Search Results (122)

Glucocorticoids are widely applied intra-articularly to alleviate inflammation and pain in osteoarthritis (OA). However, repeated administration and high local concentrations can lead to crystal deposition on the cartilage surface, contributing to chondrocyte damage and extracellular matrix (ECM) degradation, potentially accelerating OA progression. Calcium-dependent mechanosensors play a critical role in mediating catabolic responses in chondrocytes, but it remains unclear whether glucocorticoids affect chondrocyte mechanosensitivity or biomechanical properties. This in vitro study examined the dose-dependent effects of triamcinolone acetonide (TA) on chondrocyte biomechanics and mechanosensitivity. Primary human chondrocytes (N = 23) were cultured for one week with TA (2 µM–2 mM) or control medium. Cytoskeletal organization was visualized by F-actin staining (N = 6), and cellular elasticity (N = 5) was quantified via atomic force microscopy (AFM). Mechanotransduction was analyzed by Ca²⁺ imaging (Fluo-4 AM) upon AFM-based indentation (500 nN). Expression of matrix-related and mechanosensitive genes (N = 9) was assessed by qPCR. TA exposure induced a concentration-dependent reorganization of the F-actin cytoskeleton, pronounced at 0.2 mM, accompanied by a significant increase in the elastic modulus (p < 0.001). TA further augmented Ca²⁺ fluorescence intensity under basal conditions and during mechanical stimulation. Blocking cationic mechanosensitive channels with GsMtx4 (N = 3) markedly reduced the TA-evoked Ca²⁺ influx (p < 0.0001). Significant reduction in MMP1 was observed on the transcriptional level (N = 9) after TA-treatment (p < 0.05). In summary, TA enhances chondrocyte stiffness through cytoskeletal condensation and amplifies Ca²⁺-dependent mechanotransduction but reduces MMP1 expression, indicating a dual biomechanical response of chondrocytes to OA under exposure of potent corticosteroid. Full article

Background: Oral lichen planus (OLP) is a chronic inflammatory autoimmune disease. Certain clinical forms of the disease may cause significant discomfort and negatively impact patients’ quality of life. The first-line treatment is topical corticosteroids. The purpose of this narrative review is to evaluate the influence of corticosteroid injections in the treatment of OLP. Methods: A search of the literature was conducted in October 2025 using the following databases: PubMed, Web of Science, Scopus, and Cochrane. Results: Fifteen studies were evaluated. Injections with triamcinolone acetonide at a concentration of 10–40 mg/mL at weekly intervals demonstrated efficacy in reducing pain and healing OLP lesions in these studies. They showed minor adverse effects. Conclusions: Noting the limitations of this narrative review, intralesional corticosteroid injections are an effective and safe method of treating OLP. They should be considered in patients with symptomatic OLP. Full article

Background and Clinical Significance: Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) of the oral cavity is a chronic, rapidly developing mucosal lesion with an unclear pathogenesis, manifesting as a solitary ulcer. Given the malignant clinical appearance of the lesions, it is crucial to ensure the accuracy of the diagnosis to avoid unnecessary invasive surgical interventions. Case Presentation: We present a case involving a 69-year-old female affected by a wide, painful ulcer on the left margin of the tongue. An incisional biopsy was performed, and histopathological examination confirmed the diagnosis, revealing a neutrophilic inflammatory infiltrate with components of eosinophils and lymphocytes. Considering the condition’s reactive and inflammatory nature, we planned a corticosteroid treatment with intralesional injections of triamcinolone acetonide. This therapy delivers the active principle directly to the tissues beneath the ulcerative lesion. In three treatment sessions, we achieved the complete regression of the lesion’s signs and symptoms. During a one-year follow-up period, no recurrences were reported. Conclusions: The scarcity of documented cases and the ambiguity of definitions in the scientific literature highlight the importance of clinical reports, which refine scientific knowledge about this condition. At the same time, we record an effective and non-invasive treatment that could facilitate healthcare professionals in managing these types of oral pathologies. Full article

Background/Objectives: Suprascapular nerve block (SSNB) is a useful therapeutic option for chronic shoulder pain, although the synergistic use of corticosteroids with anesthetics to prolong its effect is a controversial topic. The primary objective of this study was to compare the evolution of pain and functionality using the visual analog scale (VAS) and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire between patients treated with SSNB with corticosteroids (cSSNB) and without them (sSSNB). Methods: A retrospective, observational, longitudinal, analytical cohort study was conducted in 28 patients (14 n per group) aged 50–80 years who had undergone SSNB with 4 mL of 0.25% bupivacaine and 40 mg/mL triamcinolone during 2024 for chronic shoulder pain lasting more than 6 months. The variables to be collected were VAS, DASH, range of motion (ROM) and Lattinen Index (LI) at baseline, the first and the third month. Patients were grouped according to the type of SSNB (cSSNB vs. sSSNB) and analyzed longitudinally and cross-sectionally using IBM-SPSS Statistics version 28.0.0. Results: Regarding pain, the cSSNB obtained a significant reduction in the median VAS of 4 points in the first month (p = 0.001) and in the third month (p = 0.002). In addition, significantly lower evaluations in VAS were obtained in the third month of 3 points (p = 0.04) in favor of the cSSNB. Regarding functionality, a reduction in evaluations with respect to the initial DASH were observed only in the cSSNB, with a difference in the first month of 21.80 points (p = 0.001) and 21.35 points (p = 0.003) in the third month. In addition, differences between groups were found, in favor of the cSSNB, of 19.20 points (p = 0.017) in the first month and 12.55 points (p = 0.012) in the third month. Conclusions: The combined use of corticosteroids in SSNB appears to be associated with better short-to medium-term outcomes in terms of pain and function, compared to the use of SSNB without corticosteroids in chronic rotator cuff pathologies. Full article

Background: Central giant cell granuloma of the jaw is a benign but potentially aggressive lesion that can cause pain, facial deformity, tooth loss, and jaw destruction. Many treatment methods are described in the literature, but the less invasive ones are associated with a higher recurrence rate. For several decades, extensive bone resection procedures have been the most effective treatment to date. This study aimed to evaluate a minimally invasive treatment protocol combining multiple weekly intralesional steroid injections with surgical removal of residual tumor tissue and chemical cauterization using Carnoy’s solution. Methods: Thirteen patients with histologically confirmed central giant cell granulomas of the jaws were treated according to the protocol, including weekly triamcinolone injections and, when necessary, fenestration of the cortical bone to access residual lesions. Patients were monitored clinically and radiologically over six years, with reconstruction of bone defects using autogenous grafts and platelet-rich fibrin. Results: The treatment effectively reduced tumor size, restored cortical bone, and allowed preservation of jaw structure. Only one recurrence was observed, and complications were minor and transient. The protocol was equally effective for both aggressive and non-aggressive lesions, regardless of patient age or comorbidities. Conclusions: These findings suggest that combining pharmacological and surgical approaches with chemical cauterization provides a safe, effective, and tissue-preserving strategy for managing central giant cell granulomas, minimizing recurrence while reducing surgical morbidity. Full article

Poly(lactic-co-glycolic acid) (PLGA) sustained-release systems for intra-articular (IA) delivery aim to extend joint residence time and reduce the reinjection frequency of conventional IA therapies. This review synthesizes current understanding of PLGA degradation, the acidic microenvironment inside degrading microspheres, and release behavior in joints, and surveys clinical experience with extended-release corticosteroid depots alongside emerging platforms for nonsteroidal and biologic agents. To situate PLGA within the broader IA field, we briefly summarize selected non-PLGA sustained-release approaches—such as multivesicular liposomes, hyaluronic acid conjugates, and hybrid matrices—to contextualize comparative performance and safety. For proteins and peptides, central barriers include acidification inside degrading microspheres, aggregation during fabrication and storage, and incomplete or delayed release, as illustrated by glucagon-like peptide-1 analog formulations. Mitigation strategies span pH buffering, excipient-based stabilization, and gentler manufacturing that improve encapsulation efficiency and preserve bioactivity. Translation hinges on manufacturing scale-up and quality systems that maintain critical particle attributes and enable informative in vitro–in vivo interpretation. Clinically, prolonged symptom relief after single dosing has been demonstrated for corticosteroid depots (e.g., ~50% pain reduction over 12 weeks with a single PLGA–triamcinolone injection), whereas repeat-dose safety and indication expansion beyond the knee remain active needs best addressed through multicenter trials incorporating imaging and patient-reported outcomes. Consistent real-world performance will depend on controlling batch-to-batch variability and implementing pharmacovigilance approaches suited to long dosing intervals, enabling broader clinical adoption. Full article

Background/Objectives: While epidural and periradicular corticosteroid injections are well-established treatments for degenerative spinal conditions, intrathecal administration of glucocorticoids remains uncommon and under-researched. To our knowledge, this is the first large contemporary dataset on intrathecal triamcinolone in degenerative lumbar disorders. This study retrospectively analyzes clinical outcomes and complication rates associated with this treatment. Methods: We reviewed patients who received intrathecal injections of triamcinolone for lumbar degenerative spinal diseases between May 2023 and June 2024. Data were extracted from electronic records and included demographics, indication, application method (freehand or CT-guided), dosage, symptom relief, and complications. Results: A total of 722 intrathecal injections were performed (499 patients). The most common indication was lumbar spinal canal stenosis (94.0%). Punctures were performed freehand in 68.4% of the injections; 80 mg of triamcinolone was administered in 71.2%. Follow-up data were available for 528 injections. After 87.3% of these, symptom improvement (binary yes/no) after injection was reported. Duration of benefit was documented after 144 injections: 39.6% reported a relief lasting up to six months, and 25% up to one month. Four complications (0.6%) occurred: one post-puncture headache, one pain aggravation, one case of shortness of breath, and one intracranial subdural hygroma. All were managed conservatively. Conclusions: Despite limited data quality, including missing/non-standardized follow-up and the lack of standardized pain scales for follow-up, this large retrospective cohort provides preliminary evidence that intrathecal triamcinolone may be a safe and effective treatment option for lumbar degenerative spinal disorders, with pain relief observed in the majority of cases. Given the inherent limitations of retrospective Level IV evidence, prospective controlled studies are warranted to further evaluate its role compared to other interventional pain therapies. Full article

Background/Objectives: In rhegmatogenous retinal detachment (RRD), vitreous cortex remnants (VCRs) may contribute to the development and progression of proliferative vitreoretinopathy (PVR). This study aimed to evaluate potential toxicity and trauma secondary to VCRs visualization and removal during pars plana vitrectomy (PPV) for RRD. Methods: Prospective study on patients with primary RRD who underwent PPV. Imaging assessment included widefield OCT (WF-OCT), ultra-WF retinography and fundus autofluorescence (FAF). During PPV, a filtered and diluted triamcinolone acetonide (TA) solution (20 mg/mL) was used to evaluate the presence and extension of VCRs, removed using an extendible diamond-dusted sweeper (EDDS). After six months, retinal and retinal pigment epithelium toxicity and retinal trauma due to VCRs removal were investigated. Results: Retinal reattachment was achieved in 21/21 cases included in the study. No signs of retinal or RPE toxicity were detected and WF-OCT performed in the areas of VCRs removal revealed an intact inner retinal architecture in the majority of eyes, with minor and localized inner retinal indentations in 4 cases. Conclusions: VCRs visualization and removal using TA and EDDS appears to be safe, with no retinal toxicity and very limited and circumscribed mechanical trauma. This approach may contribute to reducing the risk of postoperative PVR. Full article

The sterility of ophthalmic drugs is a fundamental requirement for ensuring patient safety, and as such, it is subject to stringent regulatory standards. However, significant gaps remain regarding the effect of sterilization techniques on the impurity profile and relative content of active pharmaceutical ingredients (API). Previous research involving a set of five APIs used in ophthalmic preparations (dexamethasone, methylprednisolone, aciclovir, tetracycline hydrochloride, and triamcinolone) demonstrated that gamma irradiation led to the formation of specific impurities in the corticosteroids, dexamethasone and methylprednisolone. This study aims to further explore the effect of both gamma and electron beam (E-beam) irradiation on the impurity profiles of these APIs under varying conditions, with and without dry ice. The analyses were conducted using high-performance liquid chromatography with ultraviolet/visible light (UV/VIS) detection and the effect of sterilization conditions was assessed in accordance with the assay and related substances test outlined in the European Pharmacopoeia (Ph. Eur.). Additionally, this study investigated whether exposure in a controlled atmosphere with reduced oxygen or water content could mitigate the formation of impurities and influence the stability of the compounds. The results indicated a protective effect of low-temperature and low-oxygen environments during both gamma and E-beam irradiation but no effect of dry conditions. Full article

The unregulated consumption of corticosteroids causes significant adverse effects on human health. Therefore, it is important to develop methodologies that allow their analysis in pharmaceutical matrices with competitive analysis times and costs. The determination of corticosteroids by micellar electrokinetic chromatography (MEKC) using a background electrolyte (BGE) composed of phosphate buffer and a micellar pseudo-stationary phase constituted by a mixture of surfactants is proposed as an alternative quantification technique. The variables involved in the BGE: phosphate concentration, surfactant (sodium dodecyl sulfate (SDS) or sodium lauryl ether sulfate (SLES)), sodium taurocholate (STC) and the pH value were optimized using a Taguchi L₉ (3⁴) experimental design. Employing the optimal BGE, the separation of the three corticosteroids is possible in a linear range of 1.05–10.0 mg L⁻¹, with limits of detection (LOD) of 0.28–0.35 mg L⁻¹. The relative standard deviation (RSD) values obtained for the repeatability (n = 3) and intermediate precision (n = 9) were less than 5.0%. Pharmaceutical formulations (ointments, injectable solution and ophthalmic solution) were analyzed using the proposed methodology (MEKC) and the official methodology (high-performance liquid chromatography, HPLC), and no significant differences were found between the corticosteroid contents obtained from both methods. Full article

Background/Objectives: Triamcinolone acetonide (TA), a poorly water-soluble corticosteroid, presents formulation challenges due to limited membrane permeability. This study aimed to identify suitable drug–polymer–plasticizer systems for TA using combined theoretical and experimental methods. Methods: Using Hansen solubility parameters, seven hot-melt extrusion (HME)-grade polymers and four plasticizers were initially screened for miscibility with TA. Based on Δδt values, four polymers—Eudragit^® L100 (EUD), Parteck^® MXP (PVA), Plasdone^® S-630 (PVPVA), and Aquasolve™ AS-MG (HPMCAS)—along with triethyl citrate (TEC), were selected for experimental evaluation. Differential scanning calorimetry, thermogravimetric analysis, and Fourier transform infrared spectroscopy assessed thermal behavior, miscibility, and chemical compatibility. Results: Amorphous TA content was highest with EUD (81.1%), followed by PVA (67.5%), PVPVA (45.6%), and HPMCAS (8.5%). Thermal incompatibility and TEC evaporation were observed in PVA, PVPVA, and HPMCAS systems. FTIR suggested TEC should be avoided in melt-based formulations with PVA and PVPVA due to PVA degradation and partial TA oxidation. No significant interactions were detected in HPMCAS samples heated to 220 °C, aligning with theoretical predictions. In contrast, the EUD–TEC system showed limited chemical reactivity and maintained TA’s structural integrity. Infrared bands at 1758 and 1802 cm⁻¹ indicated minor anhydride formation above 160 °C with partial TEC evaporation. Conclusions: EUD/TEC were identified as a promising combination for the HME processing of TA. This work supports the rational formulation of stable amorphous systems for thermolabile drugs with poor solubility. Full article

Background/Objectives: Cystoid macular edema (CMO) is a common complication that follows cataract surgery, presenting management challenges due to the lack of standardized treatment guidelines and the potential for spontaneous resolution. This study aimed to evaluate various treatment modalities for post-operative CMO, including topical non-steroidal anti-inflammatory drugs (NSAIDs), periocular steroids, and intravitreal injections. Methods: A systematic review of the literature was conducted to assess the efficacy of different treatment approaches for post-operative CMO. Studies evaluating topical NSAIDs, periocular steroids, intravitreal triamcinolone acetonide (TCA), dexamethasone implants (Ozurdex), and intravitreal bevacizumab were included. The main outcomes assessed included improvements in vision, resolution of CMO, recurrence rates, and safety profile. Results: Topical NSAIDs, particularly ketorolac and diclofenac, showed effectiveness in acute CMO, while their efficacy in chronic cases was variable. Periocular steroids, including retrobulbar TCA and sub-Tenon injections, demonstrated significant improvements in vision and the resolution of CMO, especially in cases resistant to topical therapy. Intravitreal TCA and dexamethasone implants exhibited variable effects on CMO resolution and recurrence rates, with some studies reporting sustained improvements over 12 months. The role of intravitreal bevacizumab as initial therapy remains unclear, although it may be considered in cases unresponsive to steroids. Conclusions: Topical NSAIDs, often combined with periocular steroids, serve as first-line therapy, with periocular steroids offering additional efficacy in resistant cases. Further research is needed to establish optimal treatment algorithms and improve outcomes for patients with post-operative CMO Full article

Anti-vascular endothelial growth factor (VEGF) treatment with intravitreal brolucizumab (IVBr) was launched as a novel treatment for neovascular age-related macular degeneration (AMD), but the incidence of intraocular inflammation (IOI) as a specific adverse effect of brolucizumab has been reported. We evaluated the dynamics of inflammatory factors in AMD in patients with or without IOI before and after anti-VEGF treatment with IVBr. We describe three patients who did not develop inflammation after three consecutive administrations of IVBr and three in whom inflammation occurred after the first IVBr treatment. The presence or absence of inflammation was determined by slit-lamp examination and a laser flare meter. Aqueous humor was obtained during anti-VEGF treatment with IVBr. Levels of VEGF, platelet-derived growth factor (PDGF)-AA, monocyte chemoattractant protein 1 (MCP-1), interleukin (IL)-6, IL-8, interferon-inducible 10 kDa protein (IP-10), Fms-related tyrosine kinase 3 ligands (Flt-3L), and fractalkine were measured. Vision worsened in one patient who developed IOI after initial IVBr, so IVBr was discontinued and the patient was switched to intravitreal aflibercept with sub-tenon injection of triamcinolone acetonide. IVBr was continued in the two other patients with IOI. VEGF decreased after IVBr in all patients with and without IOI. On the other hand, at 1 month IL-6, IL-8, MCP-1, IP-10, and Flt-3L were higher in the three patients with IOI compared with baseline and with the three patients without IOI. In two patients with IOI, not only flares but also IL-8, IP-10, and Flt-3L decreased from 1 to 2 months after IVBr despite continued IVBr. This case series might lead to a better understanding of the pathogenesis of IOI after IVBr. Full article

This research aimed to develop mucoadhesive buccal films incorporating nanostructured lipid carriers (NLCs) loaded with triamcinolone acetonide (TN-films). A Box–Behnken design was employed as a systematic approach to optimize the formulation. Key components of the NLCs—spermaceti, soybean oil, and polysorbate 80—were considered independent variables. The NLCs were prepared and size-reduced using a combination of hot homogenization and ultrasonic probe techniques. Films were cast using hydroxypropyl methylcellulose (HPMC) as the film-forming agent. The TN-films were characterized based on weight, thickness, tensile strength, elongation at break, contact angle, and surface free energy. Linear regression showed that spermaceti increased film weight and thickness, while polysorbate 80 decreased them. The mechanical strength of the films was primarily influenced by spermaceti; higher concentrations of spermaceti resulted in decreased film strength. Additionally, all independent variables contributed positively to the lipophilicity of the films. The TN-films were found to sustain drug release via a Fickian diffusion mechanism, exhibiting rapid swelling and favorable mucoadhesive properties. Moreover, the TN-films demonstrated superior drug release and permeation to pastes and films loaded with emulsions. These findings suggest that the TN-films represent a promising and effective approach for the buccal delivery of triamcinolone acetonide. Full article

Miescher’s cheilitis (MC) is a rare, idiopathic inflammatory condition marked by recurrent or persistent swelling of the lips and adjacent orofacial areas. This case study aims to explore the clinical presentation of Miescher’s cheilitis and evaluate the effectiveness of intralesional corticosteroid therapy as a treatment approach. A 58-year-old male presented with severe, persistent swelling of both the upper and lower lips, which had been ongoing for six months. The initial treatment with chloroquine was discontinued due to adverse effects and no efficacy. Subsequent treatment involved intralesional injections of triamcinolone acetonide, administered at concentrations of 10 mg/mL and 40 mg/mL. After a total of ten injection sessions, the patient experienced a nearly 70% reduction in lip swelling, with the therapeutic effect lasting for 9 months. Intralesional corticosteroid therapy proved to be an effective treatment for Miescher’s cheilitis, offering significant symptom relief and improvement in lip swelling when other treatments were ineffective or unsuitable. This case highlights the need for individualized treatment plans and underscores the importance of ongoing research to refine management strategies for this challenging condition. Full article