.61]. Electrogalvanic stimulation (EGS), injection of botulinum toxin A and topical glyceryl trinitrate (GTN) were less likely to produce clinical improvement [SUCRA (EGS) = 0.53; SUCRA (Botox) = 0.30; SUCRA (GTN) = 0.27]. SNM and biofeedback were associated with the largest reductions in pain scores [mean difference, range (SNM) = 4.6-8.2; (Biofeedback) = 4.6-6]. As biofeedback is noninvasive and may address underlying pathophysiology, it is a reasonable first-line choice in patients with high resting pressures or defecation symptoms. In patients with normal resting pressures, SNM or EGS are additional options. Although SNM is more likely to produce a meaningful response compared to EGS, EGS is noninvasive and has less morbidity. Whilst triamcinolone injection is associated with symptomatic clinical improvement, the magnitude of pain reduction is less.

Intravenous Catheter Employed in Peritrochlear Injection of Triamcinolone in the Treatment of Trochleitis.

PURPOSE: Injection of corticosteroid into the peritrochlear region is a widely practiced and highly successful treatment option for trochleitis, conventionally using a 25- or 27-gauge needle for the steroid injection. Injection into the vascular-rich peritrochlear region poses a risk, albeit rare, of central retinal artery occlusion or orbital hemorrhage. We describe a potentially safer method of delivering triamcinolone to the peritrochlear region using a 24-gauge intravenous catheter. METHODS: Interventional retrospective case series including all patients who received peritrochlear injections of triamcinolone via intravenous catheter for trochleitis by a single surgeon (BJW). Surgical technique: After a subcutaneous wheel of local anesthetic was delivered to the medial upper eyelid skin nearest to the trochlea, a 24-gauge intravenous catheter was used to penetrate the skin and orbital septum. Once past the septum, the needle was removed and the blunt catheter was advanced into the peritrochlear region. A 1-ml syringe filled with 40 mg/ml triamcinolone was attached to the catheter. After pulling back to ensure that the catheter was not intravascular, triamcinolone was delivered to the orbit. The catheter was then removed. RESULTS: Ten catheter injections were performed on 3 patients over an 8-year period. There were no complications. CONCLUSION: Injection of corticosteroid into the peritrochlear region using the commonly available 24-gauge intravenous catheter is an effective and theoretically safer alternative to typical injection using a 25-gauge needle for treatment of trochleitis. Use of nonparticulate steroid solutions may further decrease the risk of adverse events.

Clinical observations on the use of new anti-VEGF drug, conbercept, in age-related macular degeneration therapy: a meta-analysis.

PURPOSE: Conbercept is a new anti-vascular endothelial growth factor (VEGF) drug approved for the treatment of age-related macular degeneration (AMD). Although this novel drug has been widely used in clinic, unlike other anti-VEGF drugs, validation and consensus on its method of clinical application and clinical safety have not yet been achieved. METHODS: Relevant literature was searched on PubMed, Web of Science, China National Knowledge Internet, and Wanfang Data. Stata 12.0 was used for data analysis. Random- and fixed-effect models were employed to evaluate heterogeneity. Best-corrected visual acuity (BCVA) and central retinal thickness (CRT) were utilized to measure the improvement of AMD patients. RESULTS: In this study, we analyzed conbercept administration and compared its application with other control clinical methods for AMD treatment. Ranibizumab, triamcinolone, and traditional transpupillary thermotherapy (TTT) were administered in the control group. No differences were found in the BCVA and CRT improvement between the groups treated with conbercept and ranibizumab. However, the conbercept group had a lower serum VEGF level. After 3 months of treatment, conbercept led to a more significant BCVA and CRT improvement than triamcinolone. A more considerable BCVA improvement was observed in the group treated with conbercept than in the group treated with TTT. Moreover, even 6 months after the treatment, the effect of conbercept on CRT improvement was still more pronounced than that of TTT. CONCLUSION: In AMD patients, conbercept exerts considerably more positive effects on the long-term BCVA and CRT improvement than triamcinolone and TTT. The serum VEGF level in the conbercept group was lower than that in the ranibizumab group.

Tumor-induced Osteomalacia in a 3-Year-Old With Unresectable Central Giant Cell Lesions.

Tumor-induced osteomalacia (TIO) is a rare cause of hypophosphatemia involving overproduction of fibroblast growth factor 23. TIO has been described largely in adults with small mesenchymal tumors. We report a case of TIO in a child who presented with knee pain and radiographic findings concerning for rickets, and was found to have maxillomandibular giant cell lesions. The patient was treated with oral phosphorus and calcitriol, surgical debulking, and intralesional corticosteroids, which resulted in tumor regression and normalization of serum fibroblast growth factor 23 and phosphorus. This case illustrates the occurrence of this rare paraneoplastic syndrome in children and adds to our knowledge about clinical manifestations and pathologic findings associated with pediatric TIO.

Farmacopuntura: nueva estrategia de tratamiento para espolón calcáneo / Pharmacopuncture: new treatment strategy for calcaneal spur

Se realizó un estudio prospectivo, longitudinal descriptivo en pacientes remitidos al Servicio de Medicina Natural y Tradicional del Hospital General Docente Dr Agostinho Neto de las diferentes áreas de salud, en el período de enero - diciembre 2016 con el diagnóstico clínico radiológico de espolón calcáneo con el objetivo de evaluar los resultados del tratamiento con farmacopuntura utilizando medicamento esteroideo (triamcinolona). Se operacionalizaron las siguientes variables: edad, sexo, ocupación, alivio del dolor según sesiones tratamiento aplicado, resultados al finalizar el tratamiento y recurrencias del dolor. A todos se les midió el grado de intensidad del dolor según escala visual analógica al inicio, durante y al final del tratamiento, encontrándose alivio del dolor a partir de la tercera sesión de tratamiento y el (64.4 por ciento de los pacientes curaron, se emitieron recomendaciones(AU)

A prospective, longitudinal descriptive study was carried out in patients referred to the Natural and Traditional Medicine Service of the General Teaching Hospital Dr Agostinho Neto from the different health areas, in the period January - December 2016 with the radiological clinical diagnosis of calcaneal spur with the objective of evaluating the results of the treatment with pharmacopuncture using steroid medication (triamcinolone). The following variables were used: age, sex, occupation, pain relief according to treatment sessions, results at the end of treatment and recurrence of pain. The degree of pain and intensity was measured according to the visual analogue scale at the beginning, during and at the end of the treatment, and pain relief was found from the third treatment session and (64.4 percent) patients were cured, recommendations(AU)

Effects of Triamcinolone-soaked Packing for Endonasal Revision in Patients with Failed Endoscopic Dacryocystorhinostomy

PURPOSE: To evaluate the efficacy of endonasal revision using triamcinolone-soaked nasal packing in patients exhibiting recurrence of epiphora after endoscopic dacryocystorhinostomy. CASE SUMMARY: Four patients (4 eyes) who presented with the chief complaint of recurrence of epiphora after endoscopic dacryocystorhinostomy underwent endonasal revision under local anesthesia. On nasal endoscopy, granulation tissue and membranous tissue around the osseous foramen was removed during endonasal revision. According to the operator's judgement, the osseous foramen was additionally expanded. Following insertion of a silicone tube, triamcinolone-soaked nasal packing was used for intra-nasal packing. The silicone tube was removed after follow-up of more than 12 weeks. Immediately after removing the silicone tube, there was free passage of saline on lacrimal syringing as well as complete resolution of epiphora. At over 6 months of follow-up after tube removal, there was no recurrence of epiphora in any of the 4 patients. CONCLUSIONS: Triamcinolone-soaked nasal packing may be considered in patients with failed endoscopic dacryocystorhinostomy.

Desenvolvimento e caracterização de filmes e comprimidos bucais a base de pectina e goma gelana para liberação tópica de triancinolona / Development and characterization of films and buccal tablets based on pectin and gellan gum for the topical release of triamcinolone

O tratamento farmacológico de patologias bucais é conduzido, geralmente, por via de adminis-tração local. No entanto, devido ao pouco tempo de permanência do fármaco no local de ação, esse tratamento pode ser bastante comprometido. Assim, este trabalho teve por objetivo o de-senvolvimento de formas farmacêuticas que proporcionem a liberação local de triancinolona na cavidade oral. Foram produzidos filmes e comprimidos mucoadesivos a partir de polímeros naturais como gelana e pectina. Os filmes bucais foram preparados por meio de evaporação do solvente (solvent casting) utilizando diferentes quantidades de polímeros. As matérias-primas e os filmes foram caracterizados fisico quimicamente utilizando espectroscopia vibracional (in-fravermelho com transformada de Fourier e Raman) e difração de raios X. As propiedades físicas e mecânicas dos filmes também foram avaliadas. Além disso, realizou-se os ensaios de mucoadesividade e de dissolução do fármaco. Os comprimidos foram preparados por com-pressão direta usando como base os polímeros naturais. Diferentes parâmetros em relação as misturas e as formulações foram avaliados tais como as propriedades de fluxo dos pós consti-tuintes, peso médio, dureza, friabilidade e desintegração. Em relação aos filmes bucais, estes foram obtidos com sucesso através de um método simples, sem a utilização de agentes reticu-lantes, ácidos ou solventes orgânicos. Todos apresentaram bons resultados nas propriedades avaliadas, no entanto as formulações com quantidades intermediarias de polímeros foram as melhores. Dentre as formulações de comprimidos preparadas, apenas 4 apresentaram boas ca-racterísticas, no entanto, os resultados dos ensaios de dissolução mostraram que estas formula-ções têm capacidade de agir como sistema de liberação controlada de fármacos.

Pharmacological treatment of oral pathologies is usually conducted by local administration. However, due to the short time the drug stays in the site of action, this treatment can be quite compromised. Thus, the objective of this work was to develop pharmaceutical forms that pro-vide the local release of triamcinolone in the oral cavity. Mucoadhesive films and tablets were made from natural polymers such as gellan and pectin. The buccal films were prepared by sol-vent casting using different amounts of polymers. The raw materials and films were characte-rized physically chemically using vibrational spectroscopy (FTIR and Raman) and X-ray diffraction. The physical and mechanical properties of the films were also evaluated. In addi-tion, the mucoadhesive and drug dissolution tests were performed. The tablets were prepared by direct pressing with the natural polymers. Different parameters in relation to mixtures and formulations were evaluated such as the flow properties of the constituent powders, average weight, hardness, friability and disintegration. In relation to oral films, these were successfully obtained by a simple method, without the use of crosslinking agents, acids or organic solvents. All presented good results in the evaluated properties, however the formulations with interme-diate amounts of polymers were the best. Among the tablet formulations prepared, only 4 sho-wed good characteristics, however, the dissolution test results showed that these formulations have the ability to act as a controlled drug delivery system.

Desenvolvimento e caracterização de filmes e comprimidos bucais a base de pectina e goma gelana para liberação tópica de triancinolona / Development and characterization of films and buccal tablets based on pectin and gellan gum for the topical release of triamcinolone

O tratamento farmacológico de patologias bucais é conduzido, geralmente, por via de administração local. No entanto, devido ao pouco tempo de permanência do fármaco no local de ação, esse tratamento pode ser bastante comprometido. Assim, este trabalho teve por objetivo o desenvolvimento de formas farmacêuticas que proporcionem a liberação local de triancinolona na cavidade oral. Foram produzidos filmes e comprimidos mucoadesivos a partir de polímeros naturais como gelana e pectina. Os filmes bucais foram preparados por meio de evaporação do solvente (solvent casting) utilizando diferentes quantidades de polímeros. As matérias-primas e os filmes foram caracterizados fisico quimicamente utilizando espectroscopia vibracional (in-infravermelho com transformada de Fourier e Raman) e difração de raios X. As propriedades físicas e mecânicas dos filmes também foram avaliadas. Além disso, realizou-se os ensaios de mucoadesividade e de dissolução do fármaco. Os comprimidos foram preparados por com-pressão direta usando como base os polímeros naturais. Diferentes parâmetros em relação as misturas e as formulações foram avaliados tais como as propriedades de fluxo dos pós constituintes, peso médio, dureza, friabilidade e desintegração. Em relação aos filmes bucais, estes foram obtidos com sucesso através de um método simples, sem a utilização de agentes reticulantes, ácidos ou solventes orgânicos. Todos apresentaram bons resultados nas propriedades avaliadas, no entanto as formulações com quantidades intermediarias de polímeros foram as melhores. Dentre as formulações de comprimidos preparadas, apenas 4 apresentaram boas características, no entanto, os resultados dos ensaios de dissolução mostraram que estas formulações têm capacidade de agir como sistema de liberação controlada de fármacos

Pharmacological treatment of oral pathologies is usually conducted by local administration. However, due to the short time the drug stays in the site of action, this treatment can be quite compromised. Thus, the objective of this work was to develop pharmaceutical forms that pro-vide the local release of triamcinolone in the oral cavity. Mucoadhesive films and tablets were made from natural polymers such as gellan and pectin. The buccal films were prepared by sol-vent casting using different amounts of polymers. The raw materials and films were characte-rized physically chemically using vibrational spectroscopy (FTIR and Raman) and X-ray diffraction. The physical and mechanical properties of the films were also evaluated. In addi-tion, the mucoadhesive and drug dissolution tests were performed. The tablets were prepared by direct pressing with the natural polymers. Different parameters in relation to mixtures and formulations were evaluated such as the flow properties of the constituent powders, average weight, hardness, friability and disintegration. In relation to oral films, these were successfully obtained by a simple method, without the use of crosslinking agents, acids or organic solvents. All presented good results in the evaluated properties, however the formulations with interme-diate amounts of polymers were the best. Among the tablet formulations prepared, only 4 sho-wed good characteristics, however, the dissolution test results showed that these formulations have the ability to act as a controlled drug delivery system

Inyección ecoguiada del músculo piriforme. Un nuevo abordaje / Ultrasound-guided piriformis muscle injection. A new approach

El síndrome piriforme es una causa poco frecuente de dolor de espalda y miembros inferiores. Algunas de las opciones de tratamiento incluyen la inyección del músculo piriforme con anestésicos locales y corticoides. Se han descrito varias técnicas de inyección. Las técnicas ecoguiadas permiten la visualización directa del músculo y la inyección en tiempo real. Se presenta una serie de 5 pacientes cuya clínica es compatible con síndrome piriforme, que no han mejorado tras tratamiento farmacológico. Se optó por la inyección del músculo piriforme con anestésicos locales y corticoides mediante un nuevo abordaje ecoguiado más sencillo técnicamente, basado en la técnica estándar. En los 5 pacientes se apreció una mejoría del dolor medido por la escala verbal numérica tras la inyección. Solo en un caso se presentó como complicación una ciatalgia que mejoró espontáneamente en 10 días. En los demás pacientes no se observaron complicaciones tras la inyección. Se describe una variante de la técnica ecoguiada recomendada en la inyección del músculo piriforme, más sencilla de realizar, con un buen perfil de seguridad y con buenos resultados clínicos (AU)

Piriformis syndrome is an uncommon cause of buttock and leg pain. Some treatment options include the injection of piriformis muscle with local anesthetic and steroids. Various techniques for piriformis muscle injection have been described. Ultrasound allows direct visualization and real time injection of the piriformis muscle. We describe 5 consecutive patients, diagnosed of piriformis syndrome with no improvement after pharmacological treatment. Piriformis muscle injection with local anesthetics and steroids was performed using an ultrasound technique based on a standard technique. All 5 patients have improved their pain measured by numeric verbal scale. One patient had a sciatic after injection that improved in 10 days spontaneously. We describe an ultrasound-guided piriformis muscle injection that has the advantages of being effective, simple, and safe (AU)

Narrowband UVB-induced iatrogenic polymorphous light eruption: a case and suggestions to overcome this rare complication.

Polymorphous light eruption (PMLE) is the most common photodermatosis characterized by pruritic papules and papulovesicles, which appear hours to days following ultraviolet (UV) exposure. Herein, the authors report successful treatment of generalized plaque psoriasis with Goeckerman regimen in a patient despite new onset iatrogenic PMLE following narrowband (NB) UVB therapy. Although further studies are necessary, this case suggests that the co-existence of psoriasis and PMLE should not prevent the use of phototherapy; phototherapy, especially as part of the Goeckerman regimen, remains a valuable treatment option for psoriasis in patients with PMLE.

Uremic pruritus treated successfully with the Goeckerman Program.

Uremic pruritus (UP) is a common condition among patients with chronic kidney disease (CKD) on hemodialysis (HD). We report 19 a case of severe UP recalcitrant to conventional therapy including topical corticosteroids, anti-histamines, and phototherapy, 20 which was treated successfully with the Goeckerman regimen consisting of topical coal tar, topical corticosteroids, and broadband 21 UVB (BB-UVB). Little is known about the pathophysiology of UP, and there is currently no consensus or evidence-based 22 treatments for UP. Although further studies are necessary, Goeckerman therapy may be a promising treatment option when 23 available for severe UP intractable to conventional therapies.