Intralesional corticosteroid injection as an effective treatment method for oral lesions: a meta-analysis

Gholizadeh, Narges; Sadrzadeh-Afshar, Maryam-Sadat; Sheykhbahaei, Nafiseh

doi:10.1590/s2175-97902019000418077

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Review • Braz. J. Pharm. Sci. 56 • 2020 • https://doi.org/10.1590/s2175-97902019000418077 linkcopy

Intralesional corticosteroid injection as an effective treatment method for oral lesions: a meta-analysis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Intralesional corticosteroid injection (ICSI) is known as one of the main methods used for treating a wide range of lesions. It also results in a high concentration of drugs at lesion sites, with minimal systemic absorption. Thus, this study aimed to provide a review of the intralesional corticosteroid injection (ICSI) indications in the treatment of oral lesions. To this end; relevant key words were searched in the databases of PubMed, Google Scholar, Scopus, ScienceDirect, and UpToDate in the present study. Accordingly, the results of a total number of 62 case reports or case series articles were used in this study and the positive therapeutic effects of intralesional corticosteroid injection (ICSI) in 23 common oral lesions were reported. The most common type of intralesional steroid in the treatment of oral lesions was triamcinolone. No significant difference was also observed in terms of pain in patients following the use of steroid alone or in combination with anesthetic agents; moreover, the reported side effects of this method were exceptionally rare and transient. It was concluded that the intralesional corticosteroid injection (ICSI) could be one of the effective therapeutic methods with no significant problems in many oral lesions such as inflammatory, immunologic, and vascular ones due to its higher therapeutic effects than other topical forms of steroids and fewer side effects than systemic corticosteroid.

Keywords:
Intralesional corticosteroid injection; Triamcinolone; Betamethasone; Oral lesions; Oral disorders; Steroid injection

Author & Year	Type of Lesion	Type of ISCI	Does of ISCI	Number of ISCI	Intervals of ISCI	Result of treatment	Follow up	Side effects
Agha-Hosseini et al., 2016	CPLA	Triamcinolone 40 mg/mL		3	2 w	Complete regression	6 m	none
Buckmiller, Francis, Glade, 2008	hemangiomas	Triamcinolone and betamethasone	40 and 6 mg/cm³	1-3	6-25 w (12 w)	11 lesions complete resolution	6 m	4 Patients failure to thrive
Meeuwis et al., 1990	hemangiomas	Methylprednisolone	20-40 mg	1-5		Complete regression .	6 m to5 y	Pneumonia, slight growth, acne Retardation, and fluffy Hair growt
Farmand, Kuttengerg, 1996	lymphangioma	Triamcinolone (instilled through the suction drain)	10 mg/kg (30-160 mg)	1-2		completely disappeared in 1 case, residual tumor excised	1-4 y	None
Luo, Gan, 2013	lymphatic malformations	Triamcinolone acetonide (50 mg/5 mL) + Pingyangmycin 0.625 mg/mL	5 mL	8	2e4 weeks	pingyangmycin with triamcinolone was more effective than pingyangmycin alone	-	None
Parisi, Glick, Glick, 2006	PG	Triamcinolone 40 mg/mL	(0.1 mL with 0.5 mL of 0.5% bupivicaine	6	1 & 2 inj weekly, and 4 inj bi-weekly	90% resolved	10 w	None
De La Rosa García, 2006	PG	Triamcinolone	5 mg	3	-	complete resolution	-	none
Adenis-Lamarre et al., 2009	PG	Triamcinolone
Dolanmaz et al., 2016	CGCG	Triamcinolone + 0.5 % marcaine + epinephrine	3.5 mL	6	Weekly	4 complete resolution, 2 Partial recovery, 1 did not response	39 m	None
Nogueira et al., 2010	CGCG	Triamcinolone (20 mg/mL) + 2% lidocaine	0.1 mL/cm³	6	bweekly	15 complete resolution, 4 Partial recovery, 2 did not response	4-8 y	None
Sezer et al., 2005	CGCG	Triamcinolone (10 mg/mL) + lidocaine 2%	4 mL	6	Weekly	complete resolution	3 Y	None
Da Silva Sampieri et al., 2013	CGCG	Triamcinolone + Articaine	2 mL	6	Weekly	complete resolution	3 Y	None
Carlos, Sedano, 2002	CGCG	Triamcinolone (10 mg/mL, + Lidocaine 2% orBupivacaine 50%	3-6 mL	4-20	every 15 days- every 3 weeks	complete resolution	2-7 y	None
Haldar, 1976	Cheilitis glandularis	Triamcinolone 1.5 mg/mL	2 to 3 mg in 10 to 15 Places	10	4 weekly and 2 biweekly, 2 monthly, 2 bimonthly	complete resolution	8 m	None
Sugaya, Migliari, 2018	Cheilitis glandularis	10 mg triamcinolone suspension 0.1% tacrolimus ointment)		2	Monthly Twice daily, 2 w	completely resolving	1 y	None
Samiee, 2011	TMD	Triamcinolone acetonide, 40 mg/mL	0/5 mL	1	-	reduced signs and symptoms	1 w	temporary facial palsy
Stoll et al., 2012	TMD	Triamcinolone hexacetonide, 20 mg/mL	0/5-1 mL	1	-	reduced signs and symptoms	0.5 - 23 m	None
Alstergren et al., 1996	TMD	methylprednisolone 40 mg/mL + lidocaine	0/5-0/7 mL	1	-	reduced signs and symptoms and NPY-LI	6 w	None
Bjørnland, Gjaerum, Møystad, 2007	TMD	Betamethasone sodium phosphate+ acetate	0/7-1 mL	2	Biweekly	reduce pain and improve function	6 m	Temporary pain after injections
Lee et al., 2013	Langerhans cell histiocytosis	methylprednisolone, 40 mg/mL	3 mL	1	-	complete resolution	35 mo	None
Milián, 2001	Langerhans cell histiocytosis	Triamcinolone acetonide	25 mg	8	every 3 weeks	complete resolution	1 y	none
Esen et al., 2010	Langerhans cell histiocytosis	methylprednisolone succinate (40 mg/mL)	2 mL	3	Every 4 month	Near-complete resolution	36 m	None
Putters et al., 2005	Langerhans cell histiocytosis	methylprednisolone succinate (40 mg/mL)	1-2 mL	1	-	complete resolution	9 y	None
Graham, Barret, Goltz, 1999	Nodular fasciitis	Triamcinolone acetonide (10mg/mL)	1.5 mL.	1	-	completeresolution	1 y	None
Kaplan, 2012	necrotizing sialometaplasia	Dexamethasone+ 2% lidocaine	10 mg	1	-	The lesion got worsen.	1 w	None
Keogh et al., 2004	necrotizing sialometaplasia	Triamcinolone	10 mg	3	Weekly	There was no difference in the rate of healing	1 m	None
Picciani et al., 2010	RAS	Betamethasone dipropionate+ disodiumphosphate	5 mg/mL + 2 mg/mL	1	-	partial regression in first week. No recurrence in 6 months	6 m	None
Ohbayashi et al., 2007	GVHD	0.2% dexamethasone	0.5 mg/cm²	1	-	drastically improving	-	None
De Oliveira et al., 2011	mTOR inhibitor stomatitis	Triamcinolone 40 mg/mL (4 case clobetasol gel 0.05%	8 to 24 mg	1-9	biweekly	drastically improving	-	None
Villa et al., 2015	mTOR inhibitor stomatitis	Triamcinolone acetonide	-	1-4	Weekly (4-15d)	immediate symptomatic improvement, complete resolution 2 to 70 days	-	None
Xia et al., 2006	Ulcerative OLP	Triamcinolone (40 mg/mL	0/5 mL	1 and 2	biweek	Relief of sign & symptoms and reduction in size	4 week	None
Lee et al., 2013	OLP	(40 mg/mL) Triamcinolone acetonide	0.5 mL	5	4 weekly and 1 biweekly	significantly improve in pain and burning mouth	1 y	cushingoid features.
Liu et al., 2013	OLP	Betamethasone Triamcinolone	1.4 mg 8 mg	2	weekly	Betamethasone wes better than triamcinolone	3m	None
Borahan, Fisekcioglu, Alpay, 2014	Erosive OLP	Methylprednisolone acetate	0.1 cc	5	biweekly	significantly improvement		Abscess formation Mucosal atrophy
Metwalli et al., 2018	OLP	Triamcinolone acetonide	20 mg/mL	2	weekly	significantly improvement but no statistically significant differences with BCG-PSN	2 w	2 case atrophy and persistent \ erythema
Tilakaratne, 2016	OSF	Methylprednisolone	40 mg	6	monthly	improving mouth opening	1 y	None
Singh, 2014	OSF	Betamethasone Lycopene	4 mg	16	Twice weekly	Lycopene is better than betamethasone.	4 m	None
James, 2015	OSF	Dexamethasone+ Hyaluronidase + Lignocaine HCL	1.5 mL 1500 IU 0.5 mL	2	biweekly	Improvement in mouth opening Reduction in burning sensation and ulceration	9 m	None
Kumar, 2007	OSF	Betamethasonee + Lycopene	2 1-mL ampules of 4 mg	4	biweekly	Mouth opening was increased more in steroid group.	6 m	None
Singh, 2010	OSF	Hydrocortisone acetate+ Hyaluronidase Triamcinolone+ Hyaluronidase	1.5 mL 1500 IU 10 mg 1500 IU	22 11	Weekl Biweekly	Biweekly injections was more convenient because of number of visits and cost	3 m	None
Nguyen, Ahmed, 2014	Pemphigus vulgaris	Triamcinolone acetonidein 2% xylocaine	10-15 mg	4	Every three weeks	lesions resolved within five to sevendays.	18 m	None
Abbas et al., 2014	Pemphigus vulgaris	Triamcinolone + 2gcellcept	10 mg/mL +daily	2		Resolving within 2 months.	1 year	None
Mignogna et al., 2010	Pemphigus vulgaris	Triamcinolone acetonide	40 mg ⁄mL diluted 2 : 1 with saline (i.e. 25 mg ⁄mL) per four lesions	2-8	weekly	Reducing time of remission and total number of corticosteroids	5.3 years	Gingival pellets and Candidiasis
Kalinska-Bienias et al., 2016	MMP	Triamcinolone	0.3 - 2 mL per erosion	2- 18	-	remission	6-10 m	None
Leroux et al., 2011	Cluster headache	Cortivazol+ verapamil	3.75 mg in 1.5 mL	3	48-72 hours	Rapidly relief was seen in steroid group	3-11 m	None
Gaul et al., 2016	Cluster headache	Triamcinolone and bupivacaine	10 mg	1	-	Steroid ijectiois an easy, safe and effective	60 days	None
Sinha R, 2016	Mucocele	Betamethason 4 mg/ mL	1 mL	2-4	weekly	18 case complete resolved, 2 case Reduced in size	6 m	Mild discomfort
Mortazavi et al., 2017	M ucocele	dexamethasone (8 mg/2 mL + silk sutures )		3	weekly	Complete healing	6 m	None
Baharvand et al., 2014	Mucocele	8 mg/mL Dexamethasone	1 mL	3	weekly	7 case complete resolved 2 case Reduced in size	(6-20 m)	Mild discomfort
Mignogna et al., 2004	orofacial granulomatosis	Triamcinolone 40 mg/mL	1 mL (4 mg)	2-3	weekly	lip swellingsettle in all patients with 3 recurrences	3-30 m	Hypopigmentation of the upper lip skin
Ravindran, Karunakaran, 2013	orofacial granulomatosis	Triamcinolone acetonide	-	2	biweekly	Improvement with no recurrences	1 y	None
van der Waal et al., 2002	orofacial granulomatosis	Triamcinolone acetonide		Within 2-6 m	biweekly to monthly	Patients responded to ICSI.	8.2 y	None
Yang et al., 2005	Plasma Cell Cheilitis	Triamcinolone acetonide	5.0-4.0 mg/mL	2-4	biweekly	lesions healedcompletely	-	None
Tseng et al., 2008	Plasma Cell Cheilitis	Triamcinolone acetonide (2.5 mg ⁄ mL ).	0.1 mL	2	biweekly	healedcompletely	1 y	None
Kaur et al., 2001	Plasma Cell Cheilitis	triamcinolone acetonide 10 mg/mL		3	biweekly	healedcompletely	3 m	None
Ebrahimi, Nader, Kendall, 2016	trigeminal neuralgia			2		excellent pain relief
Elshiek, Amr, 2016	trigeminal neuralgia	Methylprednisolone	40 mg	1	-	Calcitonin was better than steroid	2w to 12m	None
Hannon, 1983	Foreign-body Granuloma	Triamcinolone diacetate	0.7 mL and 0.5 mL	2	biweekly	healed completely	6 w	None
Anjomshoaa et al., 2013	Follicular Lymphoid Hyperplasia	Triamcinolone acetonide	40 mg in 1 mL	4	weekly	completely resolved .	7 m	none

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