The safety and efficacy of intralesional triamcinolone acetonide for keloids and hypertrophic scars: A systematic review and meta-analysis

BackgroundTriamcinolone acetonide (TAC) is widely used for hypertrophic scars and keloids; however, TAC has variable efficacy and safety in different individuals.PurposeTo evaluate the efficacy and safety of intralesional TAC for treatment of hypertrophic scars and keloids.Data sourcesSearches of PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov prior to 25 March 2020.Study selectionRandomized controlled trials in English that compared TAC with a placebo or other medications that are commonly used for intralesional injection in hypertrophic scars and keloids.Data extractionPrimary outcomes were reduction in scar height, vascularity, pliability, pigmentation, total scores on the Vancouver Scar Scale (VSS) or patient and observer scar assessment scale (POSAS), telangiectasia, and skin atrophy. Secondary outcomes included overall scar improvement.Data synthesisFifteen trials met the inclusion criteria. In the short term, TAC was associated with a significant improvement in vascularity (MD: −0.22, 95% CI: −0.42 to −0.02) and pliability (MD: −0.25, 95% CI: −0.44 to −0.06) compared to verapamil. In the medium term, compared to TAC, 5-FU showed a significant improvement in scar height (SMD: 0.95, 95% CI: 0.15–1.75), while TAC led to a significant improvement in vascularity compared to 5-FU (MD: −0.45, 95% CI: −0.76 to −0.14). Compared to TAC, TAC+5-FU showed a significant improvement in pliability (SMD: 0.98, 95% CI: 0.17–1.78) and pigmentation (MD: 0.45, 95% CI: 0.12–0.78). Botulinum toxin type A resulted in significantly better pliability (SMD: 1.99, 95% CI: 0.98–3.00) compared to TAC. In the long term, compared to TAC, 5-FU led to a significant improvement in scar height (MD: 0.55, 95% CI: 0.17–0.93), but significantly less vascularity (MD: −0.35, 95% CI: −0.65 to −0.05). Compared to TAC, TAC+5-FU produced a significant improvement in scar height (MD: 1.50, 95% CI: 1.12–1.88), pliability (MD: 0.45, 95% CI: 0.10–0.80), and pigmentation (MD: 0.55, 95% CI: 0.24–0.86).ConclusionTAC may be beneficial for the short-term treatment of hypertrophic scars and keloids; however, 5-FU, 5-FU+TAC, and verapamil may produce superior results for medium- and long-term treatments. TAC injections at concentrations of 20 mg/ml or 40 mg/ml are more likely to result in skin atrophy compared to 5-FU or verapamil, and are more likely to cause telangiectasia than 5-FU, 5-FU+TAC, or bleomycin.     

Microemulsion-based delivery of triamcinolone acetonide to posterior segment of eye using chitosan and butter oil as permeation enhancer: an in vitro and in vivo investigation

The aim of the study was to formulate a microemulsion (ME) using chitosan (CH) and the butter oil (BO) as a permeation enhancer for targeting drug to the posterior segment of the eye, via topical route. Triamcinolone acetonide (TA) was selected as the model drug since it undergoes extensive first-pass metabolism, leading to poor oral bioavailability of 23%. For optimisation of BO concentration, different ratios of TA:BO were prepared by simple physical mixing in the ratio of 1:9 to 9:1 and diffusion study was performed. MEs containing TA, TA:BO and TA CH ME were formulated by water titration method. Globule sizes of TA ME, TA:BO ME and TA CH ME were found to be 66.06?±?0.32?nm, 78.52?±?1.50?nm and 97.30?±?2.50?nm, respectively. In ex vivo diffusion studies using goats eye, TA:BO ME (31.33?±?0.46 and 33.98?±?0.23) and TA CH ME (24.10?±?0.41 and 27.00?±?0.18) showed higher percentage of drug diffusion in comparison to TA ME (13.29?±?0.41and 15.56?±?0.34) and TA solution (8.20?±?1.04 and 10.39?±?0.22) in presence and in absence of vitreous humour. Fluorescence intensity of coumarin-6 (as a marker) loaded ME with BO and CH was found to be higher, confirming their role in altering membrane permeability and facilitating coumarin-6 diffusion to the posterior chamber. Overall, it was concluded that BO enhances the bioavailability of TA across the retina, thereby proving its potential as permeation enhancer in facilitating drug delivery to the posterior segment of the eye.     

多磺酸黏多糖乳膏联合曲安奈德益康唑乳膏治疗成人慢性湿疹45例

目的 观察多磺酸黏多糖乳膏与曲安奈德益康唑乳膏联合应用治疗成人慢性湿疹的临床效果.方法 选取90例成人慢性湿疹患者作为研究对象,采用随机数字表法分为两组,每组45例,其中对照组采用曲安奈德益康唑乳膏治疗,观察组在对照组治疗的基础上,联合多磺酸黏多糖乳膏治疗,观察并比较两组患者经过用药后的临床效果及随访恢复情况.结果 观察组总有效率(91.11%)明显高于对照组(60.00%),差异有统计学意义(P<0.05);观察组患者临床各指标积分(4.81 ±1.01)分明显优于对照组(10.61 ±2.60)分,差异有统计学意义(P <0.05);观察组患者透明质酸酶合成的增长率(639.15 ± 140.43)%明显高于对照组(48.98 ±14.26)%,差异有统计学意义(P<0.05);治疗后,观察组患者皮肤水份情况(46.15 ± 14.32)%明显优于对照组(40.02 ±11.56)%,差异有统计学意义(P<0.05).结论 在曲安奈德益康唑乳膏治疗的基础上,联合多磺酸黏多糖乳膏对成人慢性湿疹的治疗具有积极作用,提高临床总有效率,有效改善自觉瘙痒程度、皮损厚度和皮肤软硬度及颜色恢复等方面的临床状况,患者皮肤水份得以维持,为受损皮肤的组织再生提供了保障,值得临床广泛应用.     

曲安奈德口腔软膏联合半导体激光治疗牙龈扁平苔藓临床疗效研究

目的　探讨曲安奈德口腔软膏联合半导体激光治疗牙龈扁平苔藓（lichen planus，LP）的临床疗效。方法　选取2016年9月至2017年10月就诊于中国医科大学附属口腔医院急诊·黏膜科至少由2名临床医生做出相同诊断的牙龈LP患者90例，随机分为A、B、C 3组，每组30例。A组患者采用曲安奈德口腔软膏治疗，每日1次，睡前涂抹，持续1个月； B组患者采用半导体激光局部照射治疗，每2日1次，持续1个月；C组患者采用曲安奈德口腔软膏联合半导体激光治疗，半导体激光先照射（每2日1次），然后药膏睡前涂抹（每日1次），疗程为1个月。分别在治疗前和治疗后1周、2周、1个月观察记录各组患者创面的病损面积、疼痛程度、症状体征。采用SPSS 22.0软件对数据进行统计分析。结果　治疗后3组病损面积均缩小，疼痛程度、症状体征评分均降低，较治疗前差异均有统计学意义（P＜0.05）。治疗后不同阶段组间比较，C组病损面积均小于A组和B组，疼痛程度评分和症状体征评分亦均低于A组和B组，差异有统计学意义（P＜0.05）；A组病损面积均小于B组，B组疼痛程度评分均低于A组，差异有统计学意义（P＜0.05）。治疗后1周，A组和B组症状体征评分差异无统计学意义（P＞0.05），治疗后2周和1个月，A组症状体征评分均低于B组，差异有统计学意义（P＜0.05）。 结论　曲安奈德口腔软膏联合半导体激光治疗牙龈LP的总体效果优于单独用药和单独使用激光，值得临床推广。     

关节内注射曲安奈德对山羊颞下颌关节骨关节病的影响

目的:观察关节内注射曲安奈德后,山羊颞下颌关节骨关节病的组织病理学变化。方法:在10只山羊的双侧颞下颌关节上腔一次性注射Ⅰ型胶原酶0.8ml,诱导制作山羊骨关节病模型;随机将动物分为对照组和治疗组,每组5只,分别在注射Ⅰ型胶原酶后30、60d后,进行第1次和第2次治疗;第1次治疗90d后,处死2组动物,切取关节标本,进行光镜和扫描电镜观察,并对2组关节光镜下9个区的组织病理学变化进行评分,每个区得出平均分后,应用SAS统计软件GLM模型对治疗组和对照组的分数进行统计学处理,评价有无差异。结果:光镜和扫描电镜下观察,对照组髁突、关节盘、关节窝表现为骨关节病变化,治疗组表现出较对照组更严重的病理变化。光镜下治疗组与对照组的组织学得分有显著性差异(P<0.01)。结论:关节上腔注射曲安奈德,能加重骨关节病的程度。     

4种机用镍钛器械在模拟弯曲根管内成形能力的实验研究

 目的    比较4种不同机用镍钛器械预备树脂模拟弯曲根管的成形能力，为临床应用提供实验依据。方法    将40个单弯树脂模拟根管随机分为4组，每组10个，分别为ProTaper Universal组、iRaCe组、Reciproc Blue组和HyFlex EDM组，采用4种不同机用镍钛器械进行根管预备，并记录各组预备时间。使用单反相机采集各组预备前后根管的形态照片，采用Adobe Photoshop CS5软件进行图像重叠，使用Image Pro Plus6.0软件测量10个观测点的根管内、外侧壁树脂去除量并计算器械的中心定位能力，采用SPSS 17.0软件对数据进行统计学分析。结果    iRaCe组预备时间最短，预备效率最高（P < 0.05）。在根尖区，iRaCe组的中心定位能力最好；在弯曲点附近，iRaCe组和HyFlex EDM组的中心定位能力较好，相对优于ProTaper Universal组和Reciproc Blue组；在弯曲点冠方，iRaCe组、Reciproc Blue组、HyFlex EDM组的中心定位能力均显著优于ProTaper Universal组（P < 0.05）。结论　4种机用镍钛器械均可较好地保持原始根管的走向，无明显的偏移及台阶等出现。与ProTaper Universal相比，iRaCe、Reciproc Blue和HyFlex EDM镍钛器械对弯曲根管表现出更加出色的成形能力，更适合用于弯曲根管的预备。     

Nd:YAG激光联合曲安奈德治疗口腔黏膜下纤维化的临床研究

  目的  采用Nd:YAG激光联合曲安奈德治疗口腔黏膜下纤维化患者,观察治疗后纤维化组织的修复、愈合及病情进展情况。  方法  选取2018年6月—2019年10月于杭州师范大学附属医院口腔科就诊的80例口腔黏膜下纤维化患者,采用随机数字表法分为观察组与对照组,每组40例。对照组患者使用曲安奈德注射液治疗,观察组在此基础上使用Nd:YAG激光治疗,2组均持续治疗9周。2组患者治疗前后采用视觉模拟评分法(VAS)评分进行评价,并测量张口程度和口腔黏膜病损面积;采用酶联免疫吸附法(ELISA)测定血清血管内皮生长因子(VEGF)、血小板反应蛋白(TSP)、基质金属蛋白酶-2(MMP-2)水平及血清IL-6、TNF-α水平。  结果  治疗后,对照组口腔黏膜病损面积为(1.47±0.62)cm2,观察组为(0.86±0.23)cm2,观察组口腔黏膜病损面积小于对照组(P < 0.05);2组患者血清VEGF均升高,观察组高于对照组[(0.75±0.19)pg/mL vs.(0.61±0.23)pg/mL, P < 0.05],而血清TSP、MMP-2、IL-6和TNF-α水平均降低,观察组低于对照组(均P < 0.05)。  结论  Nd: YAG激光联合曲安奈德可有效缓解口腔黏膜下纤维化患者口腔灼痛,抑制纤维化发展,并促进纤维化组织的修复与愈合,控制病情进一步发展。      

Malignant transformation of oral lichen planus by a chronic inflammatory process. Use of topical corticosteroids to prevent this progression?

Background: Oral lichen planus is a potentially malignant disorder with a capacity, although low, for malignant transformation. Of all the factors related to the process of malignant transformation, it is believed that the chronic inflammatory process plays a key role in the development of oral cancer. This inflammatory process is capable of providing a microenvironment based on different inflammatory cells and molecules that affect cellular growth, proliferation and differentiation. Objectives: The objectives of our study are: to review the available evidence about the possible relationship between the chronic inflammatory process present in oral lichen planus and its malignant transformation, to discuss the potential therapeutic implications derived from this relationship and to study the role that topical corticosteroids play in the control of oral lichen planus inflammation and its possible progression to malignant transformation. Conclusion: The maintenance of a minimum dose of topical corticosteroids could prevent the inflammatory progression of oral lichen planus to oral cancer.