There are a wide range of treatments available for a variety of conditions. If you are looking to undergo an intralesional injections, you have a few options. The most popular include Corticosteroid and Normal saline. Other treatments include Esophageal strictures, Keloids and Psoriasis.
Corticosteroid
Intralesional corticosteroid injections are used in combination with other therapeutic modalities to treat a variety of diseases. They aim to achieve a high concentration of the steroid in the disease.
Several investigators have reported success with intralesional steroid injections. However, no consensus has reached regarding the minimum number of injections required to achieve a cure.
Some studies suggest that recurrence after surgery alone is low. Others report higher recurrence rates. This has led to the development of adjuvant treatments. In the most common form of treatment, a corticosteroid injected after the excision of a keloid.
Corticosteroid intralesional injections may be effective in recurrent cutaneous pseudolymphoma. An intralesional injection of betamethasone dipropionate, 5 mg/mL, with 0.9% saline solution, given once every 4 to 6 weeks. The interval between injections was based on the severity of the lesion. Several patients reported good or moderate responses.
There are few reported side effects with corticosteroid intralesional injections. Most are mild. These are commonly temporary and wear off within a few months.
Various types of CS preparations are available for intralesional injection. One of these is denosumab. It was use in two patients and found to be associated with a positive bone fill on CBCT. Other side effects include increased appetite and difficulty sleeping.
Another study found that recurrence after surgical excision of a keloid was higher with adjuvant corticosteroid therapy. This was like the result found with radiotherapy.
However, the rate of recurrence was higher in the TAC + BT group. Several other factors are important in determining the recurrence rate of a keloid after a treatment. Ultimately, a combination of treatments needs to tailored to the individual patient.
Normal saline
Intralesional injections of normal saline have shown to be a relatively effective treatment for mild to moderate atrophic acne scars. It is a little surprising that these injections not more commonly used. The most common sites affected are the buttocks and proximal extremities.
However, it is also possible that these injections may cause some atrophy. Therefore, it is important to minimize the risk of atrophy by preventing its occurrence by having a comprehensive medical history. For example, if you’ve had a history of intralesional corticosteroid injections, you might want to talk to your doctor about a possible plan of action.
For instance, an injection of bleomycin or triamcinolone acetonide might be better suited to your needs. These injections are available in both a suspension form and as a single dosage vial. If you choose to use the latter, you might want to dilute it with normal saline to ensure a consistent dose.
Another potential advantage of a saline injection is its ability to inject into the skin without local anesthetic. Most practitioners use a 30-gauge needle for this purpose, although some prefer to use a 25-gauge needle in more dense tissue. This is a particularly smart move if you must get a large volume of fluid into the skin.
While the medical community is still debating the best approach, one study is shedding light on the best method for this procedure. A study published in Dermatologic Surgery in 2010 found that the intralesional injection of bleomycin and triamcinolone acetonide, as opposed to a placebo, produced a greater reduction in atrophic lesions after a few months of treatment.
Ultimately, the results of this small study are likely to overshadowed by those from a more rigorous, controlled study.
Psoriasis
Psoriasis is a chronic skin disease that causes scaly, red plaques to form. It is known to affect about 2 percent of the population in the United States. There is no cure for psoriasis, but treatment can control the symptoms and improve a patient’s quality of life.
Psoriasis can treat with topical or oral medications. Injectable medications can help reduce inflammation, reduce itching, and clear up plaques. However, injections can have side effects, and the drugs must used safely.
Intralesional injections are becoming more common in psoriasis. These injections administered by a doctor to treat the underlying cause of the disease. For example, if the plaques caused by the immune system, an intralesional injection of a biologic drug, such as a tazarotene or ustekinumab, can be effective.
An intralesional drug’s dose, frequency, and duration of use will depend on the patient. Some people may have to take more than one of these types of drugs to control their psoriasis. If you have questions about the treatment of your psoriasis, talk with your doctor.
Methotrexate (MTX) is a disease-modifying anti-rheumatic drug (DMARD) that targets the immune system. It used to treat psoriasis and psoriatic arthritis.
Triamcinolone acetonide (TAC) is another DMARD that works to clear up psoriatic plaques. The injections made with a sterile disposable needle. TA injected over the course of three to four weeks.
Other drugs that approved for psoriasis include cyclosporine, anthralin, and retinoids. Each medication requires a different dosage. As with all other medications, you will need to discuss your psoriasis medication with your doctor before you start taking it. You will also need to know how to administer the medications at home.
Keloids
Keloids are a type of scar that develops in the skin due to the development of abnormal tissues. The most common areas where keloids occur are the cheeks, shoulders, earlobes, and upper arms. Typically, keloid formation occurs around an injury or wound. These keloid scars often raised and can be painful.
Intralesional injections are a form of treatment for keloid formation. They can help flatten the scar and prevent scar tissue from growing. However, they can also cause delayed reaction, bleeding, and infection.
There are two types of intralesional injections: the steroid only and the combination of steroids and fluorouracil. Both are effective for keloids. When a kelood first diagnosed, a dermatologist will determine the appropriate method of treatment. Depending on the size of the lesion and its overall appearance, the dosage can vary.
Patients with a keloid may dissatisfied with the result of treatment. This can be a symptom of recurrence. If a recurrence occurs, a second round of treatment is necessary. Some patients report itchiness or bruising.
In some cases, a nonprescription silicone gel can use to lessen the itching. Alternatively, compression dressings can use. Compression dressings must wear 12-24 hours a day for four to six months.
Keloids tend to recur after treatment. Although recurrence is uncommon, it is still possible. Therefore, it is important to maintain adequate follow-up.
Keloid growths characterized by excess hyalinised collagen bundles and dome-shaped raised tissues. A keloid typically begins as a hypertrophic scar. As it heals, it can outgrow its prior pimple.
Surgical excision is one option for removing a keloid. However, the risk of recurrence is high. For this reason, the senior author prefers to try preoperative steroid injections before surgical excision.
Esophageal strictures
In patients with esophageal strictures, intralesional injections of steroids reduce the frequency of dilatations. However, there is a need for a large scale, prospective randomized study to verify this finding.
Several studies have shown that ISI reduces the number of dilatations required to resolve a stricture. The effect seen most strongly in the first three interventions. There is little evidence to support the use of ISI in younger patients, however.
To determine the safety of ISI in young children, a systematic review of pediatric patients conducted. Studies selected using a reference screening method. Those that met all inclusion criteria included. They included 53 articles.
Studies involved in the analysis used a combination of parameters to define effectiveness. These included the length of dysphagia-free period, the number of further dilatations, and the re-stricture-free survival. Despite the low number of participants, the study showed that a long-lasting dysphagia-free period observed after ISI.
This suggests that the treatment is effective in reducing the burden of esophageal stenosis. However, there is a need for well-designed, prospective studies to assess the effectiveness of ISI in children with esophageal atresia.
An oesophageal atresia refers to a congenital malformation that results in a tracheoesophageal fistula. Children with type C must undergo primary anastomosis within the first few days of life. Afterwards, the condition may require repeated dilatation.
Steroid injections have no local side effects and may be useful in reducing the burden of esophageal narrowing. Some studies show that steroid injections improve dysphagia post-dilation.
However, recurrent strictures are difficult to treat. They often recur, and patients may experience pain when swallowing liquids and solids. Additionally, dilatations are not successful in these patients.
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