Effectiveness of oral probiotics supplementation in the treatment of adult small chalazion

AIM: To define the possible beneficial impact of probiotics oral supplementation on patients affected by chalazion. METHODS: Prospective comparative pilot study on 20 adults suffering from chalazion randomly divided into two groups. The first group (n=10) received conservative treatment with lid hygiene, warm compression, and dexamethasone/tobramycin ointment for at least 20d. The second group (n=10), in addition to the conservative treatment, received a mixture of probiotic microorganisms of Streptococcus thermophilus ST10 (DSM 25246), Lactococcus lactis LLC02 (DSM 29536) and Lactobacillus delbrueckii (DSM 16606) once a day up to 3mo. Chalazia were classified according to their size into three groups: small (<2 mm), medium (≥2 to <4 mm), or large (≥4 mm). When conservative treatment with and without probiotics supplementation failed to resolve the lesion, invasive methods were used, intralesional steroid injection in medium size chalazion and surgical incision and curettage for the largest ones. RESULTS: Medical treatment with or without probiotics supplementation was effective only on the small size chalazia. There was a significant difference in the time taken for complete resolution of small size chalazia between the two groups in favor of the patients receiving probiotics (38.50±9.04d vs 21.00±7.00d, P=0.039). Medium and large size chalazia did not respond to medical treatment with or without probiotics supplementation over the follow-up period (3mo). The treatment did not induce any complications in both groups and no recurrence of chalaziosis was recorded in both groups. CONCLUSION: The considerable difference in time taken for complete resolution of small chalazia between the two groups in favor of the experimental one confirms the presence of a gut-eye axis.

The Efficacy of Skin Cooling for Pain Relief during Intralesional Steroid Injection for Keloid Treatment: A Randomized Cross-Over Study

Objective: To evaluate if pre-treatment skin cooling can reduce the pain during steroid injection. Materials and Methods: A randomized cross-over study was conducted between September 2015 and October 2016. This study received ethical approval ID035904 No. MURA2016/152. Forty-four subjects with keloid that needed intralesional steroid injection were divided into three pretreatment groups, no treatment, skin cooling with ice pack, and skin applying with a mixture of lidocaine 2.5% and prilocaine 2.5% (EMLA®), in random order. Pain intensity was measured by using 100-mm visual analogue scale (VAS). The satisfaction levels were assessed with orderly interval rating scale from 1 to 5. Repeated-measure analysis of variance (ANOVA) and Bonferroni pairwise comparison were used for data analyses. Results: The mean VAS score at the time of needle puncturing into the skin and during steroid infiltration was statistically significant lower in skin cooling compared to no treatment group (p<0.001) and EMLA group (p<0.05). The satisfaction level was also statistically significant higher in skin cooling compared to no treatment group (p<0.001) and EMLA group (p<0.001). Thirty-seven patients (84%) selected skin cooling method as the most favorable pre-anesthetic method for intralesional steroid injection. Conclusion: Skin cooling with ice before intralesional steroid injection of keloid effectively reduces pain and patients are also satisfied. Keyword: Keloid, Corticosteroid, Pre-treatment, pain, skin cooling

Treatment of Idiopathic Granulomatous Mastitis: Combined Intralesional Steroid Injection with Topical Steroid Administration vs. Systemic (Oral) Steroid

BackgroundIdiopathic granulomatous mastitis (IGM)is characterized by non-caseating granuloma and microabscess formation limited to mammary gland lobules. It is a form of chronic mastitis of unknown pathogenesis. In this study, we aimed to compare the effectiveness of intralesional steroid injection with topical steroids versus systemic steroid therapy in the treatment of IGM. MethodsBetween June 2017 and December 2020, the patients were collected and assessed. IGM was diagnosed histopathologically by tru-cut biopsy in patients with breast mass, pain, and erythema with suspicion of IGM. Included in the study were one hundred and eleven patients who were diagnosed with IGMand who were treated with local or oral administration of corticosteroids, with at least 6 months of follow-up. The patients were divided into 2 groups: a local corticosteroid treatment group (LC, group 1, n=57); and a peroral corticosteroid treatment group (OC, group 2, n=54). Demographic characteristics, treatment responses, recurrence rates, side effects of the steroid, and the need for surgery were compared.ResultsWhile the rate of smoking was 12.3% in the LC group, was 20.4% in the OC group. There was no history of oral contraceptive use in either group of patients. Previous steroid use was significantly lower in the LC group (10.5%) compared to the OC group (55.6%) (p = 0.001). Previous antibiotic use was significantly lower in the LC group (75.4%) compared to the OC group (100%) (p = 0.001). When complete and partial responders were grouped as “responders,” 96.5% in the LC group and 75.9% in the OC group responded after the first course of treatment (p=0.001). 98.2% in the LC group and 87.0% in the OC group were complete responders after the third course of treatment (p=0.003). While 7% of the patients in the LC group had recurrence, 37% in the OC group had recurrence (p=0.001). Steroid-related side effects were lower in the LC group (no) compared to the OC group (11.1%) (p=0.010). Surgery was performed in 3.5% of the LC group, while surgery was performed in 57.3% of the OC group (p=0.001). ConclusionSteroid injection is an IGM treatment with proven efficacy, short response time, low recurrence rate, and lower need surgery. The treatment is easy to administer and minimizes the risk of systemic side effects. Even in clinically severe cases, we believe that steroid injection might be used as monotherapy, or in combination with other therapies, to improve treatment efficacy and create a transition to less aggressive treatments.

WRIST GANGLION TREATMENT: A COMPARISON OF ASPIRATION WITH INTRALESIONAL STEROID INJECTION, LOOP SUTURE, AND SURGICAL EXCISION

Introduction: Ganglions contain transilluminant growths that seem to be tight, smooth, and cystic. They are by far the most frequent soft tissue swelling of the hand, with the dorsum of the wrist being the most prevalent location. Ganglion management options currently include aspiration, loop suture, and surgery. Some supported aspiration combined with steroid injection and loop suture method into the cyst to improve therapeutic outcomes. Objectives: To assess discomfort alleviation, visual results, and recurrence rate in ganglion therapy utilizing aspiration, intralesional steroids (triamcinolone acetate) administration, loop suture approach, versus surgical resection. Material and Methods: -In this prospective and observational study, 50 participants were categorized into 3 groups and managed at GMC Kota during March 2019 and December 2020. Aspiration followed by intralesional steroid (triamcinolone acetate) injection was given to Group A (89 participants), loop suture method was given to Group B (55 patients), and surgical excision was given to Group C (16 patients). Patients were monitored on for up to a year after therapy at one, three, and six months. Results: Out of 89 patients in group A, 88 (98.76%) had pain alleviation, no scars, and just four (4.49%) had recurrence, which was handled by repeating the treatment. Out of 55 patients in group B, 52 (94.55 percent) experienced pain reduction, while three (5.45%) experienced recurrence. In group C, out of 16 patients, 14 (87.5%) experienced pain reduction, while 16 (100%) experienced linear scarring with recurrence (6.25 percent). Patients in group Aexperienced recurrence, which was treated with intralesional steroid.

Hypopigmentation with muscular and subcutaneous atrophy as a complication of Intralesional Steroid injection in Ganglion

Although ganglion cysts are commonly encountered in surgical practice, recurrences have been reported with almost all modalities used in its management [1]. We report an unusual complication following intra-lesional steroid injection. Consent was taken from the father of the patient before presenting this case; permission was also taken from the Institutional Ethics Committee

Life-Threatening Subglottic Stenosis of Granulomatosis with Polyangiitis: A Case Report

Granulomatosis with polyangiitis (GPA) is an autoimmune disease characterized by necrotizing granulomatous inflammation. Subglottic stenosis, which is defined as narrowing of the airway below the vocal cords, has a frequency of 16–23% in GPA. Herein, we present the case of a 39-year-old woman with subglottic stenosis manifesting as life-threatening GPA, which was recurrent under systemic immunosuppressive therapy. The patient underwent an emergency tracheostomy, intratracheal intervention, such as carbon dioxide (CO2) laser surgery and intralesional steroid injection via laryngomicroscopic surgery, and laryngotracheal resection with remodeling. Severe subglottic stenosis treatment requires active intratracheal intervention, surgery, and systemic immunosuppressive therapy.

Postcricoid haemangioma with laryngomalacia in infancy

Infantile haemangioma represents a congenital vascular anomaly commonly observed in the head and neck region. Such an occurrence over the postcricoid region, however, is rather unusual. Herein, the authors report a case of a synchronous postcricoid haemangioma in a 7-week-old newborn diagnosed with severe laryngomalacia. In addition to the floppy redundant arytenoid mucosa, flexible laryngoscopy revealed a lobulated bluish mass at the postcricoid. The lesion was hyperintense on T1-weighted sequence and was enhanced with contrast, supporting the diagnosis of a haemangioma. She underwent surgical excision of the haemangioma with intralesional steroid injection. Surveillance at 6-month postoperation did not show disease recurrence.

Local Steroid Treatment: An Effective Procedure for Idiopathic Granulomatous Mastitis, Including Complicated Cases

Background: This study aimed to evaluate the effectiveness of local steroid treatment (LST) for idiopathic granulomatous mastitis (IGM) and to compare with surgical methods.Methods: Data was retrospectively collected from hospital electronic records. The patients were divided into two groups, the LST group and the surgery group. Intralesional steroid injection and topical steroid administration were applied in LST group. Surgery and LST were compared with regard to: pain before and after the treatment; complication rate; recurrence rate; and treatment cost.Results: Seventy of 72 lesions responded completely to LST. Pre-treatment median maximum diameter was 23.50 (15.25-35.25) mm, which regressed to 16 (12-25) mm after the first LST session. LST was found to be superior to surgery in pain management. No recurrence occurred in any patients in LST group.Conclusion: LST is a treatment for IGM that is cheap, with high efficiency, negligible recurrence, and has good esthetic outcome.

Office-Based Intralesional Steroid Injection for Treatment of Laryngeal Sarcoidosis

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.