Therapeutic Effect of Superficial Cryotherapy versus Intralesional Corticosteroids injection in Alopecia Areata

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nour El-dissouki Ibrahim ◽  
Mahira Hamdy Elsayed ◽  
Ahmed Abdel-Fattah Afify
Keyword(s):  
Side Effects ◽  
Alopecia Areata ◽  
Response To Treatment ◽  
High Dose ◽  
Efficacy And Safety ◽  
Steroid Injections ◽  
Intralesional Steroid ◽  
Males And Females ◽  
Intravenous Steroids ◽  
Effects Assessment

Abstract Alopecia areata, one or more round bald patches appear suddenly, most often on the scalp. It can affect males and females at any age. It starts in childhood in about 50%, and before the age of 40 years in 80%. The exact mechanism is not yet understood. There is not yet any reliable cure for alopecia areata. Several topical treatments used for alopecia areata are reported to result in temporary improvement in some people. Their role and efficacy are unknown. Injections of triamcinolone acetonide 2.5–10 mg/ml into patchy scalp, its efficacy is temporary. Oral and pulse intravenous steroids in high dose can lead to temporary regrowth of hair. The sensitisers diphenylcyclopropenone provoke hair growth in treated areas Now, superficial cryotheray is introduced as a possible treatment for Alopecia Areata. With minimial side effects and being less painful. So, this study clarifies the therapeutic efficacy and safety of superficial cryotherapy for treatment of patchy Alopecia areata. Aim of the study The aim of the study is to evaluate and compare the efficacy and safety of Superficial Cryotherapy and Intralesional corticosteroids in the treatment of patchy Alopecia Areata. Patients and methods study included 20 patients complaining of Alopecia Areata. 3 patches of scalp alopecia areata will be randomly subjected to either superficial cryotherapy twice monthly for 3 months (3 cycles, 2-3 seconds) or intralesional steroid injections once monthly for 3 months (triaminoclone acetonide 1:7, 1ml) or intralesional saline (1 ml). Assessment for the response to treatment will be done at one month and three month following treatment by digital photography and by phototrichogram by comparing number of Terminal, and vellus and hair thickness, Also assessment for side effects of therapy will be done. Results Patients treated with TCA showed statistically significant high response compared to patients treated with cryotherapy. Also, side effects assessment showed minimal side effects with treatment with TCA compared to cryotherapy. Conclusion TCA treatment of alopecia areata is much tolerable than treatment with cryotherapy with also better response rates.

Assessment of side effects after serial intralesional steroid injections for idiopathic subglottic stenosis

2020 ◽  
Author(s):  
Ozlem Onerci Celebi ◽  
Sungjin A. Song ◽  
Alena Santeerapharp ◽  
Kanittha Choksawad ◽  
Ramon A. Franco
Keyword(s):  
Side Effects ◽  
Subglottic Stenosis ◽  
Steroid Injections ◽  
Intralesional Steroid

Office-Based Intralesional Steroid Injection for Treatment of Laryngeal Sarcoidosis

2021 ◽  
pp. 000348942199528
Author(s):  
Janice L. Farlow ◽  
Jiwon V. Park ◽  
Robert J. Morrison ◽  
Robbi A. Kupfer
Keyword(s):  
Steroid Injection ◽  
Symptom Relief ◽  
Case Series ◽  
Response To Treatment ◽  
Adjunctive Treatment ◽  
Current Standard ◽  
Steroid Injections ◽  
Systemic Treatments ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection

Objectives: To report preliminary outcomes of a case series of in-office intralesional steroid injections for treatment of laryngeal sarcoidosis. Methods: After diagnosis of laryngeal sarcoidosis, 3 patients were offered in-office steroid injections for primary or adjunctive treatment. Triamcinolone 40 was injected into supraglottic sarcoidosis lesions in the office using a channel laryngoscope. Response to treatment and need for further injections was determined based on patient symptoms and repeat flexible laryngoscopy. Results: In-office intralesional steroid injections provided rapid symptom relief within days that lasted for months, thus decreasing the frequency of operative interventions. For one of the patients in this series, these injections even eliminated the need for tracheostomy. No complications were observed. Conclusions: In-office intralesional steroid injection is an emerging adjunctive treatment for laryngeal sarcoidosis. Prospective studies are required to determine efficacy and long-term risk profiles in relation to the current standard of operative management and systemic treatments.

scholarly journals Does high dose intravenous acetaminophen affect liver function for PDA closure in premature neonate?

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Reza Bahrami ◽  
Aida Ezzatabadi ◽  
Nima Mehdizadegan ◽  
Hamid Mohammadi ◽  
Hamid Amoozgar ◽  
...  
Keyword(s):  
Side Effects ◽  
Liver Function ◽  
Preterm Infants ◽  
Liver Enzymes ◽  
Premature Neonate ◽  
High Dose ◽  
Efficacy And Safety ◽  
Adverse Side Effects ◽  
Significant Difference ◽  
Intravenous Acetaminophen

Abstract Objectives The aim of this study was to collect consistent data on the efficacy and safety and evaluation hepatotoxicity of intravenous acetaminophen for the treatment of PDA in preterm infants. Methods This is an observational longitudinal prospective study on 46 preterm infants with PDA who treated with high dose of acetaminophen and evaluated with echocardiography and serum liver enzymes at Hafez and Zeinabiyeh hospitals from January 2016 to December 2019. Result Forty-six preterm infants with PDA treated with intravenous acetaminophen. Rate of closure of PDA was 82.6. There was no significant difference after treatment regarding AST, ALT, Albumin, total and direct bilirubin (P value > 0.05) and no adverse side effects were observed in association with intravenous acetaminophen. Conclusion High dose of acetaminophen is not more effective than that with standard doses although without hepatotoxic side effect for PDA closure.

scholarly journals Efficacy and Safety of Methotrexate in Combination with Mini Pulse Doses of Methylprednisolone in Severe Alopecia Areata. The Vietnamese Experience

2019 ◽  
Vol 7 (2) ◽  
pp. 200-203
Author(s):  
Anh Tran Thi Van ◽  
Anh Tran Lan ◽  
Minh Ha Anh ◽  
Thuong Nguyen Van ◽  
Phuong Pham Thi Minh ◽  
...  
Keyword(s):  
Side Effects ◽  
Clinical Improvement ◽  
Alopecia Areata ◽  
Hair Growth ◽  
Efficacy And Safety ◽  
National Hospital ◽  
Withdrawal Treatment ◽  
Pulse Dose ◽  
Pre Treatment

BACKGROUND: Treatment of severe alopecia areata remains very difficult, especially in alopecia areata totalis and alopecia areata universalis. Methotrexate is known to be effective in the treatment of severe and chronic autoimmune disorders. OBJECTIVE: To assess the effectiveness and safety of MTX in combination with mini pulse dose of methylprednisolone in the treatment of severe alopecia areata. PATIENTS AND METHODS: The open, uncontrolled study compared pre-treatment and after-treatment. Thirty-eight patients (age 16-64) with severity AA (SALT score > 50 %) visiting National hospital of Dermatology and Venereology from April-2004 to September-2015 were enrolled. All patients received oral methylprednisolone 24mg/day for 3 consecutive days of a week in combination with oral MTX 7,5 mg weekly. This regimen is maintained up to 12 weeks and follow-up until to 6 months. RESULTS: After 6 months, 60.5% of patients show complete hair growth (good response) and 18.4% shows the medium response. There is a significant SALT score reduction: mean baseline SALT score 84.39 ± 17.03 compared to mean post-treatment SALT score 24.19 ± 29.42. Good clinical improvement noted in after 3 months. We do not observe any side- effects related to oral MTX and oral methylprednisolone, and no patients had to withdrawal treatment due to side- effects. CONCLUSION: Combination Methotrexate and mini pulse dose of methylprednisolone are effective and safe in treatment severity alopecia areata.

scholarly journals High Dose Dexmedetomidine: Effective as a Sole Agent Sedation for Children Undergoing MRI

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Sheikh Sohail Ahmed ◽  
Tamara Unland ◽  
James E. Slaven ◽  
Mara E. Nitu
Keyword(s):  
Side Effects ◽  
Vital Signs ◽  
High Dose ◽  
Efficacy And Safety ◽  
Discharge Time ◽  
Exact Test ◽  
Sole Agent ◽  
Institutional Review ◽  
Pediatric Mri ◽  
Dexmedetomidine Infusion

Objective. To determine the efficacy and safety of high dose dexmedetomidine as a sole sedative agent for MRI. We report our institution’s experience.Design. A retrospective institutional review of dexmedetomidine usage for pediatric MRI over 5.5 years. Protocol included a dexmedetomidine bolus of 2 μg/kg intravenously over ten minutes followed by 1 μg/kg/hr infusion. 544 patients received high dose dexmedetomidine for MRI. A second bolus was used in 103 (18.9%) patients. 117 (21.5%) required additional medications. Efficacy, side effects, and use of additional medicines to complete the MRI were reviewed. Data was analyzed using Student’st-test, Fisher’s exact test, and Analysis of Variance (ANOVA).Main Results.Dexmedetomidine infusion was associated with bradycardia (3.9%) and hypotension (18.4%). None of the patients required any intervention. Vital signs were not significantly different among the subgroup of patients receiving one or two boluses of dexmedetomidine or additional medications. Procedure time was significantly shorter in the group receiving only one dexmedetomidine bolus and increased with second bolus or additional medications (P<0.0001). Discharge time was longer for children experiencing bradycardia (P=0.0012).Conclusion. High dose Dexmedetomidine was effective in 78.5% of cases; 21.5% of patients required additional medications. Side effects occurred in approximately 25% of cases, resolving spontaneously.Corrigendum to “High Dose Dexmedetomidine: Effective as a Sole Agent Sedation for Children Undergoing MRI”

scholarly journals SEVERE SINUS BRADYCARDIA SECONDARY TO THE USE OF INTRAVENOUS STEROIDS.

2020 ◽  
Author(s):  
Laura Linares Carsí ◽  
María Tallón García ◽  
Ana María Ocampo Alvarez ◽  
Raquel Cantero Rey ◽  
Cristina Lorenzo Fírvida ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Side Effects ◽  
Sinus Bradycardia ◽  
Corticosteroid Treatment ◽  
Paediatric Oncology ◽  
High Dose ◽  
Intravenous Bolus ◽  
Intravenous Methylprednisolone ◽  
Childhood Diseases ◽  
Intravenous Steroids

High-dose glucocorticoids are commonly used for a wide variety of childhood diseases. They are known to cause several side-effects by oral administration; nonetheless, side-effects associated with intravenous bolus are not well known1. Whereas a rise in blood pressure is a well-known side-effect of corticosteroid treatment, sinus bradycardia has been reported as another adverse effect of high-dose glucocorticoid therapy2. This effect mainly occurs in adults and few cases have been described in children. We report two cases of sinus bradycardia due to intravenous methylprednisolone administration in paediatric oncology patients and the approach we adopted for their resolution.

scholarly journals Pulse steroid therapy in infantile facial hemangiomas: the early experience

2018 ◽  
Vol 5 (2) ◽  
pp. 487
Author(s):  
Pardeep Bhatia ◽  
Preet Mohan Singh ◽  
Vaibhav Sharma ◽  
Manu Kohli
Keyword(s):  
Side Effects ◽  
Steroid Therapy ◽  
Patient Monitoring ◽  
Early Experience ◽  
Response To Treatment ◽  
Efficacy And Safety ◽  
Pulse Steroid Therapy ◽  
Pediatric Cardiologist ◽  
Methyl Prednisolone ◽  
Pulse Steroid

Background: To investigate the efficacy and safety of Pulse steroid therapy in the management of Infantile facial hemangioma in five subjects.Methods: Consecutive patients who presented with facial hemangioma were prospectively enrolled in this study between January 2014 till August 2017. All subjects underwent treatment with 30mg/kg/day I/V methyl prednisolone for 6days and then weekly for 6weeks and then followed by oral daily dosing. All subjects underwent systemic, and radiologic evaluations before treatment and at periodic intervals after starting therapy. Side effects from therapy were also evaluated.Results: Five subjects under 6 months of age, with facial hemangioma were enrolled in this study. After hospital admission, I/V steroid therapy was initiated in all subjects under monitoring by a pediatric cardiologist. Subsequent oral therapy after 6 weeks was performed with periodic out-patient monitoring. All subjects had excellent response to treatment, with regression of facial hemangioma. There were no side effects from therapy.Conclusions: I/V methyl prednisolone pulse steroid therapy for facial hemangioma was effective in all the five subjects. 

scholarly journals Effect of moderate potassium-elevating treatment in long QT syndrome: the TriQarr Potassium Study

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001670
Author(s):  
Peter Marstrand ◽  
Kasim Almatlouh ◽  
Jørgen K Kanters ◽  
Claus Graff ◽  
Alex Hørby Christensen ◽  
...  
Keyword(s):  
Side Effects ◽  
Long Qt Syndrome ◽  
Qt Interval ◽  
Low Dose ◽  
Beta Blockers ◽  
Plasma Potassium ◽  
Response To Treatment ◽  
High Dose ◽  
Long Qt ◽  
Qt Syndrome

BackgroundIn long QT syndrome (LQTS), beta blockers prevent arrhythmias. As a supplement, means to increase potassium has been suggested. We set to investigate the effect of moderate potassium elevation on cardiac repolarisation.MethodsPatients with LQTS with a disease-causing KCNQ1 or KCNH2 variant were included. In addition to usual beta-blocker treatment, patients were prescribed (1) 50 mg spironolactone (low dose) or (2) 100 mg spironolactone and 3 g potassium chloride per day (high dose+). Electrocardiographic measures were obtained at baseline and after 7 days of treatment.ResultsTwenty patients were enrolled (10 low dose and 10 high dose+). One patient was excluded due to severe influenza-like symptoms, and 5 of 19 patients completing the study had mild side effects. Plasma potassium in low dose did not increase in response to treatment (4.26±0.22 to 4.05±0.19 mmol/L, p=0.07). Also, no change was observed in resting QTcF (QT interval corrected using Fridericia's formula) before versus after treatment (478±7 vs 479±7 ms, p=0.9). In high dose+, potassium increased significantly from 4.08±0.29 to 4.48±0.54 mmol/L (p=0.001). However, no difference in QTcF was observed comparing before (472±8 ms) versus after (469±8 ms) (p=0.66) high dose+ treatment. No patients developed hyperkalaemia.ConclusionIn patients with LQTS, high dose+ treatment increased plasma potassium by 0.4 mmol/L without cases of hyperkalaemia. However, the potassium increase did not shorten the QT interval and several patients had side effects. Considering the QT interval as a proxy for arrhythmic risk, our data do not support that potassium-elevating treatment has a role as antiarrhythmic prophylaxis in patients with LQTS with normal-range potassium levels.Trial registration numberNCT03291145.

Resistance of Transplanted Hair Follicles to the Onslaught of Diffuse Alopecia Areata

2017 ◽  
Vol 34 (2) ◽  
pp. 70-72
Author(s):  
Angeline Anning Yong ◽  
Robin Unger
Keyword(s):  
T Lymphocyte ◽  
Alopecia Areata ◽  
Rapid Onset ◽  
Hair Follicles ◽  
Relative Resistance ◽  
Viable Option ◽  
Hair Transplantation ◽  
Steroid Injections ◽  
Intralesional Steroid ◽  
Scalp Biopsy

A 55-year-old man who previously underwent a successful hair transplantation for androgenetic alopecia now presents with rapid onset hair loss over the anterior to mid-scalp areas during a 2-month period. The alopecic area noticeably extended diffusely from anterior hairline to scalp vertex while rows of previously transplanted hair follicles appeared intact. Further dermoscopic features and a scalp biopsy were consistent with alopecia areata incognita. This patient was subsequently successfully treated with intralesional steroid injections. This case report is the first demonstrating the relative resistance of transplanted hair follicles to the process of alopecia areata when compared with local indigenous hairs. Prior to this, a few reports have demonstrated the use of hair transplantation to treat stable areas of alopecia areata resistant to medical treatment with mixed results but at least some initial success. This could be related to the local irritation and inflammatory response resultant from needling during hair transplantation that causes a degree of scarring and fibrosis around each transplanted graft, hence lending a protective barrier to an autoimmune-based T-lymphocyte attack on hair bulbs and subsequent increased survival of transplanted hair follicles. This unexpected observation provides new avenues for investigation into alopecia areata pathophysiology and further supports hair transplantation as a viable option for patients with stable, localized alopecia areata that is recalcitrant to other modalities.

Indian Dermoscopic Study of One Thirty Eight Cases of Alopecia Areata

2018 ◽  
Vol 3 (02) ◽  
Author(s):  
Rahul Kumar Sharma, Divya Sharma, Rajendra Kumar Sharma
Keyword(s):  
Alopecia Areata ◽  
Smart Phone ◽  
Cotton Wool ◽  
Exclusion Criteria ◽  
Dermatology Clinic ◽  
Exclamation Mark ◽  
Single Feature ◽  
Males And Females ◽  
Vellus Hairs ◽  
Difficult Cases

Alopecia areata (AA) is a type of non-scarring alopecia first described by Cornelius Celsus, characterized by hair loss without any clinical inflammatory signs and affecting both males and females equally. The activity of AA is by the presence of black dots, broken hair, and tapering, furthermore black dots and yellow dots are equated to severity of AA. Aim - To study dermoscopic features of untreated cases of alopecia areata. Study subjects-All the patients who attended the dermatology clinic from March 2015 to March 2017 with the clinical diagnosis of alopecia areata and who fulfilled the inclusion and exclusion criteria. Study period - Two year (from March 2015 to March 2017). Methodology - All the patients who attended the dermatology clinic from March 2015 to March 2017 with the diagnosis of alopecia areata and who fulfilled the inclusion and exclusion criteria were recruited for the study. Trichoscopy was performed with DL4 dermatoscope. The images were further magnified with smart phone. Results - We got various dermoscopic signs in different combinations in our study. Yellow dots were seen in 10 cases, White dots in cotton wool pattern were seen in 3 cases, Black dots were seen in 25 cases, Dermoscopic coudability sign was demonstrated in 38 cases, Pigtail hairs were present in 2 cases, five cases showed short vellus hairs, Short broken hairs were found in 18 cases, Exclamation mark hairs were very common and were detected in 131 patients out of 138. Discussion - Single feature is not leading to the diagnosis so we should use combination of features which will help in difficult cases like AA incognito. Dermatoscope is an indispensible valuable tool in trichology practice which helps in prognosticating and making early diagnosis of AA. It also helps to differentiate it from trichotillomania and other causes of alopecia. In our study the incidence of AA was almost similar in both sexes. Our study revealed that exclamation mark hair is very common and sensitive dermoscopic marker of AA.

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