Search

Pathological scars (PS) are involved in the excessive response of inflammation and overactivation of myofibroblasts. Herein, a novel microneedle (MN) patch based on the adipose‐derived stem cell concentrated conditioned medium (ADSCC‐CM) cross‐linked keratin hydrogel is developed to load triamcinolone acetonide (TA), thereby achieving the dual‐drug delivery of ADSCC‐CM and TA to simultaneously reduce the inflammation and guide myofibroblast behaviors. Results not only confirm the ability of ADSCC‐CM to drive the formation of keratin‐based hydrogel, but also verify the dual‐drug release capacities of the hydrogel‐developed MNs (TA@AC‐MN). Using human hyperplastic scar fibroblast (HSF), the combination of ADSCC‐CM and TA demonstrates a pronounced synergistic effect in mitigating the detrimental effects of the inflammatory microenvironment on HSFs, including suppressing the production of reactive oxygen species and attenuating the expression of inflammatory factors. Compared with the clinically used TA, TA@AC‐MN promotes scar biomimetic repair (i.e., optimizing the proportion of collagen and increasing the tissue tensile strength). This study demonstrates that TA@AC‐MN has the capacity to provide a self‐managing and minimally invasive therapeutic strategy for PS. [ABSTRACT FROM AUTHOR]

Intra‐articular corticosteroid injections, such as triamcinolone acetonide (TA), are commonly used by clinicians to manage joint synovial inflammation. However, due to conflicting evidence in literature, there is a fear among clinicians that the injections may be harmful to otherwise healthy cartilage in young patients. The purpose of this study was to evaluate the effects of TA on young, healthy chondrocytes. Articular cartilage samples were harvested from bovine knee joints (1–2 months old). In both healthy and inflammatory (interleukin‐1β) challenged cartilage, samples were treated with TA at doses ranging from 1 nM to 200 μM. Following a short‐ (2 days) or long‐term (10–14 days) treatment, chondrocyte viability, proliferation, and extracellular matrix (ECM) synthesis and degradation were evaluated with a click chemistry‐based technique. Chondrocyte viability, proliferation, and anabolic activity were all minimally affected by short‐term and long‐term TA treatment. After both acute and sustained inflammatory challenges, TA reduced the catabolic activities in cartilage, reducing nascent glycosaminoglycan loss and maintaining cartilage mechanical properties. Overall, at physiologically relevant doses, TA had minimal negative impact on chondrocytes when maintained within their native ECM. Clinical significance: The findings provide new insight for current clinical practices concerning the use of TA in intra‐articular injections, especially in young patients, and established a foundation for future investigations into the impact of corticosteroids on joint homeostasis. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Materials and Methods Results Conclusions The aim of this study was to compare the topical therapeutic efficacy of triamcinolone acetonide (TA) (0.2%) plus hyaluronic acid (HA) (0.1%) versus monotherapy in patients with symptomatic oral lichen planus (OLP), as well as to investigate the oxidative stress of saliva under the different treatments.Sixty OLP patients were included in a randomized, double‐blind, singlecenter study with a treatment duration of 28 days and 3‐month follow‐up period. Participants were randomized into three groups: Group I (TA + HA), Group II (TA), and Group III (HA). Treatment efficacy was assessed by means of Thongprasom scale, Oral Health Impact Profile‐14 (OHIP‐14), and visual analog scale (VAS). In addition, biochemical analyses were performed in order to determine the level of antioxidant biomarkers in saliva, including superoxide dismutase (SOD), glutathione (GSH), and total antioxidant capacity (TAC).All treatments seem to exhibit a significant effect in accordance with Thongprasom scale (p < 0.001), VAS reduction (p < 0.001), and OHIP14 (p < 0.05), which maintains over time. No significant changes in salivary oxidative stress in any of the three groups occurred.The results exhibited a significant improvement in the treated patients in all three groups. There were no significant changes in salivary stress biomarkers under treatment condition. [ABSTRACT FROM AUTHOR]

Background: Patients with hypertrophic scarring tend to experience recurrence after treatment, which often occurs in areas of the body with high skin tension. Aims: To evaluate better treatments aimed at reducing the risk of scar recurrence in areas of high skin tension. Methods: Patients were randomly divided into the following three treatment groups: botulinum toxin type A (BTA) via dual‐plane micro‐drop injections, triamcinolone acetonide (TAC) suspension, and CO2 via fractional CO2 laser. Interventions were implemented in all three groups once a month for three consecutive sessions. After the final treatment, scarring was evaluated at 1, 3, 6, 12, and 24 months using the Patient and Observer Scar Assessment Scale (POSAS). Results: The 3‐month POSAS score for each scar indicator in the treatment groups was significantly lower than that in the preoperative groups (p < 0.001). The scar score in the TAC group decreased at 3 months and increased thereafter. For other groups, the scar score continually decreased at all time points according to the Patient Scar Assessment Scale. Based on the Observer Scar Assessment Scale, the scar score continuously decreased at all time points in the BTA group; in the TAC group, it decreased at 1 month and increased thereafter; and in the CO2 group, the scar score decreased at 3 months and subsequently stabilized. Conclusions: All three treatment methods were effective. However, the BTA group experienced a reduced risk of scar recurrence and maintained long‐term treatment effects. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Severe diabetic macular edema (DME) is often resistant to anti‐vascular endothelial growth factor therapy. Steroids are particularly effective at reducing edema by suppressing inflammation; they are also used as an alternative to expensive anti‐vascular endothelial growth factor therapy in some patients. Therefore, the use of steroids in DME reflects an unmet need for anti‐vascular endothelial growth factor therapy. Notably, triamcinolone acetonide (TA) injections are widely used in Japan. Here, we evaluated the frequency of TA as an indicator of the efficacy of sodium–glucose cotransporter 2 inhibitors (SGLT2is) in DME treatment using a health insurance claims database. Materials and Methods: In this cohort study, we retrospectively analyzed the health insurance claims data of 11 million Japanese individuals from 2005 to 2019. The frequency and duration of TA injection after the initiation of SGLT2is or other antidiabetic drugs were analyzed. Results: Among the 2,412 matched patients with DME, the incidence rate of TA injection was 63.8 times per 1,000 person‐years in SGLT2i users and 94.9 times per 1,000 person‐years in non‐users. SGLT2is reduced the risk for the first (P = 0.0024, hazard ratio 0.66, 95% confidence interval 0.50–0.87), second (P = 0.0019, hazard ratio 0.53, 95% confidence interval 0.35–0.80) and third TA (P = 0.0053, hazard ratio 0.44, 95% confidence interval 0.25–0.80) injections. A subanalysis of each baseline characteristic of the patients showed that SGLT2is were effective regardless of the background factors. Conclusions: The use of SGLT2is reduced the frequency of TA injection in patients with DME. Therefore, SGLT2i therapy might be a novel, noninvasive and low‐cost adjunctive therapy for DME. [ABSTRACT FROM AUTHOR]

Background: Hyaluronic acids (HAs) can have very different actions not only depending on injector and host factors but also depending on their molecular weight. Whereas short chain HA has immunological activity long chain HA influences fibroblasts and may stimulate them to produce collagen. Although this is generally thought to be a positive feature it may be disadvantageous in certain localizations. Patients and Methods: We have encountered 23 patients who developed fibrous tissue next to the nasolabial folds accentuating them and becoming very obvious while smiling. Hyaluronidase injection did not reduce this mass. Results: Intralesional triamcinolone acetonide injection led to rapid improvement. Discussion: Fibrotic tissue reaction not responding to hyaluronidase may be the result of HA injection and can effectively be treated with intralesional steroid injection [ABSTRACT FROM AUTHOR]

Objective: This study evaluates the efficacy of a novel mucoadhesive patch containing Nigella sativa 10% extract compared to triamcinolone 0.1% in alleviating symptoms and reducing lesion severity in patients with erosive‐atrophic oral lichen planus. Methods and Materials: A pilot study comprising two groups, each with 10 patients, was conducted. The intervention group received mucoadhesive patches containing N. sativa 10% extract, while the control group received triamcinolone acetonide 0.1% patches. Pain and burning intensity, measured through visual analog scale, and lesion severity based on the Thongprasom scale were assessed weekly for 4 weeks. Descriptive records were kept for side effects and patient satisfaction. Results: Pain and burning intensity decreased in both groups throughout the sessions, with the N. sativa group showing a greater reduction than the triamcinolone group. The reduction in burning intensity within each group was significant (p <.001), and there was a significant difference between groups only in the second session (p =.045). The overall difference between groups was not significant (p >.05). Lesion severity also decreased significantly in both groups (p <.001), with a significant difference between groups observed in the third session (p =.043) and overall throughout the study (p =.006). Conclusion: The use of N. sativa extract in mucoadhesive patches was as effective as corticosteroids in reducing pain, burning, and lesion severity in patients with oral lichen planus, with N. sativa showing superior results in some sessions. Notably, no significant complications were observed with N. sativa use, making it a promising treatment option for lichen planus. [ABSTRACT FROM AUTHOR]

This article is a case report of a 53-year-old woman who developed acute generalised exanthematous pustulosis (AGEP) after receiving betamethasone sodium phosphate treatment for COVID-19. The woman had a history of contact dermatitis and AGEP caused by other steroids in the past. Patch tests confirmed her allergy to certain groups of corticosteroids. Her skin rash improved with topical treatment. The article highlights the rare occurrence of AGEP induced by systemic steroids and emphasizes the importance of conducting various tests for accurate diagnosis. [Extracted from the article]

Objectives: This study aimed to compare the effectiveness of carbon dioxide (CO2) laser vaporisation versus intralesional injection of triamcinolone acetonide (TA) in the management of oral lichen planus (OLP). Methods: A randomised clinical trial with a split‐mouth design was conducted on 16 patients with bilateral symptomatic OLP lesions. One side was treated with CO2 laser vaporisation, and the counterpart was treated with TA intralesional injection. The reticular–erythematous–ulcerative (REU) score, Thongprasom sign scoring (TSS), visual analogue scale (VAS) and lesion area were used to evaluate the lesions at weeks 0, 4 and 9. All participants were followed up for 9 months. Results: Reduction in the REU, TSS scores and lesion area from baseline to the end of treatment was significantly greater in the CO2 group than in the TA group (p values were 0.001, 0.002 and 0.048 respectively). However, the reduction in VAS score did not differ between the two groups (p = 0.54). The recurrence rate was significantly higher in the TA group than in the CO2 group (75% vs. 31.1%; p = 0.016). Conclusions: CO2 laser vaporisation was more effective than TA intralesional injection in managing OLP and decreased recurrence rates. [ABSTRACT FROM AUTHOR]

Objective: Alopecia areata (AA) is often characterized by sudden onset of patchy hair loss. Topical corticosteroid injection is the most common treatment. This study retrospectively observed the clinical efficacy of microneedle minoxidil combined with triamcinolone acetonide in the treatment of AA. Methods: A total of 230 patients with AA were selected. The experimental group (n = 120) received physician training and home microneedle treatment with minoxidil combined with triamcinolone acetonide once a week. Topical minoxidil and triamcinolone acetonide were used twice daily at other times. The control group (n = 110) was treated with minoxidil combined with triamcinolone acetonide, twice a day. Cure rate, response rate, SALT, dermatological Quality of Life Index (DLQI), visual analogue (VAS), and cost were assessed at weeks 4 and 12. Results: Treated group SALT score(Severity of Alopecia Tool) remarkable lower than control group after treated 4 and 12 weeks. After 12 weeks treatment, DLQI score of the treated group (1.8 ± 1.67) were significantly lower than those of the control group (2.45 ± 1.88) (p < 0.05). VAS score and adverse reaction between two group showed no significant different (p = 0.823, p = 0.484 respectively). The total cost was 53.93 ± 15.85 in the treatment group and 53.26 ± 11.51 in the control group. There was no significant difference between the two groups (p = 0.72). In the treated group, the complete response rate (CR: 78.33%) and total effective rate (CR+PR: 95%) were significantly higher than those in the control group (CR: 40.91% and CR+PR: 51.82%), with statistically significant differences (p < 0.001). Conclusion: Microneedle introduction of minoxidil and triamcinolone acetonide in the treatment of AA is a safe, effective, economical, and convenient method, with few adverse reactions, and has a good application prospect. [ABSTRACT FROM AUTHOR]

Hypertrophic scar (HS), which results from prolonged inflammation and excessive fibrosis in re‐epithelialized wounds, is one of the most common clinical challenges. Consequently, sophisticated transdermal transfersome nanogels (TA/Fu‐TS) are prepared to control HS formation by synergistically inhibiting inflammation and suppressing fibrosis. TA/Fu‐TSs have unique structures comprising hydrophobic triamcinolone acetonide (TA) in lipid multilayers and hydrophilic 5‐fluorouracil in aqueous cores, and perform satisfactorily with regard to transdermal co‐delivery to macrophages and HS fibroblasts in emerging HS tissues. According to the in vitro/vivo results, TA/Fu‐TSs not only promote macrophage phenotype‐switching to inhibit inflammation by interleukin‐related pathways, but also suppress fibrosis to remodel extracellular matrix by collagen‐related pathways. Therefore, TA/Fu‐TSs overcome prolonged inflammation and excessive fibrosis in emerging HS tissues, and provide an effective therapeutic strategy for controlling HS formation via their synergy of macrophage phenotype‐switching and anti‐fibrosis effect. [ABSTRACT FROM AUTHOR]

Background: Tissue‐resident memory T (TRM) cells are detrimental in allergic contact dermatitis (ACD), in which they contribute to the chronicity and severity of the disease. Methods: We assessed the impact of a standard topical corticosteroid (TCS) treatment, triamcinolone acetonide (TA), on the formation, maintenance and reactivation of epidermal TRM cells in a preclinical model of ACD to 2,4‐dinitrofluorobenzene. TA 0.01% was applied at different time points of ACD response and we monitored skin inflammation and tracked CD8+ CD69+ CD103+ TRM by flow cytometry and RNA sequencing. Results: The impact of TA on TRM formation depended on treatment regimen: (i) in a preventive mode, that is, in sensitized mice before challenge, TA transiently inhibited the infiltration of effector T cells and the accumulation of TRM upon hapten challenge. In contrast, (ii) in a curative mode, that is, at the peak of the ACD response, TA blocked skin inflammation but failed to prevent the formation of TRM. Finally, (iii) in a proactive mode, that is, on previous eczema lesions, TA had no effect on the survival of skin TRM, but transiently inhibited their reactivation program upon allergen reexposure. Indeed, specific TRM progressively regained proliferative functions upon TA discontinuation and expanded in the tissue, leading to exaggerated iterative responses. Interestingly, TRM re‐expansion correlated with the decreased clearance of hapten moieties from the skin induced by repeated TA applications. Conclusions: Our results demonstrate that TCS successfully treat ACD inflammation, but are mostly ineffective in impeding the formation and expansion of allergen‐specific TRM, which certainly restricts the induction of lasting tolerance in patients with chronic dermatitis. [ABSTRACT FROM AUTHOR]

Background: Despite the common practice of intraarticular corticosteroid injections (ICSIs) for peripheral joint disease, little is known about their systemic effects on the hypothalamic–pituitary‐gonadal axis. Objective: To assess the short‐term effects of ICSIs on serum testosterone (T), luteinizing hormone (LH), and follicle stimulating hormone (FSH) levels together with changes in Shoulder Pain and Disability Index (SPADI) scores in a veteran population. Design: Prospective pilot study. Setting: Outpatient musculoskeletal clinic. Participants: Thirty male veterans, median age 50 (range 30–69) years. Interventions: Ultrasound‐guided glenohumeral joint injection using 3 mL of 1% lidocaine HCl and 1 mL of 40 mg triamcinolone acetonide (Kenalog). Outcome Measure(s): Serum T, FSH, and LH levels, Quantitative Androgen Deficiency in the Aging Male (qADAM), and SPADI questionnaires at baseline, 1, and 4 week(s) post procedure. Results: At 1 week post injection, serum T levels decreased by 56.8 ng/dL (95% confidence interval (CI): 91.8, 21.7, p =.002) compared with baseline. Between 1 and 4 weeks post injection, serum T levels increased by 63.9 ng/dL (95% CI: 26.5, 101.2, p =.001), recovering to near baseline levels. SPADI scores were reduced at 1 week (–18.3, 95% CI: –24.4, –12.1, p <.001) and 4 weeks (–14.5, 95% CI –21.1, –7.9, p <.001). Conclusions: A single ICSI can temporarily suppress the male gonadal axis. Future studies are needed to evaluate for long‐term effects of multiple injections at a single setting and/or higher corticosteroid doses on male reproductive axis function. [ABSTRACT FROM AUTHOR]

Background: The high recurrence rate after nonsurgical treatment of keloid is a major challenge for clinicians. Although there are many existing treatment options, how to optimize and upgrade the existing options and make a reasonable combination of utilization is our concern. The aim of this study is to provide a comprehensive non‐surgical treatment for keloid—cocktail therapy. Methods: According to the different changes of keloid with treatment, the treatment was divided into four stages, and different treatment schemes were adopted for each stage. The incidence of side effects of keloid at each stage and the effective rate and cure rate 16 months after the end of treatment were analyzed. Results: All patients completed this study on time, and were followed up 16 months after the end of treatment, the treatment effective rate was 100%, and the cure rate was up to 92.8%. Conclusion: Cocktail therapy can achieve a higher cure rate of keloid, and is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Background: Similar immune responses in the nasal and bronchial mucosa implies that nasal allergen challenge (NAC) is a suitable early phase experimental model for drug development targeting allergic rhinitis (AR) and asthma. We assessed NAC reproducibility and the effects of intranasal corticosteroids (INCS) on symptoms, physiology, and inflammatory mediators. Methods: 20 participants with mild atopic asthma and AR underwent three single blinded nasal challenges each separated by three weeks (NCT03431961). Cohort A (n = 10) underwent a control saline challenge, followed by two allergen challenges. Cohort B (n = 10) underwent a NAC with no treatment intervention, followed by NAC with 14 days pre‐treatment with saline nasal spray (placebo), then NAC with 14 days pre‐treatment with INCS (220 μg triamcinolone acetonide twice daily). Nasosorption, nasal lavage, blood samples, forced expiratory volume 1 (FEV1), total nasal symptom score (TNSS), peak nasal inspiratory flow (PNIF) were collected up to 24 h after NAC. Total and active tryptase were measured as early‐phase allergy biomarkers (≤30 min) and IL‐13 and eosinophil cell counts as late‐phase allergy biomarkers (3–7 h) in serum and nasal samples. Period‐period reproducibility was assessed by intraclass correlation coefficients (ICC), and sample size estimates were performed using effect sizes measured after INCS. Results: NAC significantly induced acute increases in nasosorption tryptase and TNSS and reduced PNIF, and induced late increases in nasosorption IL‐13 with sustained reductions in PNIF. Reproducibility across NACs varied for symptoms and biomarkers, with total tryptase 5 min post NAC having the highest reproducibility (ICC = 0.91). Treatment with INCS inhibited NAC‐induced IL‐13 while blunting changes in TNSS and PNIF. For a similar crossover study, 7 participants per treatment arm are needed to detect treatment effects comparable to INCS for TNSS. Conclusion: NAC‐induced biomarkers and symptoms are reproducible and responsive to INCS. NAC is suitable for assessing pharmacodynamic activity and proof of mechanism for drugs targeting allergic inflammation. [ABSTRACT FROM AUTHOR]

Common biliary tract is ≈4 mm in diameter to deliver bile from liver to small intestine to help digestion. The abnormal narrowing leads to severe symptoms such as pain and nausea. Stents are an effective treatment. Compared with non-degradable stents which require repeated removal, biodegradable stents have the advantage of reducing secondary injury related to endoscopic operation and patient burden. However, current biodegradable materials may cause tissue hyperplasia and the treatment method does not target etiology of stricture. So recurrence rates after biodegradable stent implantation are still high. Here, a biodegradable helical stent fabricated from biosynthetic P(3HB-co-4HB) is reported. Tunable properties can be acquired through altering culture substrates. Stent shows shape memory in various solvents. The stent has an optimized design with helical structure and outer track. The self-expanding of helical structure and double drainage realized by outer track greatly improve drainage of bile. Importantly, stent-loading triamcinolone acetonide can inhibit proliferation of fibroblasts and reduce incidence of restricture. Therapeutic effect is also demonstrated in minipigs with biliary stricture. The results of minipig experiments show that biliary duct in treatment group is unobstructed and tissue hyperplasia is effectively inhibited. [ABSTRACT FROM AUTHOR]

Background: The first metatarsophalangeal joint is the most common site of osteoarthritis (OA) in the foot and ankle. Intra-articular corticosteroid injections are widely used for this condition, but little is known about their use in practice. This study explored current practice within the UK National Health Service (NHS) relating to the administration of intra-articular corticosteroids for people with painful first metatarsophalangeal joint (MTPJ) OA. Methods: A cross-sectional survey using Qualtrics online survey platform (Qualtrics, Provo, UT, USA), distributed through professional bodies, special interest groups, and social media. Results: One hundred forty-four healthcare professionals responded, including podiatrists (53/144; 39%), orthopaedic surgeons (28/144; 19%), podiatric surgeons (26/144; 17%) and physiotherapists (24/144; 16%). Half of respondents administered up to 25 corticosteroid injections per year (67/136; 49%) but some administered more than fifty (21/136; 15%). Injections were administered across the healthcare system but were most common in hospital settings (64/136; 44%) followed by community (38/136; 26%), with less delivered in primary care (11/136; 8%). Half of respondents routinely used image-guidance, either ultrasound or x-ray/fluoroscopy (65/136; 48%) although over one third used none (52/136; 38%). Imaging guidance was more common amongst medical professionals (21/31; 68%) compared to non-medical health professionals (45/105; 43%). Overall, methylprednisolone acetate was the most common corticosteroid used. Medical professionals mostly injected methylprednisolone acetate (n = 15/27; 56%) or triamcinolone acetonide (n = 11/27; 41%), whereas premixed methylprednisolone acetate with lidocaine hydrochloride was the most common preparation used by non-medical health professionals (41/85; 48%). When injecting non premixed steroid, lidocaine hydrochloride (15/35; 43%) was the most common choice of local anaesthetic for non-medical health professionals but medical professionals showed more variation between lidocaine hydrochloride (8/23; 35%) levobupivacaine hydrochloride (9/23; 39%) and bupivacaine hydrochloride (5/23; 22%). Conclusions: Multiple professional groups regularly administer intra-articular corticosteroids for symptomatic first MTPJ OA across a range of NHS healthcare settings. Overall, methylprednisolone acetate was the most commonly administered steroid and lidocaine hydrochloride the most common local anaesthetic. There was large variation in the use of imaging guidance, type and dose of steroid, local anaesthetic, and clinical pathways used in the intra-articular injection of corticosteroids for people with first MTPJ OA. [ABSTRACT FROM AUTHOR]

Background: The recurrence of keloids after intralesional injections is significant, and a review of the literature shows an inconsistent range of success rates. In this study, the modified medical proportion and intralesional injection method were intended to enhance the treatment effect. Methods: Twenty patients completed the study. Regional block anesthesia (lidocaine, ropivacaine) was performed. Triamcinolone acetonide (40 mg/mL), 5‐fluorouracil (25 mg/mL), and ropivacaine (7.5 mg/mL) were configured in a ratio of 2:1:4 and applied on the lesion by reticular injection (horizontal fan‐shaped stratified and vertical shaking pressurized injection). The minimum volume of injection per square centimeter was approximately 3.5 mL. The outcome indicators were the Vancouver Scar Scale (VSS), Visual Analogue Scale (VAS), treatment frequency. Results: The patients had an 82% ± 7% average reduction in VSS scores and 89% ± 13% and 93% ± 10% reductions in VAS scores of pain and pruritus, respectively, after an average of 2.5 ± 0.7 injections administered within 1 year. Conclusion: The sufficient mesh polyhedral intralesional injection can achieve excellent results for the treatment of keloid scars. [ABSTRACT FROM AUTHOR]

Objectives: The use of autologous platelet concentrates has shown growing evidence as a promising therapy. We conducted a split‐mouth study to evaluate the effectiveness of injectable platelet‐rich fibrin (PRF) compared with triamcinolone acetonide (TA) in the treatment of oral lichen planus (OLP). Materials and methods: This split‐mouth randomized trial included 12 patients with symptomatic, bilateral OLP lesions. The participants were randomly allocated to receive a 1‐ml intralesional PRF injection on one side of the buccal mucosa and a 0.5‐ml TA injection on the counterpart side. The application was performed once a week for 4 weeks. The outcomes were measured using a visual analog scale score, REU score, and lesion areas. Results: Both injectable TA and PRF were effective in the management of oral lichen planus. After 4 weeks of treatment, there was an average reduction in the VAS score (68.5% i‐PRF, 91% TA) and an average reduction in the REU score (74% i‐PRF, 91% TA). There were no statistically significant differences between the two treatment methods (p > 0.05). Conclusions: Intralesional injection with TA showed more effectiveness than i‐PRF in the management of OPL lesions. Although, i‐PRF cannot be considered a first‐line treatment option, it showed promising alternative therapy choice with no side effects. [ABSTRACT FROM AUTHOR]

This report describes a dog diagnosed with insertional biceps tendinopathy that was palliated with intra‐articular triamcinolone acetonide injections. The patient was a 6‐year‐old spayed female Chihuahua dog that had left thoracic limb lameness for 3 months before presentation. On physical examination, moderate pain was elicited by performing the biceps test and isolated full elbow extension on the left thoracic limb. Gait analysis showed asymmetrical peak vertical force and vertical impulse between thoracic limbs. Computed tomography (CT) revealed enthesophyte formation on the ulnar tuberosity of the left elbow joint. Ultrasonography showed a heterogeneous fibre pattern at the biceps tendon insertion site on the left elbow joint. These findings confirmed insertional biceps tendinopathy based on physical examination, CT and ultrasonography results. The dog received an intra‐articular triamcinolone acetonide injection with hyaluronic acid in the left elbow joint. Clinical signs improved after the first injection, including a range of motion, pain and gait. A second injection was given in the same manner because of recurring mild lameness 3 months later. No clinical signs were observed during the follow‐up period. [ABSTRACT FROM AUTHOR]

Fundoscopy revealed severe cupping of the right optic nerve head (ONH) even though the RNFL thickness was within normal range, see Figure 2b. Six months after IOP normalization we found glaucomatous visual field defects and reduction of the RNFL and GCL thickness in the left eye, se Figure 2g and Figure 3. As in the right eye, cupping of the left ONH was noted during increased IOP even though the RNFL and GCL thickness were within normal range, see Figure 2f. Trabeculotomy was therefore performed in the left eye also. [Extracted from the article]

Background: Keloids and hypertrophic scars frustrate patients by the deformity of appearance and organ dysfunction. Many modalities had been tried in clinic practice, but the results are unsatisfied. Objective: We retrospectively analysed the combined application of bleomycin and triamcinolone for the treatment of keloids and hypertrophic scars. Methods: The combination of bleomycin and triamcin acetonide was applied to the treatment of keloids and hypertrophic scars, 86 cases accepted the treatment. Follow‐up 2–5 years after treatment. Results: (1) The pain of scars and itching symptoms have basically subsided through treatment. (2) After drug injection treatment, the keloid began to shrink, some of the keloids disappeared. (3) Small keloids did not recur after treatment. Large keloids had local recurrence after treatment. When further treatment was given, the recurrence disappeared. Conclusion: The combined application of bleomycin and triamcin acetonide can effectively cure keloids and hypertrophic scars. [ABSTRACT FROM AUTHOR]

Background: Oral licen planus (OLP) is a chronic inflammatory disease and may have immunological background. Both intralesional injection of PRP and steroids succeeded in treating and decreasing recurrence of the disease. Patients and Methods: Twenty‐four participants with clinically diagnosed as OLP were enrolled in this study. We separated the patients in 2 groups, 12 patients in group A were treated by intralesional PRP every two weeks for 2 months or stopped if healing occurred earlier. Group B (12 patients) treated by intralesional Triamcinolone Acetonide (TA) (20 mg) every two weeks for 2 months or may be less if healing occurred earlier. The response of OLP lesions to treatment was evaluated by reduction of lesional areas, REU scores, and NRS scores. The patients with complete response (CR; 80%–100% reduction in the lesion area) were followed for 3 months biweekly. Results: There was a statistically significant decrease in REU and pain score in both groups after treatment compared to before. There was a statistically increase in frequency of side effects among patients received PRP especially pain compared to those treated by steroid. Also, recurrence of the disease after treatment during follow‐up for 3 months was more significant among patients treated by PRP. Conclusion: Intralesional PRP is a good and safe modality for treatment of OLP and intralesional TA. However, there were some side effects and recurrence of disease after follow‐up for three months in patients treated by PRP more than those treated by TA. [ABSTRACT FROM AUTHOR]

Background: Keloids are common and have significant negative effects on quality of life. There is a need for more effective treatment approaches for keloids. Aims: We investigated treatment outcomes of intralesional triamcinolone acetonide (IL TAC) compared with combination IL TAC and cryotherapy, including changes in pruritus, pain, and keloid size. Patients/Methods: We performed a prospective study of patients referred to one provider who treated patients with combination therapy and compared them to a historic control cohort treated with IL TAC alone. All patients were seen at Thomas Jefferson University between 2019 and 2021. Patient demographics, location of keloids, and inciting events were recorded. Pruritus and pain scores were self‐reported by patients using a 10‐point Likert scale administered as standard of care. Changes in keloid size were denoted as "No change," "up to 50% decrease," "more than 50% decrease," and "completely flattened." Results: While both treatments produced a significant reduction in mean pruritus and pain scores, there was no difference between the two treatment groups (p = 0.3933 and p = 0.2123, respectively). A greater percentage of keloids in the combination therapy group had a post‐treatment size difference greater than 50% compared with those in the IL TAC only treatment group (p = 0.0021). In the subgroup of pubic keloids, all lesions treated with combination IL TAC and cryotherapy responded remarkably well to treatment. Conclusions: While both IL TAC and IL TAC with cryotherapy were effective at reducing pruritus and pain, combination therapy was more effective in reducing keloid size, specifically for pubic keloids. [ABSTRACT FROM AUTHOR]

Photodynamic therapy emerged in the 1900s and recently, it has been developed as a novel modality for treating tumors, precancerous lesions, hypertrophic skin diseases, vascular diseases and so on. We aimed to compare the efficacy and adverse effects of surgery combined with photodynamic therapy or triamcinolone acetonide injection for keloid treatment. This self‐controlled study included nine patients with keloids. Two keloid sites were selected for each patient: one site received photodynamic therapy (PDT group) and the other site received local triamcinolone acetonide injections (TA group). All the keloids were surgically excised. The Vancouver Scar Scale and pruritus and pain scores were assessed at 3 and 6 months, respectively. At 3 and 6 months postoperatively, the pruritus and pain scores decreased significantly (P <.01) and equally in both groups (P >.05). At 6 months postoperatively, the PDT group showed the following results: complete cure, one patient; significantly effective, four patients; effective, four patients; and ineffective, no patient (efficacy, 100%). The TA group showed the following results: complete cure, one patient; significantly effective, three patients; effective, four patients; and ineffective, one patient (efficacy, 88.9%). Between‐group differences were not significant (P >.05). Hyperpigmentation was observed (n = 2) in the experimental group, whereas menstrual disorders (n = 2), local capillary dilation (n = 1) and subcutaneous atrophy (n = 1) were observed in the TA group. Photodynamic therapy and local triamcinolone acetonide are equally and highly effective in treating keloids with few side effects and when combined with surgery. [ABSTRACT FROM AUTHOR]

Background: Lumbar spinal stenosis is a common degenerative disease that causes low back and lower‐extremity pain that increases with age. The treatment of lumbar spinal stenosis is either conservative or surgical. ESI is a commonly performed conservative treatment, but evidence of its effectiveness in lumbar spinal stenosis is limited. Case series: We encountered the three patients with back pain and claudication due to lumbar spinal stenosis, which could not be controlled by conservative therapy including ESIs. Trimacinolone acetonide was injected into the patients' ligamentum flavum. All patients experienced dramatic improvement in their symptoms. Conclusions: Trimacinolone acetonide injection into the ligamentum flavum may be effective for lumbar spinal stenosis that does not improve with ESIs. [ABSTRACT FROM AUTHOR]

Linear frontal lipoatrophy secondary to intralesional steroid injection simulating linear scleroderma in a 6 year-old female Reports in the literature have shown spontaneous resolution within 6-12 months of corticosteroid injection, therefore watch full was initially recommended.[[6], [8], [10]] If atrophy persists more than 1 year, fat or hyaluronic acid filler may be considered.[5] In our case, at 18 month follow-up the atrophic plaque was almost imperceptible. 6 Call JE, Mann JA, Linos KD, Perry A, Yost J. Linear lipoatrophy following intra-articular triamcinolone acetonide injection mimicking linear scleroderma. [Extracted from the article]

Intralesional injections of triamcinolone acetonide are widely used to successfully treat several inflammatory nail conditions. This procedure is well described in adults, but less frequently reported in children and teenagers, being largely considered too invasive and fear‐provoking for pediatric patients. Our report shows how this procedure is feasible and successful in children, even without a digital block. The step‐by‐step technique and tips to reduce pain should encourage clinicians to offer it as an alternative option to children with inflammatory nail disorders. [ABSTRACT FROM AUTHOR]

Background and purpose: Corticosteroids such as triamcinolone acetonide (TAA) are potent drugs administered intra‐articularly as an anti‐inflammatory therapy to relieve pain associated with osteoarthritis (OA). However, the ability of early TAA intervention to mitigate OA progression and modulate immune cell subsets remains unclear. Here, we sought to understand the effect of early intra‐articular injection of TAA on OA progression, local macrophages, and peripheral blood monocytes. Experimental approach: Degenerative joint disease was induced by intra‐articular injection of collagenase into the knee joint of male C57BL/6 mice. After 1 week, TAA or saline was injected intra‐articularly. Blood was taken throughout the study to analyse monocyte subsets. Mice were killed at days 14 and 56 post‐induction of collagenase‐induced OA (CiOA) to examine synovial macrophages and structural OA features. Key results: The percentage of macrophages relative to total live cells present within knee joints was increased in collagenase‐ compared with saline‐injected knees at day 14 and was not altered by TAA treatment. However, at day 56, post‐induction of CiOA, TAA‐treated knees had increased levels of macrophages compared with the knees of untreated CiOA‐mice. The distribution of monocyte subsets present in peripheral blood was not altered by TAA treatment during the development of CiOA. Osteophyte maturation was increased in TAA‐injected knees at day 56. Conclusion and implications: Intra‐articular injection of TAA increases long‐term synovial macrophage numbers and osteophytosis. Our findings suggest that TAA accentuates the progression of osteoarthritis‐associated features when applied to an acutely inflamed knee. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical efficacy of intralesional platelet‐rich plasma (PRP) injections compared to intralesional triamcinolone acetonide (TA) injections in the treatment of erosive oral lichen planus (EOLP). Material and Methods: Twenty patients with EOLP were assigned randomly to either PRP or TA group. Patients received weekly intralesional injections for 4 weeks, and then followed up for 3 months on regular visits every 2 weeks. Pain scores using numerical pain score and clinical score were recorded by a blinded assessor each visit for all patients and remission score at the end of the trial was recorded. Results: Both groups showed significant improvement in the clinical parameters (pain and clinical score) "p =.001." Regarding remission of the lesions, 80% of patients in the PRP group showed complete remission compared to 70% in the TA group. However, there is no statistical significance when comparing the two groups in pain score, clinical score, or remission. Conclusions: PRP injections could be considered as an effective alternative single treatment modality for EOLP. The protocol for this study registered in Clinicaltrials.gov registry under the identifier number: NCT03293368. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present a new surgical technique to remove vitreous cortex remnants. Methods: Non‐consecutive retrospective interventional case series. Results: When the posterior vitreous is split, its outermost layer may remain attached to the retina, developing vitreoschisis‐induced vitreous cortex remnants (VCR). Their role in macular pathology etiopathogenesis has been well documented; however, recently, it has been proposed that VCR also play a crucial role in proliferative vitreoretinopathy and consequent retinal redetachment. The prevalence of VCR is underestimated because triamcinolone acetonide is not routinely used for vitreous staining. Vitreous cortex remnants (VCR) removal is challenging, and several surgical techniques have been proposed. However, they require sclerotomy enlargement, material that may not be readily available, and manual fashioning. Alternatively, a diamond‐dusted membrane scraper (DDMS), already widely used in macular pathology treatment, can follow the contour of the retina, as it is a silicone tube, and remove VCR with its abrasive tip. A DDMS may also be introduced in the vitreous cavity through a standard trocar. Finally, the use of a DDMS provides predictable feedback, making the learning curve short. In this case series, 34 eyes affected by primary rhegmatogenous retinal detachment were enrolled. The retinal redetachment rate was 2.9% at six months of follow‐up, below the average literature value of 21%. No adverse events were reported. Conclusion: A DDMS can be suitable for use in VCR removal, although further studies are warranted to understand the indications and extent of this surgical technique for improving the management of rhegmatogenous retinal detachment. [ABSTRACT FROM AUTHOR]

Background: Treatment of vitiligo with intralesional steroid (ILS) injections has shown to be successful in quite a few studies. It is a simple and safe treatment when used with caution with a better response in localized lesions. Objectives: The aim of the present study is to explore the efficacy and safety of using different concentrations of intralesional corticosteroid combined with NB‐UVB phototherapy in the treatment of non‐segmental vitiligo (NSV) patients. Methodology: Twenty patients with non‐segmental vitiligo were subjected to different concentrations of ILS injections (triamcinolone acetonide); that was carried out monthly for six sessions. All patients were also subjected to twice‐weekly sessions of NB‐UVB for 6 months. Punch biopsy was taken from each patch before and at the end of treatment sessions. Each biopsy was stained with hematoxylin and eosin (H&E), Orcein, and Masson's trichrome stains. Results: There was a significant difference between all groups in their repigmentation response (P = 0.017). After treatment, the epidermal thickness (histometry) was decreased (epidermal atrophy), especially with concentrations of 2.5 and 5 mg/ml of intralesional triamcinolone acetonide injection with decreased and disorganized collagen fibers. Conclusion: Intralesional corticosteroid injections combined with NB‐UVB showed a good and well‐tolerated therapeutic option for vitiligo. The concentrations of 0.625 and 1.25 mg/ml of triamcinolone acetonide were the safest with fewer side effects and complications. However, higher concentrations of 2.5 and 5 mg/ml were more effective but with more side effects. [ABSTRACT FROM AUTHOR]

In this study, modified kappa‐carrageenan/pectin hydrogel patches were fabricated for treatment of buccal fungal infections. For this purpose, kappa‐carrageenan‐g‐acrylic acid was modified with different thiolated agents (L‐cysteine and 3‐mercaptopropionic acid), and the thiol content of the resulting modified kappa‐carrageenan was confirmed by elemental analyzer. Then, the hydrogel patches were fabricated, and characterized by Fourier‐transform infrared spectroscopy, thermogravimetric analysis, ex vivo mucoadhesion test, and swelling behavior. Triamcinolone acetonide was added either directly or by encapsulating within the poly(lactic‐co‐glycolic acid) nanoparticles. The release amount of the drug from the directly loaded patch was 7.81 mg/g polymer, while it was 3.28 mg/g polymer for the encapsulated patch with the same content at 7 hr. The hydrogel patches had no cytotoxicity by cell culture studies. Finally, the drug loaded hydrogel patches were demonstrated antifungal activity against Aspergillus fumigatus and Aspergillus flavus. These results provide that the novel modified kappa‐carrageenan and pectin based buccal delivery system has promising antifungal property, and could have advantages compared to conventional buccal delivery systems. [ABSTRACT FROM AUTHOR]

Purpose: To compare the efficacy of topical nepafenac 0.1% versus intravitreal triamcinolone acetonide (IVTA) at the conclusion of vitrectomy surgery versus no adjuvant therapy (NAT) in improving macular morphology post‐operatively in patients undergoing vitrectomy for epiretinal membrane (ERM), as measured by optical coherence tomography (OCT) imaging and best‐corrected visual acuity (BCVA). Methods: Design: Prospective randomized clinical trial Setting: Multi‐centre 80 patients scheduled to undergo vitrectomy surgery for idiopathic ERM were randomized to receive either IVTA (4 mg/0.1 cc) at the end of surgery, topical nepafenac sodium 0.1% TID for 1 month post‐operation or no adjuvant treatment (NAT). Optical coherence tomography (OCT) imaging, best‐corrected visual acuity and intraocular pressure (IOP) were measured before surgery, and 1 and 2 months post‐operation. Results: Although all three groups showed reduction in macular thickness post‐operation, the NAT group showed the most improvement, with a reduction of 136.18 ± 29.84 μm at two months. There was no statistically significant difference in macular thickness between the groups at each time point, p = 0.158. The NAT group also had the best recovery in BCVA with an improvement of 0.207 logMAR (10.35 letters) at two months post‐operation. There was no statistically significant difference in BCVA between the groups, p = 0.606. There was statistically significant difference in the IOP between the three groups, p = 0.04 only at 1‐month visit. The IVTA group had the highest rise in average IOP at both 1 and 2 months post‐operation (2.72 and 1.58 mmHg, respectively). Conclusion: Our study data suggest there was no advantage in the use of topical nepafenac or IVTA for post‐vitrectomy ERM surgery. [ABSTRACT FROM AUTHOR]

Background: Multiple therapeutic modalities are available for alopecia areata (AA) but still a challenging disease with variable severity, recurrence, and a major cosmetic concern. Aims: Compare the effectiveness and safety of intralesional methotrexate (MTX) versus triamcinolone acetonide (TrA) in the treatment of localized AA in adults, both clinically and trichoscopically. Patients/Methods: 40 adult patients with localized AA were recruited and divided into two groups. 20 patients were treated by intralesional TrA and the other 20 patients were treated by intralesional MTX every 3 weeks, for maximum four sessions. Clinical and trichoscopic evaluation at baseline, each session and for 3 months after the last session was performed. Results: At the end of sessions (12 weeks), regrowth scale was significantly higher in TrA group compared to MTX group (p‐value = 0.028). But, after 3‐month follow‐up, regrowth scale was higher in MTX group compared to TrA group (p‐value = 0.153). A statistically significant reduction in AA specific trichoscopic signs after 12 weeks and at the 3‐month follow‐up in both groups. Local adverse events in both groups were transient and disappeared during the follow‐up period. Conclusion: Intralesional MTX in treatment of localized AA in adults can be promising and comparable to intralesional TrA with the need for further controlled and extensive trials. Trichoscopy can reveal early clinical response through disappearance of AA‐specific trichoscopic signs and also early detection of adverse effects. [ABSTRACT FROM AUTHOR]

Triamcinolone acetonide (TAA) is the drug of choice in the management of ocular inflammations due to its anti‐inflammatory and immuno‐suppressant activity. Available marketed formulations (Triesence, Trivaris, Kenalog) are in the suspension form recommended to be administered via intravitreal injection, which has many major complications. In the present study, we have designed and evaluated Hydroxypropyl‐β‐cyclodextrin (HP‐β‐CD),) based conventional formulations of TAA (aqueous suspensions) with different dose strengths to identify the dose strength required for achieving the effective concentrations in vitreous humor following pre‐corneal administration of the formulations. Ocular pharmacokinetic studies of conventional formulations of triamcinolone acetonide (TAA) with different dose strengths (1 mg/30µL, 2 mg/30µL, 4 mg/30µL) were performed to identify the dose strength required to produce effective concentrations of TAA in the aqueous and vitreous humor. A rapid, sensitive, selective, accurate and precise bioanalytical method utilizing a small sampling volume (<45 µL) was developed and validated for quantification of TAA in the samples obtained from the ocular pharmacokinetic studies. Aqueous suspensions of TAA with 20% HP‐β‐CD produced time course profiles in the aqueous humor at all the dose strengths. However, measurable concentrations and time course of TAA in vitreous humor were achieved only with 4 mg/30µL dose strength. [ABSTRACT FROM AUTHOR]

Background: This post hoc analysis compared the efficacy and safety of suprachoroidally administered triamcinolone acetonide (CLS-TA) to other commonly available treatments for non-infectious uveitis. Methods: Results from the PEACHTREE study were compared between subjects randomised to CLS-TA not requiring rescue therapy and those subjects randomised to control, who subsequently required rescue therapy. Endpoints included best corrected visual acuity (BCVA), central subfield thickness (CST), treatment emergent adverse events and intraocular pressure (IOP) related safety findings. Results: In this analysis, there were 83 unrescued CLS-TA subjects and 46 rescued control subjects. At Week 24, 51.9% of the unrescued CLS-TA subjects gained =15 letters in BCVA, compared to 37.0% of the rescued control subjects (p = 0.115). Unrescued CLS-TA subjects showed a mean gain of 15.7 versus 10.9 letters in rescued control subjects (p = 0.080). A significantly greater mean reduction in CST was observed for unrescued CLS-TA subjects versus rescued control subjects (174.0 and 148.5 µm; p = 0.040). Of unrescued CLSTA subjects, 4.9% experienced IOP elevations =30 mm Hg at any visit versus 10.9% of rescued control subjects. Further, use of IOP-lowering medications appeared lower in unrescued CLS-TA subjects versus rescued control subjects (7.2% vs. 13.0%). There were no IOP-lowering surgical interventions in either group. Conclusion: CLS-TA subjects experienced significantly greater reduction in CST and tended towards greater improvement in BCVA, compared with rescued control subjects. Suprachoroidally administered CLS-TA showed a lower incidence of IOP-related safety findings. [ABSTRACT FROM AUTHOR]

Background: Intranasal corticosteroids (INCS) are used in the management of sinonasal conditions. Use of exogenous steroids can be associated with hypothalamic‐pituitary‐adrenal axis dysfunction and adrenal insufficiency (AI). We aimed to estimate the rate of AI after INCS use in a meta‐analysis, stratified by steroid type and treatment duration. Methods: Ovid Medline, Embase Classic, PubMed, Web of Science, and CINAHL databases were searched following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines to identify studies investigating INCS use and AI. AI was defined as morning serum cortisol <550 nmol/L and <80 nmol/L with and without adrenocorticotropic hormone stimulation. INCS were classified as first (beclomethasone dipropionate, triamcinolone acetonide, beclomethasone, budesonide, dexamethasone) and second (ciclesonide, mometasone furoate, and fluticasone propionate) generation. Duration of treatment was classified as short (<1 month), medium (1‐12 months), and long‐term (>12 months) time periods. Results: This search identified 3668 articles. A total of 39 studies (1678 patients) were included in the final analysis. The pooled percentage of AI for routinely utilized first‐ and second‐generation INCS was 0.70% (95% confidence interval [CI], 0.29‐1.12%). Stratified by type, AI was observed in 0.78% (95% CI, 0.25‐1.30%) of first‐generation and 0.58% (95% CI, −0.1% to 1.26%) of second‐generation steroids. AI was seen in 0.48% (95% CI, −0.01% to 0.96%) of short‐term, 1.13% (95% CI, 0.2‐2.1%) of medium‐term, and 1.67% (95% CI, 0.37‐2.9%) of long‐term use of INCS. Conclusion: Overall, the use of INCS carries a low risk for AI. Although modest, this risk may differ depending on the length of duration and type of INCS used. Informing patients of these risks is of importance for the treatment of chronic sinonasal conditions. [ABSTRACT FROM AUTHOR]

Background: Intra‐articular triamcinolone acetonide is a widely used treatment for joint inflammation despite limited scientific evidence of its efficacy. Objectives: To investigate if intra‐articular triamcinolone acetonide has sustained anti‐inflammatory effects using an equine model of repeated joint inflammation. Study design: Randomised controlled experimental study. Method: For three consecutive cycles 2 weeks apart, inflammation was induced in both middle carpal joints of eight horses by injecting 0.25 ng lipopolysaccharide (LPS). After the first LPS injection only, treatment with 12 mg triamcinolone acetonide (TA) followed in one randomly assigned joint, while the contralateral joint was treated with sterile saline (control). Clinical parameters (composite welfare scores, joint effusion, joint circumference) were recorded and synovial fluid samples were analysed for various biomarkers (total protein, WBCC; PGE2; CCL2; TNFα; MMP; GAGs; C2C; CPII) at fixed timepoints (post injection hours 0, 8, 24, 72 and 168). The effects of time and treatment on clinical and synovial fluid parameters and the presence of time–treatment interactions were tested using a linear mixed model for repeated measures with horse as a random effect, and time and treatment as fixed effects. Results: The TA treated joints showed significantly higher peak synovial GAG concentrations (Difference in means 283.1875 µg/mL, 95% CI 179.8, 386.6, P < 0.000), and PGE2 levels (Difference in means 77.8025 pg/mL, 95% CI 21.2, 134.4, P < 0.007) after the first inflammation induction. Significantly lower TP levels were seen with TA treatment after the second induction (Difference in means −7.5 g/L, 95% CI −14.8, −0.20, P < 0.04). Significantly lower WBCC levels were noted with TA treatment after the first (Difference in means −23.7125 × 109 cells/L, 95% CI −46.7, −0.7, P < 0.04) and second (Difference in means −35.95 × 109 cells/L, 95% CI −59.0, −12.9, P < 0.002) inflammation inductions. Significantly lower general MMP activity was also seen with TA treatment after the second inflammation inductions (Difference in means −51.65 RFU/s, 95% CI −92.4, −10.9, P < 0.01). Main limitations: This experimental study cannot fully reflect natural joint disease. Conclusions: In this model, intra‐articular TA seems to have some anti‐inflammatory activity (demonstrated by reductions in TP, WBCC and general MMP activity) up to 2 weeks post treatment but not at 4 weeks. This anti‐inflammatory effect appeared to outlast a shorter‐lived, potentially detrimental effect illustrated by increased synovial GAG and PGE2 levels after the first induction. [ABSTRACT FROM AUTHOR]

Background: Keloids are common fibroproliferative tumors, and their treatment still represents a dilemma. Intralesional triamcinolone acetonide (TAC) injection is effective, but frequently associated with side effects. Pentoxifyllin (PTX) is a vasodilator, anti‐inflammatory, and antifibrotic agent. Its intralesional injection in keloids has not been evaluated yet. Aims: Evaluating the efficacy and safety of intralesional PTX versus intralesional TAC and their combination for treatment of keloids. Patients/Methods: Thirty patients with keloids were divided into three equal groups and treated by intralesional injection of TAC, PTX, or their combination (admixed in 1:1 ratio). Injections were repeated every 3 weeks until lesional flattening or for maximum of 5 sessions. The evaluation was done using the Vancouver Scar Scale and the Verbal Rating Scale for pain and itching. Results: A significant improvement in VSS was detected in all groups. Significantly better improvements in keloid height, pliability, pain, and itching were detected in the TAC and combination groups than in the PTX group. There was a significantly higher incidence of side effects (atrophy, hypopigmentation, telangiectasia, and precipitation of TAC) in the TAC group than in the combination group, while no side effects were reported in the PTX group. A statistically significant reduction in the number of treatment sessions (required to achieve best results) was detected in patients in the combination group. Conclusions: Intralesional injection of PTX is a potentially helpful, safe, and well‐tolerated therapeutic tool for keloids, but with lower efficacy than intralesional TAC when used solely. Combining PTX and TAC produces significantly better results for keloid treatment and lowers the risk of TAC‐induced side effects. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to observe the effect of the triamcinolone acetonide injections in thick skinned patients with ultrasonographic measurements and to compare these results with the postoperative nasal skin thickness of patients that were not injected with steroids. Methods: A prospective study was planned with 42 thick nasal skinned rhinoplasty candidates in our clinic. Skin thickness of specific points along nose was measured and documented. On the 10th day after surgery, triamcinolone acetonide injections were performed into the supratip region of 21 patients in the study group. No injections were made for the control group. Nasal ultrasonographic measurements were repeated 40 days after the surgery for all 42 patients by the same radiologist and results were evaluated. Results: Seventeen women (40.5%) and 25 men (59.5%) were included in the study. Patients' ages ranged from 18 to 53 with an average age of 27.9. In study group, all injections sites showed thinning on the 40th day after surgery. These findings were statistically significant at B (rhinion), D (middle of supratip), and G (middle of the tip). In the control group, all injection sites except A (nasion) displayed thickening on the 40th day after surgery. These findings were statistically significant at B (rhinion), D (middle of supratip), H (left side of the tip), and J (left alar region). Conclusion: Triamcinolone acetonide injections are effective in the prevention of edema and provide thinning of the post‐rhinoplasty skin envelope. [ABSTRACT FROM AUTHOR]

Chronic inflammatory skin diseases (CISDs) negatively impact a large number of patients. Injection of triamcinolone acetonide (TA), an anti‐inflammatory steroid drug, directly into the dermis of diseased skin using needle‐syringe systems is a long‐established procedure for treating recalcitrant lichenified lesions of CISDs, referred to as TA intralesional injection (TAILI). However, TAILI causes severe pain, causing patients to be stressed and reluctant to undergo treatment. Furthermore, the practitioner dependency on the amount and depth of the injected TA makes it difficult to predict the prognosis. Here, candle flame ("candlelit")‐shaped TA‐loaded dissolving microneedles (Candlelit‐DMN) are designed and fabricated out of biocompatible and biodegradable molecules. Candlelit‐DMN distributes TA evenly across human skin tissue. Conjoined with the applicator, Candlelit‐DMN is efficiently inserted into human skin in a standardized manner, enabling TA to be delivered within the target layer. In an in vivo skin inflammation mouse model, Candlelit‐DMN inserted with the applicator effectively alleviates inflammation by suppressing inflammatory cell infiltration and cytokine gene expression, to the same extent as TAILI. This Candlelit‐DMN with the applicator arouses the interest of dermatologists, who prefer it to the current TAILI procedure. [ABSTRACT FROM AUTHOR]

Background: Intralesional corticosteroids (ILCs) is the first‐line therapy for patients older than 10 years having patchy alopecia areata, however some patients do not respond effectively. Aims: To evaluate the efficacy of a chemical peel trichloro acetic acid (TCA 35%) in comparison to ILCs. Patients/Methods: Twenty‐two patients with two patches of alopecia areata were included. Two treatment modalities with ILCs and topical TCA 35% were performed in two randomly selected patches. Three sessions were done, 3 weeks apart and were followed‐up for three months. Evaluation was done using Mac Donald Hull and Norris grading system and by counting trichoscopic parameters in each patch. Results: Both ILCs and TCA 35% treated patches showed measurable improvement with no statistically significant difference between the results of the two modalities (p>0.05) at different times of the study. Yellow dots, black dots, exclamation marks and dystrophic hair were all reduced by 100%, 82.0%, 100% and 88.3% in ILCs treated patches and by 70.4%, 69.1%, 100% and 75.0% in TCA treated patches, respectively. Conclusion: Topical TCA 35% is an effective and safe treatment for the treatment of AA without serious side effects, despite the slower response when compared to ILCs. [ABSTRACT FROM AUTHOR]

80% of the patients underwent 5 maintenance injections, the keloid in the laser treated area showed a white, soft healing state. Treating cysts in keloids with Ultrapulse mode-fractionated carbon dioxide lasers can effectively cure the cysts, thereby inhibiting the growth of keloids and reducing the recurrence rate of keloids. Treatment of sebaceous cysts in keloids: Ultrapulse mode-fractionated carbon dioxide lasers combined with injection of low-concentration triamcinolone acetonide and 5-fluorouracil. [Extracted from the article]

Objective: Equine recurrent uveitis (ERU), a chronic, immune‐mediated intraocular inflammatory disease, is a common cause of blindness in horses. The severity and recurrent nature of ERU makes it difficult to treat with current therapeutics leading to a poor visual prognosis. The suprachoroidal space (SCS), a potential space between the choroid and sclera surrounding the ocular posterior segment, offers a promising alternative site for drug application to the eye. Corticosteroid administration within this space is hypothesized to be safe and effective at controlling intraocular inflammation, especially in horses with poorly responsive ERU. Animal studied: Horses with active, poorly responsive ERU. Procedure(s): A retrospective study was performed with 29 horses (36 total eyes) that received SCS injection of triamcinolone acetonide (TA) with ERU not well controlled with standard uveitis treatment. A standardized ocular inflammation score (OIS) was used to assess inflammation at the time of injection and at follow‐ups. Results: Standardized OIS revealed a significant decrease in ocular inflammation over time after SCS TA administration (p <.004). Adverse effects after injections occurred in <20% of the horses at follow‐up, but some of these effects were attributed to chronic inflammation prior to effective treatment, long‐term topical corticosteroid use, or complications from hospitalization rather than the SCS injections. Most horses (86.7%) in this study remained visual greater than 3 months after SCS injection. Conclusions: Based on these results, SCS TA injections appear to be a safe and possible effective treatment modality for managing poorly responsive ERU; further clinical study is warranted. [ABSTRACT FROM AUTHOR]

Objectives: Endoscopic submucosal dissection (ESD), a preferential approach for early oesophageal neoplasms, inevitably results in oesophageal strictures in patients. Clinical use of glucocorticoids through submucosal injection is beneficial for inhibiting oesophageal stricture following injury; however, it also has limitations, such as dose loss and perforation. Hence, alternatives to glucocorticoid therapy should be developed. Methods: A novel porous composite scaffold, ChCo‐TAMS, composed of chitosan, collagen‐I and triamcinolone acetonide (TA) loaded into poly (lactic‐co‐glycolic) acid (PLGA) microspheres (TAMS), was successfully constructed and subjected to biological testing to ameliorate oesophageal ESD‐related stenosis. Results: The synthesized biomaterials displayed unique properties in inhibiting the activation of macrophages, chemokine‐mediated cell recruitment and fibrogenesis of fibroblasts. Further application of the scaffolds in the rat dermal defect and porcine oesophageal ESD model showed that these novel scaffolds played a robust role in inhibiting wound contracture and oesophageal ESD strictures. Conclusions: The developed composite scaffolds provide a promising clinical medical device for the prevention of post‐operative oesophageal stricture. [ABSTRACT FROM AUTHOR]

Background: The etiopathogenesis of melasma is not yet completely elucidated; however, certain inflammatory cytokines are involved in its pathogenesis as interleukin (IL) 1a, IL 1b, IL6, prostaglandin (PG) D2and PGE2. Corticosteroid suppressive effect on these cytokines may explain its therapeutic effect in the treatment of melasma. Aims: To assess the efficacy and safety of intralesional triamcinolone versus Kligman's formula in treatment of melasma. Methods: This study included 2 groups of female patients with melasma; group1 (treatment group) included 22 patients who were treated by intralesional injection of triamcinolone acetonide at a concentration of 4 mg/mL once monthly for four sessions as a maximum and group 2 (control group), included 22 patients who were treated by Kligman's formula once daily for 3 months. All patients were evaluated by dermoscope before treatment and at each follow‐up visit to record any adverse effects of treatment. Results: The severity of melasma, assessed by MASI score, significantly decreased in both groups at the end of third month. There was no statistically significant difference in the therapeutic response between both groups. No side effects were reported with triamcinolone injection except for mild pain during injection, while Kligman's formula was associated with dermatitis, irritation, and burning sensation. Conclusions: Triamcinolone injection at low concentration could be an effective treatment modality of melasma. [ABSTRACT FROM AUTHOR]

This procedural report details the case of a 10‐year‐old boy with oral Crohn's disease successfully treated with intralesional corticosteroid injections. The intervention used topical anesthesia with a eutectic mixture of lidocaine 2.5%/prilocaine 2.5% cream followed by intralesional triamcinolone acetonide. This approach safely and effectively reduced patient discomfort while allowing for an acceptable and durable clinical outcome. [ABSTRACT FROM AUTHOR]

Purpose: A distinct pattern of granulomatous anterior uveitis, with white anterior chamber (AC) granuloma, has been reported in certain endemic areas. The aim of this work was to compare the outcome of conservative treatment to surgical intervention for the treatment of large AC granulomas presenting with moderate–severe anterior uveitis. The secondary outcome is ultrasound biomicroscopy (UBM) characterization of AC granulomas. Methods: This is a prospective randomized interventional study including 41 eyes of 39 patients with active AC granuloma ≥3 mm (flare & cells ≥ +2). Patients were randomly assigned to either conservative treatment in the form of topical prednisolone and cycloplegic drops with orbital floor (transseptal) injection of Triamcinolone acetonide (20 eyes) or surgery in the form of granuloma excision and AC wash (21 eyes). As a perioperative care, topical steroids and cycloplegic drops were given few days before surgery and tapered gradually over 6 weeks. Patients were followed up at first day, 2 weeks, 1 and 3 months. Results: Thirty‐seven patients were males, and 2 were females (13.0 ± 3.5 years). After 2 weeks, disappearance/healing of granuloma was achieved in 20 eyes in the surgical group versus 2 eyes in the conservative group (p < 0.0001). This effect was maintained throughout the follow‐up period, for the surgical group and reached up to 70%, for the medical group. At every follow‐up, BCVA was better in the surgical group, but this was only statistically significant at 1 and 3 months. The granuloma appeared as a homogenous hyperreflective lesion in examined eyes (16 eyes of 15 patients). Conclusion: Surgical treatment of large granulomas leads to a more complete and rapid resolution of inflammation. [ABSTRACT FROM AUTHOR]