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Treatment Algorithm for Acne Scars
Published in Antonella Tosti, Maria Pia De Padova, Gabriella Fabbrocini, Kenneth R. Beer, Acne Scars, 2018
Daniele Innocenzi, Ilaria Proietti, Concetta Potenza, Patrick M. Zito, Kenneth R. Beer
The use of corticosteroid injections to date is the core treatment available for the management of excessive tissue production in scars. Currently, the most effective and safe regimen for hypertrophic and keloidal acne management appears to be the use of corticotherapy injection of intradermal steroids (triamcinolone acetonide 10 or 40 mg/mL or betamethasone sodium phosphate and betamethasone acetate 5.7 mg/mL). Usually it is best to start with triamcinolone acetonide (10 mg/mL) or betamethasone sodium phosphate and betamethasone acetate (5.7 mg/mL), reserving triamcinolone acetonide (40 mg/mL) for resistant cases [95].
Guidelines for the Practice of Interventional Techniques
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Laxmaiah Manchikanti, Vijay Singh, Andrea M. Trescot, Timothy R. Deer, Mark V. Boswell
There is no consensus among interventional pain management specialists with regards to type, dosage, frequency, total number of injections, or other interventions, yet significant attention in the literature seems to be focused on the complications attributed to the use of epidural steroids in the entire arena of interventional pain management. Thus, various limitations of interventional techniques, specifically neural blockade, have arisen from basically false impressions. Based on the available literature and scientific application, the most commonly used formulations of long-acting steroids (see Table 57.1), which include methylprednisolone (Depo-Medrol®), triamcinolone diacetate (Aristocort®), triamcinolone acetonide (Kenalog®), and betamethasone acetate and phosphate mixture (Celestone Soluspan®), appear to be safe and effective.10 Based on the present literature, it appears that if repeated within 2 weeks, betamethasone probably would be the best choice in avoiding side effects; whereas if treatment is carried out at 6-week intervals or longer, any one of the four formulations would be safe and effective.
Osteoarthritis
Published in Rajan Madhok, Hilary Capell, The Year in Rheumatic Disorders Volume 4, 2004
INTERPRETATION. One hundred patients were randomized to receive either three injections at weekly intervals of hylan G-F 20 (Synvisc) or a single injection of corticosteroid + local anaesthetic (2 ml betamethasone sodium phosphate/betamethasone acetate + 4 ml bupivicaine + 4 ml lignocaine), with further injections allowable if required. The study had a blinded observer but of course the subjects were not blinded. Although both groups improved from baseline for most of the outcome measures (including pain scores and WOMAC indices) there was no significant difference between the groups. For example in the hyaluronic acid group the median visual analogue pain score went from 70 mm to 52 mm over the 6-month study period compared with a change from 64 mm to 52 mm over the same time period for the corticosteroid-treated group. It should be noted that almost half of the corticosteroid-treated group requested a second injection. This still meant, however, that they only received two injections over the 6-month period rather than three.
Intralesional corticosteroid administration in the treatment of keloids: a survey among Dutch dermatologists and plastic surgeons
Published in Journal of Dermatological Treatment, 2023
Qi Yin, Frank B. Niessen, Susan Gibbs, Oren Lapid, Juliette M. I. Louter, Paul P. M. van Zuijlen, Albert Wolkerstorfer
In contrast to RCTs, which scarcely mention syringe and needle sizes (Yin et al. Amsterdam UMC, 2022, unpublished observation), the majority of respondents did mention having preferences for specific syringe and needle sizes. One-third (34.4%) and 12.5% of the participants opted that the choice of syringe and needle size should depend on the type of keloid. Notably, syringe and needle diameter are closely correlated to corticosteroid dosing. The treating physician should realize that larger syringes generate lower injection pressure, and their use may result in inadequate drug delivery. On the other hand, smaller syringes generate higher injection pressure, which increases the risk of drug delivery into the surrounding healthy tissue. However, smaller syringes may generally be indicated, as most keloids, especially naïve ones, are very firm and the operators’ thumb force may not be sufficient to generate the necessary pressure for adequate drug infiltration (17). Considering needle size, injecting with thinner needles may be less painful. However, thinner needles tend to occlude easier. A 30-gauge needle has an inner diameter of 0.16 mm. It has been reported that in TAC 40 mg/mL and betamethasone phosphate/betamethasone acetate 6 mg/mL, particles sizes of >50 µm (0.05 mm) account for 4–12% and 1–3% of the total distribution, respectively (18,19). The larger the number and size of particles, the larger the chance of needle occlusion, especially when the orifice is smaller.
Antenatal corticosteroids-to-birth interval in preterm birth
Published in Acta Clinica Belgica, 2021
Isabelle Dehaene, Kris De Coen, Anna Oostra, Johan Decruyenaere, Kristien Roelens, Koenraad Smets
In our center, when patients are admitted for threatening PTB, a two injection course of ACS (1:1 mixture of betamethasone-acetate and betamethasone-phosphate) is initiated or completed. As regards repeating ACS, the policy (since 2014) is to Repeat ACS when more than 7 days elapsed and a new episode of threatened PTB occurs, 2 injections of 12 mg betamethasone with an interval 24 of hours are given (full repeat course)Repeat ACS weekly when there is threatened PTB at a gestational age of less than 28 weeks, weekly injections of 12 mg betamethasone, with a maximum of 3 repeated gifts, are given (weekly partial repeat course)
Reduction of systemic exposure and side effects by intra-articular injection of anti-inflammatory agents for osteoarthritis: what is the safer strategy?
Published in Journal of Drug Targeting, 2023
Zuoxu Xie, Lu Wang, Jie Chen, Zicong Zheng, Songpol Srinual, Annie Guo, Rongjin Sun, Ming Hu
Clinical studies on IA corticosteroids for OA have been conducted as early as the 1950s [24]. Since then, many of the corticosteroids through IA injection have been approved by the regulatory authorities. Currently, FDA has approved methylprednisolone acetate, triamcinolone acetate (TCA), betamethasone acetate, betamethasone sodium phosphate, triamcinolone hexacetonide, and dexamethasone, for treating OA by IA injection. Generally, IA corticosteroids are recommended for short-term relief to the pain and swelling in the joint (Table 1). Meanwhile, repeated IA corticosteroids have brought up safety concerns, which will be further discussed in the later part of this review.