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Psoriasis
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Potent or superpotent topical steroids can be used once daily (at night) under occlusion. They should be used for 4–6 months and they should be applied to the nail plate, at the hyponychium at the nail folds and at the nail bed, in case the onycholytic nail plate is clipped back. Long-term and repeated use can lead to nail fold atrophy, telangiectasias, and atrophy of the underlying phalanx (disappearing digit). Topical treatment with corticosteroids is unable to act properly in case of subungual hyperkeratosis. Therefore, nail debridement, using 40% urea under occlusion, allows treatment of the nail bed, after removal of the pathological area. Intralesional steroids should follow patients’ counseling. Sometimes, topical anesthesia with freezing spray or distal block is needed, and this depends on the patient, the technique, and the size of the needle. A 30-gauge needle locked to the syringe should be used. Triamcinolone acetonide, in a frequency of monthly injections for 5–6 months, is the medication of choice. The injection site depends on the clinical symptom that we are trying to treat (nail matrix or nail bed). Should Dermojet be used for intralesional treatment? Most experts have abandoned this modality due to sterilization problems of the apparatus and also because of the possibility of ‘splash back’ of small quantities of blood at the time of injecting.
Triamcinolone
Published in Anton C. de Groot, Monographs in Contact Allergy, 2021
General aspects of corticosteroids used on the skin and mucous membranes are discussed in Chapter 2.4. A practical guideline for diagnosing allergic reactions to corticosteroids is presented in ref. 1. Triamcinolone base (alcohol) is used in tablets only. In other applications, esters are used: triamcinolone acetonide (Chapter 3.353), triamcinolone diacetate (Chapter 3.354) or triamcinolone hexacetonide (Chapter 3.355). In topical preparations, triamcinolone acetonide is (virtually) always used. As triamcinolone base is used in oral preparations only, most positive patch test reactions to this corticosteroid must have been the result of sensitization to one of its esters or of cross-sensitization to another corticosteroid.
Scar Care after Surgical Treatment in Oncology Patients
Published in Paloma Tejero, Hernán Pinto, Aesthetic Treatments for the Oncology Patient, 2020
Verapamil is a calcium channel antagonist that both decreases collagen synthesis and increases collagen breakdown [15]. A study from 1992 was the first to report the use of the calcium channel blocker verapamil in the treatment of keloids and hypertrophic scars [18]. There is some controversy in the demonstrated efficacy, whether administered by itself or in combination with corticosteroid. A lower rate of local adverse effects associated with its intralesional infiltration has been described, compared to the infiltration of triamcinolone acetonide [19].
Transdermal delivery via medical device technologies
Published in Expert Opinion on Drug Delivery, 2022
Shubhangi Shukla, Ryan H. Huston, Blake D. Cox, Abhay R. Satoskar, Roger J. Narayan
Researchers have chosen to avoid the water solubility issue by using other nontoxic organic solvents for their iontophoresis buffer mixture. One study dissolved triamcinolone acetonide in a solution of N-N,-dimethylacetamide (as the organic solvent) and water at a ratio of 7/3 v/v [129]. Triamcinolone acetonide is an uncharged drug that is used to inhibit collagen synthesis for keloid and hypertrophic scar treatment. This drug was typically administered via pressure jet injection; however, this approach caused discomfort to patients, necessitating the development of alternative delivery methods [129]. Rats that were treated with iontophoresis for 30 minutes were found to retain triamcinolone acetonide in their skin 24 hours after treatment, indicating the success of N-N,-dimethylacetamide as an alternative solvent for drugs that may not otherwise be suitable for delivery using iontophoresis [129].
Comparison of therapeutic effects of steroid injection by benign vocal fold lesion type
Published in Acta Oto-Laryngologica, 2021
Satoka Takahashi, Takeharu Kanazawa, Tomohiro Hasegawa, Mayu Hirosaki, Daigo Komazawa, Ujimoto Konomi, Yoshitsugu Nimura, Yu Sakaguchi, Miki Nozawa, Tomohiko Yamauchi, Yusuke Watanabe
We used a commercial form of triamcinolone acetonide with a depot solution to prolong the development period (KENACORT-A; Bristol-Myers Squibb K. K., Tokyo, Japan). The KENACORT-A was injected under local anesthesia. In brief, the pharynx and larynx were completely anaesthetized with 4% lidocaine. Three milligrams of triamcinolone acetonide dissolved in 0.3 ml per side of depot solution was injected into and spread onto the superficial lamina propria (SLP), and not into the muscle layer, using a 23-gauge injection needle (Varixer; TOP Corp., Tokyo Japan) under transnasal fiberscopic monitoring of the larynx (Figure 1). The triamcinolone acetonide dose was determined by referring to the manufacturer’s instructions and a previous study [11]. All the participants received the injection bilaterally. To detect possible allergic reactions such as vocal fold edema, the vocal folds were checked using a fiberscope one hour after the injection. Participants received a single dose of injection, which was not repeated. Participants were instructed to rest their voices on the day of the injection but were allowed to use their voices from the following day onwards according to our previously reported injection protocol [12].
Herpetic Anterior Uveitis in a Chinese Referral Center: Clinical Manifestations and Laboratory Test Results
Published in Ocular Immunology and Inflammation, 2020
Zhuyun Qian, Hua Fan, Yong Tao, Wensheng Li, Wei Gu
Additional differences in the clinical features between the HSV-AU group and the VZV-AU group included the age of the patients and the occurrence of scleritis and diffuse iris atrophy. The average age of the patients with HSV-AU was less than the average of the patients with VZV-AU. Van der Lelij et al. also found that HSV was more common in adults under the age of 50, while VZV predominantly affected adults older than. 6017 In our study, anterior scleritis was diagnosed in two eyes infected with VZV-AU. One eye presented with scleral staphyloma and underwent allo-sclera transplantation. Loureiro et al. proposed that VZV-associated scleritis triggered an immune response in addition to direct viral damage, which caused the development of scleritis even with antiviral therapy.18 In our cases, a high dose of sub-conjunctival triamcinolone acetonide (TA) (10 mg) was given to suppress the inflammation. We also found a significantly high rate of diffuse iris atrophy in eyes infected with VZV-AU. The large transillumination defect consisted of multifocal pigment epithelial atrophy, which is different from the diffuse iris atrophy caused by CMV or rubella virus (RV) infection. We speculated that this clinical feature was associated with higher viral load and more severe intraocular inflammation in VZV-AU.