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BackgroundGranulomatous mastitis (GM) is a benign, chronic, inflammatory disease lacking clear treatment guidelines. The purpose of this American Society of Breast Surgeons (ASBrS) prospective, multisite registry was to characterize the presentation of GM and identify treatment strategies associated with symptom resolution and optimal cosmesis.MethodsASBrS members entered data into a registry on patient demographics, treatment, symptoms, and cosmesis over a 1-year period. Initial symptoms were graded as mild, moderate, or severe. The Chi-square test and logistic regression were used to identify factors related to symptom improvement and cosmesis.ResultsOverall, 112 patients with a mean age of 36 years were included. More patients were Hispanic (49.1%) and from the Southwest (41.1%), and management included observation (4.5%), medical (70.5%), surgical (5.4%), or combination treatment (19.6%). Immunosuppression was used in 83 patients (74.1%), including 43 patients who received intralesional steroid injections. Patients with severe symptoms were more likely to undergo surgical intervention compared with those with mild or moderate symptoms (21.4% vs. 0% and 7.5%, respectively; p = 0.004). Within 1 year, 85 patients (75.9%) experienced symptom improvement and/or resolution at a median of 3 months. Receipt of immunosuppressive therapy was predictive of improvement or resolution at 1 month (odds ratio 4.22; p = 0.045). One-year physician-assessed cosmesis was excellent or good for 20/35 patients (57.1%) and was not associated with type of treatment or symptom severity.ConclusionAlthough GM can have a protracted course, the majority of patients in this registry resolved within 1 year, with good cosmetic result. Treatment with immunosuppression appears to be most beneficial, and a symptom-based algorithm may be helpful to guide treatment.

Key Clinical Message: Melkersson–Rosenthal syndrome (MRS) remains an enigmatic pathology due to an unknown etiology. Our report, of a 69‐year‐old man with MRS misdiagnosed for about 40 years, underlines the diagnostic difficulty of this condition. A holistic view of the patient, with a correct medical history investigation, are often decisive in the diagnosis of MRS. Melkersson–Rosenthal syndrome (MRS) is a rare disorder with a still unknown etiology. It is defined by three main symptoms, which are orofacial granulomatosis (OFG), facial palsy, and fissured tongue. It generally presents in young people, during the second or third decade, and its incidence in the entire population is about 1%. We focus our attention on a 69‐year‐old man who came to us with an important swelling of the upper lip. His anamnesis revealed that he suffered from a facial palsy four times in his life and at the physical examination we attested the presence of scrotal tongue. We suspected a misdiagnosed MRS and we searched the web in order to give him a diagnosis and a therapy. We found that OFG is the most common symptom of MRS and that it can show as a non complete form, where the three main symptoms cannot occur simultaneously. We also prescribed a therapy based on the use of topic steroids and antiviral, according to literature. After the positive response to the therapy and according to data found in the most recent literature, we can assume that our patient suffers from a misdiagnosed MRS for about 40 years. [ABSTRACT FROM AUTHOR]

Introduction: Alopecia areata (AA) is a non-scarring alopecia of chronic autoimmune etiology with heterogenous severity against the anagen hair follicle over the scalp, beard, or any part of the body and is associated with a significant psychological morbidity in the mental status of the patients leading the patients to seek treatment for cosmetic reasons. The management of AA is very unpredictable and is associated with various cosmetic adverse effects. This study aimed at comparing the efficacy and safety of a novel procedure of laser-assisted drug delivery system of steroids with the first-line procedure of intralesional steroids (ILS) for the treatment of patchy AA. Aims and Objectives: To assess and compare the efficacy and safety of fractional CO2 laser in combination with topical triamcinolone acetonide aqueous solution and intralesional triamcinolone acetonide as a monotherapy and in the treatment of AA. Materials and Methods: A total of 60 patchy AA patients were included in this study. Patients were randomized into two equal groups: Group A and Group B with 30 patients in each group using a computer-generated block randomization. Patients in Group A received fractional CO2 laser with topical triamcinolone acetonide aqueous solution and Group B received ILS. Both groups received treatment for five settings with each setting a gap of 3 weeks. The efficacy and safety of treatment modalities in both groups were assessed using global photograph assessment (GPA)-scale, lesional area density score percentage of improvement (LAD score improvement %), visual discomfort scale (VDS), visual analogue scale, and documentation of adverse effects in each setting. Results: Efficacy of treatment modality-assessed using means score of GPA-scale and LAD score improvement % suggests quicker results to patients in Group B in initial settings but drastic improvement happens to patients in Group A in subsequent settings. At the end of 5th setting, GPA-scale and LAD score improvement % suggest maximum efficacy in patients in Group A and they are statistically significant (P-value < 0.001). The mean VDS in both groups suggests maximum discomfort in Group A, yet the patient satisfaction at the end of 5th setting was maximum with patients in Group A and they are statistically significant (P-value < 0.001). Cosmetic notable adverse effect of atrophy of skin was documented in 30% of patients in Group B. Conclusion: This study showed that fractional CO2 laser with topical triamcinolone acetonide is a better treatment modality than the intralesional triamcinolone acetonide for the treatment of AA with respect to efficacy, safety, and adverse events. [ABSTRACT FROM AUTHOR]

Key Clinical Message Melkersson–Rosenthal syndrome (MRS) remains an enigmatic pathology due to an unknown etiology. Our report, of a 69‐year‐old man with MRS misdiagnosed for about 40 years, underlines the diagnostic difficulty of this condition. A holistic view of the patient, with a correct medical history investigation, are often decisive in the diagnosis of MRS. Abstract Melkersson–Rosenthal syndrome (MRS) is a rare disorder with a still unknown etiology. It is defined by three main symptoms, which are orofacial granulomatosis (OFG), facial palsy, and fissured tongue. It generally presents in young people, during the second or third decade, and its incidence in the entire population is about 1%. We focus our attention on a 69‐year‐old man who came to us with an important swelling of the upper lip. His anamnesis revealed that he suffered from a facial palsy four times in his life and at the physical examination we attested the presence of scrotal tongue. We suspected a misdiagnosed MRS and we searched the web in order to give him a diagnosis and a therapy. We found that OFG is the most common symptom of MRS and that it can show as a non complete form, where the three main symptoms cannot occur simultaneously. We also prescribed a therapy based on the use of topic steroids and antiviral, according to literature. After the positive response to the therapy and according to data found in the most recent literature, we can assume that our patient suffers from a misdiagnosed MRS for about 40 years.

Objective: To determine the efficacy of office-based intralesional steroid injections (ILSI) as a management therapy for adult subglottic stenosis (SGS). Data Sources: A systematic review was completed using PubMed and Science Direct for office-based management of SGS due to various etiologies. Review Methods: The primary end point measured was a change in surgery free interval (SFI) between endoscopic procedures due to office-based serial ILSI. The secondary end point was to determine what percentage of patients did not require further operative intervention for SGS maintenance therapy after changing management to office-based serial ILSI. Results: We identified 187 abstracts, 4 of which were included in the analysis. The total number of participants was 55. The mean age was 50.4, and 78.1% were women. The etiologies were as follows: idiopathic (58.2%), postintubation/tracheotomy (29.1%), and autoimmune (12.7%). The SFI was reported in 3 of the 4 studies. The reported mean pre-ILSI SFI was 362.9 days and the post-ILSI SFI was 582.2 days. The secondary outcome was reported in 3 of the 4 studies. Forty-one of the 55 patients (74.5%) did not require further operative intervention during the duration of the study. Conclusion: This review explored office-based ILSI as a potential treatment option for patients with SGS. The limited data presented found ILSI significantly lengthened SFI, potentially reducing surgical burden. In addition, ILSI was found to be safe with few reported side effects. [ABSTRACT FROM AUTHOR]

Intralesional corticosteroids are associated with various, uncommon, local adverse events [1]. Atrophy and hypopigmentation most commonlyremain localized to sites of injection. However, outward radiation in a linear, streaky pattern has been reported and is termed “perilesional/perilymphatic hypopigmentation or atrophy [2].” We report a case of this rare adverse event.

Orofacial granulomatosis is a condition that manifests clinically as painless labial enlargement, perioral and mucosal edema, oral ulcers, and gingivitis. It is characterized by non-necrotizing granulomatous inflammation of the oral and maxillofacial region. When the swelling only affects the lips, the pathology is called Miescher's granulomatous cheilitis; however, when it also causes facial paresis and lingua plicata, it is known as Melkersson-Rosenthal syndrome. We report a case that was successfully treated with a combination of a local (intralesional) steroid, a systemic antibiotic, and a systemic steroid. After 6 months of therapy, we observed improvement in gingival hyperplasia and buccal mucosa and lip edema. [ABSTRACT FROM AUTHOR]

Rosai-Dorfman disease was first described in the 1960s and is characterized by hyperproliferation of histiocytes, which presents as painless lymphadenopathy with fever, night sweats, and weight loss. This disease often affects young adults and children of African descent. Different types of RDD exist, including familial, classical (nodal), extranodal, neoplasia-associated, and immune-associated. While this disease can cause significant pain, there is currently no consensus on treatment. This case series outlines three cases of bony involvement of histiocytic neoplasms and our technique for intralesionoal steroid injections. Two cases were successfully treated with intralesional steroid injections and one patient was treated with oral steroids. Histiocytic neoplasms can cause significant pain for patients and there is no standardized treatment as of yet. An interesting finding on MRI was a characteristic peripheral edema we termed the "Halo Sign". Steroids are believed to exert their benefit in treating this disease by apoptosis and reducing tumoral swelling. This case series demonstrates the successful management of bony involvement of RDD with intralesional steroids similar to eosinophilic granuloma. While intralesional steroid injection has previously been described for other types of RDD, this is the first description of bony RDD treated with this technique to our knowledge. • Histiocytic neoplasms represent a wide array of pathology. • Treatment for these neoplasms can vary as well. • Intralesional steroid injections for these neoplasms can be beneficial. [ABSTRACT FROM AUTHOR]

Jihan M Muhaidat,1 Firas Al-Qarqaz,1 Yousef Khader,2 Diala M Alshiyab,1 Hadeel Alkofahi,1 Mohanad Almalekh1 1Department of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; 2Department of Public Health, Community Medicine, Jordan University of Science and Technology, Irbid, JordanCorrespondence: Jihan M MuhaidatDepartment of Dermatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, JordanTel +96227200600Fax +96227200624Email jmmuhaidat@just.edu.joBackground: Alopecia areata (AA) usually manifests as patches of non-scarring hair loss due to immune dysregulation. Intradermal injection of steroids is considered a first-line treatment of patchy AA.Purpose: To compare the efficacy and safety of two commonly used concentrations of intralesional triamcinolone acetonide (ILT) (5 mg/mL vs 10 mg/mL) in the treatment of patchy AA on the scalp.Patients and Methods: A retrospective comparative study that included 85 patients diagnosed with patchy AA on the scalp, who were treated with monthly injections of ILT. Patients were divided into Group 1 that received 5 mg/mL and Group 2 that received 10 mg/mL. The response rate (defined as the percentage of patients who achieved complete hair regrowth) and the side effects were compared between the two groups after completion of three treatment sessions, and recurrence was assessed after 1− 3 years.Results: Demographic composition of the two groups was comparable. The difference in response rate and the side-effects between the two groups were not statistically significant. Complete hair regrowth was noted in 43.5% of patients in Group 1 and 53.8% of those in Group 2 (P=0.340). About 17% and 25% of patients in Group 1 and Group 2, respectively, developed minor local side-effects (P=0.354), and almost 45% of patients from both groups had recurrence after 1− 3 years. Disease duration exceeding 6 months correlated with poor treatment response.Conclusion: Intralesional injection of triamcinolone acetonide 5 mg/mL is equally effective and safe compared to 10 mg/mL in the treatment of patchy alopecia areata.Keywords: alopecia areata, intralesional steroids, triamcinolone acetonide

The management of hidradenitis suppurativa (HS) flares with intralesional steroids lacks strong scientific evidence but limited data suggest that it may be useful. The objective of this study is to assess the clinical and ultrasound responses of HS flares to ultrasound‐guided injections of intralesional triamcinolone (40 mg/ml) with a dilution 1:4 versus 1:2 at 30‐day (t1), 60‐day (t2), and 90‐day (t3) follow‐up. We recruited patients with ≤3 acute lesions, unresponsive to topical therapy. At baseline we assessed lesions clinically and by ultra‐high frequency ultrasound (48 or 70 MHz) and randomly performed an ultrasound‐guided injection of triamcinolone. Assessments were repeated at t1, t2, and t3 follow‐up, re‐injecting the lesion in the case of no or partial response. We treated 49 lesions: 38.8% showed improvements at t1; 46.9% at t2; 6% at t3; and 8.3% showed no clinical and ultrasound improvements. Long‐term follow‐up data confirmed a statistically significant reduction in Visual Analogue Scale (VAS)‐pain, Dermatology Life Quality Index (DLQI), and HS‐Physician Global Assessment (HS‐PGA), as well as edema and vascular signals. No adverse effects were reported. Our study suggests that ultrasound‐injections with a 1:2 dilution are beneficial for HS flares that do not respond to topical treatment and should be included in the therapeutic algorithm. [ABSTRACT FROM AUTHOR]

A 20-year old woman presented to our clinic for multiple keloids owing to various injuries over 3 years. These keloids were distributed over the flexor aspect of the left forearm, the lateral aspect of the left elbow and the superomedial aspect of the left calf. The patient was anxious for treatment to make the keloids flatter.

A Caresse Gamret,1 V Sumanth Potluri,1 Karthik Krishnamurthy,2 Raymond M Fertig31Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; 2Division of Dermatology, Orange Park Medical Center, Orange Park, FL, USA; 3Department of Graduate Medical Education, Orange Park Medical Center, Orange Park, FL, USAAbstract: Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia characterized by loss of follicular stem cells, fibrosis, and a receding frontotemporal hairline, with frequent loss of eyebrows, and less commonly, body hair involvement. Diagnosis is clinical and the disease most often affects postmenopausal women. Treatment is difficult with the goal of disease stabilization rather than hair regrowth due to the scarring nature of FFA. To date, there are no randomized controlled trials evaluating efficacy of treatments. Therefore, much of our knowledge is based on small retrospective studies. In this review, we highlight the various and most current treatment options for FFA, including 5-α-reductase inhibitors, intralesional steroids, hydroxychloroquine, topical steroids, topical calcineurin inhibitors, systemic retinoids, pioglitazone, oral antibiotics, minoxidil, excimer laser, and hair transplantation. Currently, 5-α-reductase inhibitors, intralesional steroids, and hydroxychloroquine have the highest level of evidence for treating FFA, while the remaining therapies have variable results and require further data to draw definitive conclusions.Keywords: frontal fibrosing alopecia, frontal fibrosing alopecia treatment, FFA, FFA therapy

Objectives: Bladder neck contracture (BNC) is a well‐recognized complication following radical prostatectomy (RP). This problem may recur after failing initial endoscopic management. This study evaluated the efficacy of intralesional steroid injection combined with bladder neck incision (BNI) for recurrent BNC following RP. Methods: Between November 2011 and March 2018, data from all men who underwent BNI and intralesional steroid injection for recurrent BNC from a single regional center were collected. BNC was diagnosed endoscopically and identified as recurrent if having previously failed endoscopic management with BNI alone. Follow up was initially performed at 3 months with an International Prostate Symptom Score and urinary flow rate. Patients were noted to be recurrence‐free when discharged from follow up or after having undergone a continence procedure indicating stability of the contracture. Results: Thirty patients underwent BNI and intralesional steroid injection for recurrent BNC over the study period. All patients had received prior endoscopic incision of BNC without lasting success. Seventy percent (21/30) of patients were recurrence‐free post‐procedure, and this increased to 83.3% (25/30) after a repeat procedure in four patients. All five patients who had previous salvage radiotherapy had their recurrent BNC successfully managed with one BNI and intralesional steroid injection. The mean follow up was 33.4 months (range 7‐75). There were no adverse events recorded. Conclusions: BNI combined with injection of intralesional steroids is a simple, cost‐effective intervention which requires no specialist equipment/skills outside the realm of a general urologist. It is safe and has an excellent success rate. [ABSTRACT FROM AUTHOR]

Aim: To report a rare case of cheilitis granulomatosa (CG) with pica disorder presented as chronic persistent lip swelling with an unusual eating disorder., Background: Cheilitis granulomatosa or Miescher's cheilitis is a rare, persistent, or recurring nontender chronic painless swelling of one or both the lips due to granulomatous inflammation, which was first described by Miescher in 1945. It can present as a monosymptomatic form or as a part of other entities of Melkersson-Rosenthal syndrome (MRS)., Case Description: A 14-year-old female patient presented with persistent diffuse swelling of the upper lip for 1 year. She also had an unusual habit of eating clay, mud, and potentially harmful items like flakes of paint for 1.5 years. Clinically, chronic persistent lip swelling involving upper lip and gingival enlargements were present along with systemic manifestations. Patient counseling with combination therapy showed excellent response with no signs of relapse at 6 months of follow-up., Conclusion: Cheilitis granulomatosa is a unique rare inflammatory disorder with many possible contributory factors and exact etiology is poorly understood., Clinical Significance: This case report draws attention to constant exposure to an allergen that could be one of the possible etiological factors to CG secondary to pica eating disorder. Though it is a rare disease, research on the pathogenesis of CG and clinical trials evaluating the efficacy of the various treatments are needed to enhance our understanding of this disease, to improve the quality of life, as patients are very disturbed by the unsightly and distressing nature of macrocheilitis., How to Cite This Article: Dayanarayana U, Shastry SP, Kempegowda RT, et al. Management of Cheilitis Granulomatosa with Pica Disorder: A Rare Case Report. Int J Clin Pediatr Dent 2024;17(4):483-489., Competing Interests: Source of support: Nil Conflict of interest: None Patient consent statement: The author(s) have obtained written informed consent from the patient's parents/legal guardians for publication of the case report details and related images.Conflict of interest: None, (Copyright © 2024; The Author(s).)

Introduction: Cheilitis granulomatosa is an idiopathic granulomatous disorder which is rare and cosmetically disturbing. It presents with a persistent painless labial swelling which obscure etiology. Diagnosis is mainly based on the histopathological features following biopsy. There is no definitive treatment of this disease, reason being its lack of well-defined etiology. It has been proven largely resistant to most of the treatment options. Case Description: A 28-year-old man presented with the labial swelling which was confirmed to be cheilitis granulomatosa following histopathologic examination. We have successfully managed this case using intralesional steroids. Conclusion: Intralesional steroids can be used successfully in management of cheilitis granulomatosa. [ABSTRACT FROM AUTHOR]

BACKGROUND: Langerhans cell histiocytosis (LCH) of the orbit is a rare clinical entity with a diagnostic and therapeutic dilemma. MATERIALS AND METHODS: This was a retrospective study of eight patients with orbital LCH. RESULTS: All eight patients in our series were male, and the mean age at presentation was 8 years (median 6 years; range, 7 months–23 years). All of them had unilateral disease, and the most common presenting complaint was upper eyelid swelling (n = 6). The mean duration of symptoms was 6 weeks (median, 3 weeks; range, 2–20 weeks). Visual acuity was unaffected in seven cases. Clinical diagnosis included rhabdomyosarcoma (n = 4), malignant lacrimal gland tumor (n = 2), orbital cysticercosis (n = 1), and orbital tuberculosis (n = 1). The diagnosis of orbital LCH was confirmed by incisional biopsy (n = 7) or fine-needle aspiration cytology (n = 1). Four cases underwent careful limited curettage and received intralesional steroid, and four cases were treated with intralesional steroid alone after incisional biopsy. Complete tumor resolution was achieved in seven cases after receiving a mean of one intralesional steroid injection (median, 1; range, 1–2), while one patient was advised systemic chemotherapy for residual tumor. No tumor recurrence was noted in any case at a mean follow-up duration of 30 months (median, 23 months; range, 7–96 months). None of the cases developed diabetes insipidus or multisystem disease during the follow-up period. CONCLUSION: Minimal local intervention with intralesional steroids with/without careful curettage achieves complete tumor resolution in unifocal orbital LCH.

Granuloma annulare (GA) is a benign granulomatous skin disease. Subcutaneous granuloma annulare is a rare variant in adults, predominantly affects women and typically involves hands. Differential diagnosis should be made with rheumatoid nodules, which frecuently pose a challenge because of the clinical and histological resemblance. Histopathologically, subcutaneous granuloma annulare is a necrobiotic non-infectious granuloma surrounded by chronic inflammatory infiltrate. Treatment is not standarised, although topical or intralesional stereoids and surgery are used. [ABSTRACT FROM AUTHOR]

Mycosis fungoides is the most common form of cutaneous T-cell lymphoma (CTCL); it rarely exhibits a predilection for hair follicle infiltration. We describe a patient with preferential localization of skin lesions in the head and neck region with eyelid involvement, grouped follicular papules and acneiform lesions, severe pruritus and secondary bacterial infections. The histological presentation showed folliculotropic neoplastic lymphoid cells instead of epidermotropic infiltrates. The final diagnosis was folliculotropic mycosis fungoides (FMF), a rare, more aggressive variant of CTCL. Clinical manifestations of FMF may be challenging; thus, multiple, deep biopsy containing adnexal structures, are required to make this crucial diagnosis.

Introduction: Alopecia areata (AA) is a non-scarring alopecia of chronic autoimmune etiology with heterogenous severity against the anagen hair follicle over the scalp, beard, or any part of the body and is associated with a significant psychological morbidity in the mental status of the patients leading the patients to seek treatment for cosmetic reasons. The management of AA is very unpredictable and is associated with various cosmetic adverse effects. This study aimed at comparing the efficacy and safety of a novel procedure of laser-assisted drug delivery system of steroids with the first-line procedure of intralesional steroids (ILS) for the treatment of patchy AA., Aims and Objectives: To assess and compare the efficacy and safety of fractional CO 2 laser in combination with topical triamcinolone acetonide aqueous solution and intralesional triamcinolone acetonide as a monotherapy and in the treatment of AA., Materials and Methods: A total of 60 patchy AA patients were included in this study. Patients were randomized into two equal groups: Group A and Group B with 30 patients in each group using a computer-generated block randomization. Patients in Group A received fractional CO 2 laser with topical triamcinolone acetonide aqueous solution and Group B received ILS. Both groups received treatment for five settings with each setting a gap of 3 weeks. The efficacy and safety of treatment modalities in both groups were assessed using global photograph assessment (GPA)-scale, lesional area density score percentage of improvement (LAD score improvement %), visual discomfort scale (VDS), visual analogue scale, and documentation of adverse effects in each setting., Results: Efficacy of treatment modality-assessed using means score of GPA-scale and LAD score improvement % suggests quicker results to patients in Group B in initial settings but drastic improvement happens to patients in Group A in subsequent settings. At the end of 5th setting, GPA-scale and LAD score improvement % suggest maximum efficacy in patients in Group A and they are statistically significant ( P -value < 0.001). The mean VDS in both groups suggests maximum discomfort in Group A, yet the patient satisfaction at the end of 5th setting was maximum with patients in Group A and they are statistically significant ( P -value < 0.001). Cosmetic notable adverse effect of atrophy of skin was documented in 30% of patients in Group B., Conclusion: This study showed that fractional CO 2 laser with topical triamcinolone acetonide is a better treatment modality than the intralesional triamcinolone acetonide for the treatment of AA with respect to efficacy, safety, and adverse events., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Cutaneous and Aesthetic Surgery.)

Summary: Background: Alopecia areata (AA) is nonscarring patchy area of hair loss. Platelets rich plasma (PRP) promotes development of new hair follicles. Dermoscopy is a diagnostic tool that helps in evaluation of skin microstructures which are not visible to naked eye. Aim: To evaluate safety and efficacy of (PRP) vs intralesional corticosteroid (ILCs) in treatment of AA. Patients and methods: This study was conducted on 80 patients of both sexes who had AA. Patients were classified into Group I treated by ILCs and group II treated by (PRP). Results were assessed by dermoscopic evaluation and by hair re‐growth score (RGS) at (baseline), 2, 4, 6, 8, and 12 weeks. Patients were followed up for 6 months. Results: There was greater hair re‐growth after treatment in both groups. In group I, (26) patients (65%) showed improvement >70% compared to 29 patients (72.5%) in group II. There was significant re‐growth of pigmented hair and decrease in dystrophic hair (P < 0.001) by dermoscopic evaluation in both groups. The difference between both groups was insignificant (P = 0.57). At follow‐up, two (5%) patients in group II had relapse compared to 10 (25%) patients in group I. Conclusion: Platelets rich plasma is safe and promising therapeutic option in AA. [ABSTRACT FROM AUTHOR]

The present study was conducted to study the efficacy of intralesional steroid (ILS) injection in small benign vocal fold lesions and compare the outcomes with microlaryngeal surgery in terms of improvement in symptoms and reduction in lesion size. The current randomized control trial was conducted in the Department of Otolaryngology at the Postgraduate Institute of Medical Education and Research in Chandigarh between 2014 and 2015. The clinical diagnosis was based on appearance of the lesion during endoscopy and the mucosal vibration pattern. Subjects with lesions of size less than or equal to 5 mm were included. A total of 29 subjects were included in the study and 15 (nine men and six women) of them were randomized to receive ILS injection. Fourteen (13 men and one woman) were randomized to the second group to receive initial microlaryngeal surgery. We noted significant reduction in the size of the lesion among subjects undergoing ILS injection at 12 weeks (1.11 + 1.45 mm) as compared to baseline (2.63 + 1.28 mm) with no recurrence. ILSs are effective in reducing size of lesion and also improve acoustic parameters, perceptual analysis, and grade of dysphonia in patients presenting with small benign vocal cord lesions. [ABSTRACT FROM AUTHOR]

Keloids are abnormal tissue response to cutaneous injury. They are benign fibrocollagenous growth that rise above the skin surface and extend beyond the borders of the original wound. They may also rarely regress spontaneously and show a high level of recurrence after treatment. They usually arise after cutaneous insult, but idiopathic spontaneous etiology is also reported. Their high recurrence creates nuisance not only for the patient but also for the doctors. Bilateral keloids of ear lobules are rare. We report one such case of giant keloids of bilateral ear lobules in a 42-year-old male patient. Keloids have known to be notorious for their poor response to treatment owing to complex and ill-deciphered pathophysiology. Recent studies indicate that transforming growth factor beta and platelet-derived growth factor play an integral role in the formation of keloids. In this article, we have reviewed the available literature to discuss the pathophysiology and treatment modalities that may be used to prevent the recurrence of keloids.

BACKGROUND: Langerhans cell histiocytosis (LCH) of the orbit is a rare clinical entity with a diagnostic and therapeutic dilemma. MATERIALS AND METHODS: This was a retrospective study of eight patients with orbital LCH. RESULTS: All eight patients in our series were male, and the mean age at presentation was 8 years (median 6 years; range, 7 months–23 years). All of them had unilateral disease, and the most common presenting complaint was upper eyelid swelling (n = 6). The mean duration of symptoms was 6 weeks (median, 3 weeks; range, 2–20 weeks). Visual acuity was unaffected in seven cases. Clinical diagnosis included rhabdomyosarcoma (n = 4), malignant lacrimal gland tumor (n = 2), orbital cysticercosis (n = 1), and orbital tuberculosis (n = 1). The diagnosis of orbital LCH was confirmed by incisional biopsy (n = 7) or fine-needle aspiration cytology (n = 1). Four cases underwent careful limited curettage and received intralesional steroid, and four cases were treated with intralesional steroid alone after incisional biopsy. Complete tumor resolution was achieved in seven cases after receiving a mean of one intralesional steroid injection (median, 1; range, 1–2), while one patient was advised systemic chemotherapy for residual tumor. No tumor recurrence was noted in any case at a mean follow-up duration of 30 months (median, 23 months; range, 7–96 months). None of the cases developed diabetes insipidus or multisystem disease during the follow-up period. CONCLUSION: Minimal local intervention with intralesional steroids with/without careful curettage achieves complete tumor resolution in unifocal orbital LCH. [ABSTRACT FROM AUTHOR]

Purpose To describe the clinical presentation, treatment, and outcome of patients with histiocytic lesions of the orbit. Methods Retrospective study of 9 patients treated and followed up between October 2001 and January 2018. Results Eight patients in our series were males and one patient was female. The mean age at presentation was 16.8 years (range, 1 to 42 years). All patients had unilateral disease. The most common presenting complaint was upper eyelid swelling in 8 of 9. All patients underwent preoperative computed tomography (CT) and magnetic resonance imaging (MRI). Eight of 9 patients demonstrated orbital bone erosion with adjacent soft tissue mass. Destruction of the orbital roof and contrast enhancement of dura were detected in 3 cases. All cases underwent orbitotomy and subtotal tumor excision with additional bone curettage (4 cases) and intraorbital steroid (40 mg triamcinolone acetonide) injection (3 cases). Adjuvant systemic chemotherapy consisting of vinblastine and prednisone was administered in 3 cases with dural involvement. External radiotherapy (1000 cGy) was applied in one case because of widespread disease. Histopathologic diagnoses were eosinophilic granuloma (7 cases), necrotic xanthogranuloma (1 case), and Langerhans cell sarcoma (1 case). The mean follow-up period after diagnosis was 19.7 months (range, 1–96 months). There was no systemic or multifocal bone involvement in eosinophilic granuloma cases at initial presentation and follow-up. None of these patients developed diabetes insipidus or neurologic symptoms. The patient with Langerhans cell sarcoma died from systemic disease 1 month after diagnosis of the orbital tumor. The patient with necrotic xanthogranuloma did not develop any malignancy at 9 months follow-up. Conclusions Eosinophilic granuloma was the most frequently encountered orbital histiocytic lesion in our series. Eosiophilic granuloma usually responded well to subtotal tumor excision, bone curettage, and intraorbital corticosteroid injections. Systemic chemotherapy was used in cases with full thickness bone destruction and adjacent dural enhancement in an effort to prevent the development of central nervous system disease. [ABSTRACT FROM AUTHOR]

An 11-month-old male child weighing 8 kg was brought to the plastic surgery out-patient department by his parents with chief complaints of sudden increase in size of a swelling over the upper lip and difficulty in feeding for the last 7 days. It was diagnosed as a case of hemangioma of the upper lip. All the routine and special investigations including coagulation profile of the child were normal. The child was planned for ablation of feeding vessels along with intralesional steroid injection. Airway management of the child posed the challenge for us as the size and site of the lesion carried the risk of difficult intubation and possible risk of extensive hemorrhage. All the requisite equipment for difficult airway management was made ready. We were able to intubate the child with miller number-2 blade from the left angle of mouth without putting much pressure on the swelling. The surgical and postoperative period was uneventful and the child was discharged the next day to be followed up after 2 weeks.

Intralesional ( IL) corticosteroid therapy is a treatment for keloids. IL botulinum toxin type A ( BTA) has been postulated in such an indication with controversial reports. To compare efficacy and safety of IL BTA to the IL corticosteroid therapy in treatment of keloids. Twenty-four patients with keloids were randomly divided into two equal groups: receiving IL steroid repeated every 4 weeks for six sessions (group A) and IL BTA 5 IU/cm3 repeated every 8 weeks for three sessions (group B). Objective parameters (hardness, elevation, and redness), subjective complaints (itching, pain, and tenderness), patient satisfaction, and side effects were evaluated. There was a significant decrease in the volume of the lesions after treatment ( P < 0.01), with a volume reduction of 82.7% and 79.2%, respectively, in both groups. A significant softening of lesions vs. baseline was observed ( P < 0.01), with statistically significant improvement in softening in group A ( P < 0.01). There was a significant decrease in height of lesions and in redness score compared with baseline ( P < 0.01) with no significant difference in between both groups. All patients mentioned a significant reduction of their subjective complaints ( P < 0.01) that were more significant in group B. Skin atrophy and telangiectasia were evident in three patients of group A. The efficacy and safety of the IL BTA were clearly evident in the current work from the rapid significant amelioration of the subjective complaints and the comparable significant improvement of the objective parameters as well as the volume of the keloids in comparison with the IL corticosteroids . [ABSTRACT FROM AUTHOR]

Keloids are abnormal tissue response to cutaneous injury. They are benign fibrocollagenous growth that rise above the skin surface and extend beyond the borders of the original wound. They may also rarely regress spontaneously and show a high level of recurrence after treatment. They usually arise after cutaneous insult, but idiopathic spontaneous etiology is also reported. Their high recurrence creates nuisance not only for the patient but also for the doctors. Bilateral keloids of ear lobules are rare. We report one such case of giant keloids of bilateral ear lobules in a 42-year-old male patient. Keloids have known to be notorious for their poor response to treatment owing to complex and ill-deciphered pathophysiology. Recent studies indicate that transforming growth factor beta and platelet-derived growth factor play an integral role in the formation of keloids. In this article, we have reviewed the available literature to discuss the pathophysiology and treatment modalities that may be used to prevent the recurrence of keloids. [ABSTRACT FROM AUTHOR]

Cheilitis glandularis (CG) is a rare disorder characterized by swelling of the lip with hyperplasia of the labial salivary glands. CG is most commonly seen in the lower lip, in middle-aged to older Caucasian men; however, rarely reported in Asians. The exact cause of CG is unknown, but various agents have been attributed like smoking, chronic irritation, poor oral hygiene, allergy, bacterial infections, syphilis, chronic exposure to sunlight and wind, compromised immune system, and genetic transmission. In this paper, we report a rare case of CG of the superficial suppurative type in a 43-year-old Indian female affecting lower lip which was diagnosed based on clinical and histopathological findings and was treated with intralesional steroid injections. Even though the incidence and occurrence of CG in clinical practice is rare, it presents a diagnostic challenge to dentists because the etiologic factors are uncommon with variations in clinical presentation. Early diagnosis with definitive treatment and frequent monitoring should be carried out to prevent further complications. [ABSTRACT FROM AUTHOR]

The article discusses research conducted to compare intramuscularly applied botulinum toxin A (BTX-A) in the gastroc-soleus complex with intralesional steroids for the treatment of plantar fasciitis. Researchers evaluated 36 patients. They found that patients who received BTX-A experienced more rapid and sustained improvement than patients who received steroids.

Angiolipomas are benign encapsulated, well circumscribed tumours, which show excessive degree of vascular proliferation. Clinically, lesions present as sudden onset of multiple painful nodules. Pain usually does not respond to analgesics. We herein, report a case of a young male, presenting with multiple painful nodules over the forearm and back, which on histopathological examination revealed, encapsulated benign tumour, comprising of proliferated small-caliber vascular channels with microthrombi and variable amounts of mature adipose tissue. Pain subsided on treatment with intralesional steroids and the nodules were excised through a narrow-hole extrusion technique.

To report our experiences of treating periocular capillary haemangioma with particular emphasis on visual outcomes. Patients who underwent treatment for periocular capillary haemangioma were identified, and a chart review was performed. There were seventeen patients in the study. The main indications for treatment were increased size of lesion with threat of amblyopia and partial or full pupil occlusion. Seven patients required more than one type of treatment. Fourteen patients had intralesional steroid treatment and six patients had oral steroids. Intralesional steroids gave variable results with minimal side-effects, oral steroids were very effective but 4 out of 6 patients developed side-effects. The average pretreatment astigmatism was 2.4D and post treatment this had reduced to 1.3D. Final visual outcomes were available for 15 patients, 13 had visual acuity of 6/7.5 or better, two were amblyopic with vision of 6/9-2 and 6/18. In this study, intralesional steroids were used for localized lesions and oral steroids for diffuse haemangiomas with orbital involvement. Treatment especially with oral steroids was found to halt the proliferative phase and assist early haemangioma regression reducing ocular sequelae. [ABSTRACT FROM AUTHOR]

Although keloids were recognised in the Smith Papyrus of ancient times, the precise definition, cause and management have remained elusive. Several forms of treatment have been used with varying success. This study assesses and compares the value of intralesional steroid (Triamcinolone acetonide 40mg/ml), cryotherapy and cryotherapy with intralesional steroid in the treatment of keloids. 33 patients were studied, 11 each in the three arms and the volume of the keloids was recorded using wax patterns of alginate impressions of the keloids to note the change in size postoperatively. The best average percentage response was observed is patients who received both Cryotherapy (CRY) and Intralesional Steroid (ILS) (69.02%) followed by patients who received only intralesional steroid (43.98%). Among the patients who received only cryotherapy, the average percentage response was only 39.24%. 72.73% patients who received intralesional steroid with cryotherapy showed more than 50% improvement (good response) while only 9.09% patients who received intralesional steroid alone and cryotherapy alone showed similar improvement. In patients with keloids good response can be obtained with CRY with ILS as compared to ILS alone and CRY alone. [ABSTRACT FROM AUTHOR]

Abstract: Background: Hemangioma is a common vascular tumor. Though it involutes spontaneously, results are unpredictable. Steroid therapy is an effective mode of its regression. We present our experience of largest series and possible recommendations for treatment. Materials and methods: A total of 2398 patients were treated during the study period of 20 years. They were given oral prednisolone, intralesional triamcinolone, or combination of both as per the protocol and followed for the response. Response to the treatment was graded as excellent, good, poor, or no response. Results: The male-to-female ratio was 1:2.3. In 81% of patients, hemangioma was noticed within first month of life. The commonest site of involvement was head and neck (57%). The commonest clinical presentation was discoloration and swelling. Mean age and size were 8.43 ± 7.04 months and 23.64 ± 20.13 cm2. Response rate was highest for superficial type using any modality of treatment. Patients younger than 1 year showed better response (90.3%) in comparison with children older than 1 year (80.8%). The specific complications occurring were infections in 249 (12.4%), cushingoid facies and growth delay in 62 (3.1%), and hypertension in 51 (2.5%) patients. Conclusion: Steroid therapy either oral or intralesional as per the requirement is an easy and safe modality. Results are good to satisfactory in most patients. The complications are minimal. If treatment is needed, it should be used as a first-line therapy, especially when cost is an important concern. [Copyright &y& Elsevier]

A 7‐year‐old healthy boy presented with an asymptomatic smooth, firm red plaque on the cheek. Histopathology, immunostaining, molecular testing and imaging confirmed a diagnosis of a primary cutaneous marginal zone B‐cell lymphoma. The lesion was treated with intralesional triamcinolone, with complete clinical resolution achieved within one year. Intralesional steroid injection is an effective first‐line modality for the treatment of patients with limited disease in cosmetically sensitive areas. [ABSTRACT FROM AUTHOR]

The mechanical properties of 17 keloids in 9 patients before and during treatment with intralesional triamcinolone acetonide were studied using a recently developed noninvasive suction device for measuring skin elasticity in vivo. Each keloid was treated with intralesional injections of 10 mg/ml triamcinolone acetonide without local anaesthetic at intervals of 3 weeks. A total of four measurements per keloid were performed, before treatment and 3 weeks after the first, second and third treatments. The parameters used were: immediate distension ( Ue), delayed distension ( Uv), immediate retraction ( Ur) and final distension ( Uf). Relative parameters independent of skin thickness were calculated: Uv/ Ue, the ratio between the viscous and the elastic deformation of the skin, and Ur/ Uf, representing the ability of the skin to return to its initial position after deformation (biological elasticity). After three injections of triamcinolone acetonide a marked decrease in Uv/ Ue and a lesspronounced increase in Ur/ Uf compared with baseline values was observed. These findings indicate that the main effect of intralesional steroids on the connective tissue of keloids is a decrease in viscosity due to a loss of ground substance. This method provides a noninvasive quantitative assessment of the mechanical properties of scars and is well suited to comparative studies on the efficacy of various scar therapies. [ABSTRACT FROM AUTHOR]

An 11-month-old male child weighing 8 kg was brought to the plastic surgery out-patient department by his parents with chief complaints of sudden increase in size of a swelling over the upper lip and difficulty in feeding for the last 7 days. It was diagnosed as a case of hemangioma of the upper lip. All the routine and special investigations including coagulation profile of the child were normal. The child was planned for ablation of feeding vessels along with intralesional steroid injection. Airway management of the child posed the challenge for us as the size and site of the lesion carried the risk of difficult intubation and possible risk of extensive hemorrhage. All the requisite equipment for difficult airway management was made ready. We were able to intubate the child with miller number-2 blade from the left angle of mouth without putting much pressure on the swelling. The surgical and postoperative period was uneventful and the child was discharged the next day to be followed up after 2 weeks. [ABSTRACT FROM AUTHOR]