Intralesional corticosteroids keloid

The history, MRI, and histology suggest pigmented villonodular synovitis of the knee. However, the question asks what is the analogous histologic disease process of PVNS when located away from the synovial lining of joints, which is giant cell tumor of tendon sheath. Features that help make the diagnosis of PVNS in this case include the intra-articular location, signal uptake on MRI, and the diagnostic hemosiderin laden macrophages on histology. The reference by Abdul-Karim et al. describes the histologic similarities between giant cell tumor of tendon sheath and PVNS. Fibrous dysplasia would show a fibrous histiocytic background with the characteristic chinese letters. Hemangiomas show vascular structures on histology. There is no cellular atypia or high nuclear to cytoplasmic ratio as would be seen with synovial sarcoma and the characteristic giant cell tumor of bone would show the spindle cell background with associated multinucleated giant cells. In addition, none these lesions "change" names with anatomic location. In the reference by McCarthy et al, they discuss the differential diagnosis and treatment of synovial based lesions including PVNS. They argue that because PVNS is a difficult disease to cure, if a patient is relatively asymptomatic treat first with observation followed by synovectomy if pain continues.

Bleomycin is a chemotherapeutic agent that inhibits DNA synthesis in cells and viruses. 9 It causes acute tissue necrosis that may stimulate an immune response. 10 There is no consistent evidence regarding the effectiveness of bleomycin for nongenital cutaneous warts. In five RCTs, cure rates ranged from 16 to 94 percent; one trial even showed higher cure rates in the placebo group. 2 , 7 Adverse effects of bleomycin include pain, swelling, and redness for one week after treatment. Necrosis in the skin may cause scarring, pigment change, or nail damage. Because treatment can lead to significant systemic drug exposure, bleomycin should be avoided in children, pregnant women, and patients with peripheral vascular disease or Raynaud disease. 27 Patients are usually referred to a dermatologist for this treatment.

Treatment is difficult. Due to the intensity of the itch patients often go from doctor to doctor looking for relief. No one treatment is always effective and several treatments may need to be tried. Initial treatment is often potent prescription steroid creams . If these help, a milder cream can be used for longer-term control. Antihistamine creams (Zonalon, Pramoxine) or pills (Atarax, Periactin) are often added for additional relief. Intralesional steroid injections , anti-depressant pills, and non-prescription capsaicin cream helps many of those not improved with the usual treatment.

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.

Bleomycin (Blenoxane), a chemotherapeutic agent, inhibits DNA synthesis in cells and viruses. Bleomycin is an alternative therapy for warts that have not responded to other therapies or warts that may be difficult to surgically excise. Bleomycin comes in 15-unit vials; it typically is diluted with 30 mL of saline, and mL ( units) are injected into the wart. 6 Additional injections can be given every three to four weeks until clearance is achieved. 6 Pain is the major limiting factor to treatment. Potential side effects include scarring, change in pigmentation, nail damage, and Raynaud’s phenomenon. 4 , 21 Bleomycin is listed as pregnancy category D, given its potential for significant absorption following injection. 22 One study 23 examined the use of bleomycin for the treatment of recalcitrant warts. Following application of a topical anesthetic, bleomycin was placed on the wart and “pricked” into the wart using a needle. A clearance rate of 92 percent was observed. 23

Intralesional corticosteroids keloid

intralesional corticosteroids keloid

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.

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