Intralesional steroid injections for alopecia

We hypothesize that the fibroblast, or the myofibroblast, or both are the key cells responsible for keloid and hypertrophic scar formation. These cell types produce the bulk of extracellular matrix components during normal wound healing. In fact, experimental evidence suggests that hy­pertrophic scars and keloids result from excessive amounts of collagen and proteoglycan production or from lack of remodeling of these moie­ties.''-" We also hypothesize that wound tension is a major factor in the formation of both the hypertrophic scar and the keloid, which occurs sec­ondary to direct biochemical changes induced by this mechanical factor. Most likely these changes are a direct result of the effect of wound tension on the metabolism of the fibroblast or myofibroblast. Fibroblasts have been shown to increase cell proliferation in response to mechanical tension in Mechanical stretch alone has been shown to raise the number of myofibroblasts in mouse dermis in Presumably, mechanical ten­sion is also responsible for a positive balance in the collagen and proteo­glycan production-degradation cycle in the wound healing under exces­sive tension. We are currently studying the effects of mechanical tension on wound healing at the biochemical level. The cause-effect relationship between hypertrophic scar and keloid formation as well as other etiologic factors, such as the age and race of the patient, remain more highly spec­ulative and are not discussed here.

In patients with the adrenogenital syndrome, a single intramuscular injection of 40 mg every two weeks may be adequate. For maintenance of patients with rheumatoid arthritis , the weekly intramuscular dose will vary from 40 to 120 mg. The usual dosage for patients with dermatologic lesions benefited by systemic corticoid therapy is 40 to 120 mg of methylprednisolone acetate administered intramuscularly at weekly intervals for one to four weeks. In acute severe dermatitis due to poison ivy, relief may result within 8 to 12 hours following intramuscular administration of a single dose of 80 to 120 mg. In chronic contact dermatitis, repeated injections at 5 to 10 day intervals may be necessary. In seborrheic dermatitis, a weekly dose of 80 mg may be adequate to control the condition.

Another issue with usage of intra-lesional steroids is the size, length and thickness of the needle used to inject the keloid lesions. Some physicians falsely believe that a large and thick needle should be used to inject large keloid lesions. This belief comes from the fact that injecting some old and dense keloid lesions is a rather difficult task. In treating keloid lesions, the smaller and thinner the needle is, the less damage it causes to the keloid tissue. Dr. Tirgan only uses the smallest and thinnest needles, those that are used to inject insulin under the skin. With this method, Dr. Tirgan is able to inject any keloid.

Meshkinpour et al (2005) examined the safety and effectiveness of the ThermaCool TC radiofrequency system for treatment of hypertrophic and keloid scars and assessed treatment associated collagen changes.  Six subjects with hypertrophic and 4 with keloid scars were treated with the ThermaCool device: 1/3 of the scar received no treatment (control), 1/3 received one treatment and 1/3 received 2 treatments (4-week interval).  Scars were graded before and then 12 and 24 weeks after treatment on symptoms, pigmentation, vascularity, pliability, and height.  Biopsies were taken from 4 subjects with hypertrophic scars and evaluated with hematoxylin and eosin (H & E) staining, multi-photon microscopy, and pro-collagen I and III immunohistochemistry.  No adverse treatment effects occurred.  Clinical and H & E evaluation revealed no significant differences between control and treatment sites.  Differences in collagen morphology were detected in some subjects.  Increased collagen production (type III > type I) was observed, appeared to peak between 6 and 10 weeks post-treatment and had not returned to baseline even after 12 weeks.  The authors concluded that use of the thermage radiofrequency device on hypertrophic scars resulted in collagen fibril morphology and production changes.  ThermaCool alone did not achieve clinical hypertrophic scar or keloid improvement.  They noted that the collagen effects of this device should be studied further to optimize its therapeutic potential for all indications.

Intralesional steroid injections for alopecia

intralesional steroid injections for alopecia

Meshkinpour et al (2005) examined the safety and effectiveness of the ThermaCool TC radiofrequency system for treatment of hypertrophic and keloid scars and assessed treatment associated collagen changes.  Six subjects with hypertrophic and 4 with keloid scars were treated with the ThermaCool device: 1/3 of the scar received no treatment (control), 1/3 received one treatment and 1/3 received 2 treatments (4-week interval).  Scars were graded before and then 12 and 24 weeks after treatment on symptoms, pigmentation, vascularity, pliability, and height.  Biopsies were taken from 4 subjects with hypertrophic scars and evaluated with hematoxylin and eosin (H & E) staining, multi-photon microscopy, and pro-collagen I and III immunohistochemistry.  No adverse treatment effects occurred.  Clinical and H & E evaluation revealed no significant differences between control and treatment sites.  Differences in collagen morphology were detected in some subjects.  Increased collagen production (type III > type I) was observed, appeared to peak between 6 and 10 weeks post-treatment and had not returned to baseline even after 12 weeks.  The authors concluded that use of the thermage radiofrequency device on hypertrophic scars resulted in collagen fibril morphology and production changes.  ThermaCool alone did not achieve clinical hypertrophic scar or keloid improvement.  They noted that the collagen effects of this device should be studied further to optimize its therapeutic potential for all indications.

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