Use of Potent Topical Corticosteroids (TCS) for Hypergranulation Tissue (HGT) in Pediatric Sufferers


Hypergranulation is a standard complication of wound therapeutic that dermatologists face and is characterised by extra granulation tissue, leading to delayed therapeutic and re-epithelialization. Though a number of remedy choices have been offered within the literature, much less invasive and worsening remedy regimens are sometimes most popular within the pediatric inhabitants. Right here we current the case of a 14-year-old feminine with hypergranulation tissue (HGT) of the scalp who was efficiently handled with topical corticosteroids (TCS). Moreover, a literature assessment was performed to find out the prevalence of topical corticosteroid use for HGT within the pediatric inhabitants. Though not first-line, TCS ought to be thought-about as a non-invasive and painless remedy for HGT within the pediatric inhabitants.

introduction

Hypergranulation is characterised by extra granulation tissue, leading to delayed wound therapeutic and re-epithelialization. Hypergranulation tissue (HGT) usually presents as scaly crimson tissue that extends above and past the unique wound floor [1], Numerous remedy choices have been offered within the literature, similar to silver nitrate and surgical debridement, with none particular optimum possibility. [2], Nonetheless, much less invasive and fewer irritating remedy regimens are most popular within the pediatric inhabitants. Right here we current a case reporting the profitable use of high-potency topical corticosteroids (TCS) for the remedy of HGT in a pediatric affected person.

case presentation

A 14-year-old already wholesome girl, alongside along with her mom, was offered to the clinic complaining of a burning sensation within the scalp. Six weeks in the past, the affected person had dyed her hair with an expired hair product, leading to scalp ache and irritation. She visited the emergency division (ED) the place she offered with an erythematous, scaly scalp erosion. She was prescribed cephalexin and silver sulfadiazine each different day after which each day for 10 days. Two weeks after initially recovering, she started to expertise worsening ache, scaling, and discharge. She returned to ED and was given a 10-day course of 300 mg clindamycin 4 instances each day for potential an infection. After that she was referred for Pediatric Dermatology.

Throughout clinic follow-up, the affected person said that the wound had not improved considerably regardless of remedy. On examination, a 3.5 x 3.0 cm crimson, friable eroded plaque was famous on the highest cranium (Fig. 1) she was identified with HGT and prescribed clobetasol 0.05% ointment to be utilized topically twice each day. After six weeks of remedy, she had full decision (Fig.) 2,

full-resolution-of-hypergranulation-tissue-(HGT)-after-clobetasol-use

Given the particular bodily examination and medical historical past, the prognosis of HGT was extremely suspected over the much less doubtless differential prognosis of pyogenic granuloma and a cutaneous malignancy. The affected person’s mother and father postponed a biopsy rather than empirical remedy and adopted up six weeks later to re-evaluate medical progress. In instances the place the prognosis is unclear or empirical remedy fails, nonetheless, a biopsy ought to be carried out to substantiate the prognosis. If there was medical suspicion of a probably dangerous prognosis, similar to malignancy or an infection, a biopsy would have been really useful. Moreover, if the affected person was not bettering clinically at their six-week follow-up, a biopsy could be the subsequent step.

argument

HGT is characterised by an overgrowth of fibroblasts and endothelial cells that hinder therapeutic by inhibiting the migration of epithelial cells into the wound. It’s related to an elevated danger of an infection [1], Surgical wounds of the scalp, specifically, have elevated susceptibility to the event of HGT [3,4],

Typical remedies for HGT embody silver nitrate, TCS, surgical debridement and pulsed dye laser. [2], Much less generally, topical timolol has been used. [5], Silver nitrate, whereas normally the primary line, is usually ineffective and painful. [2,6], Pulsed dye laser remedies goal the elevated vascular provide of HGT, and are sometimes efficient in refractory instances [4], Nonetheless, attaining an answer usually requires a number of remedies, which might be time-consuming and dear. Though not thought-about a primary line, using TCS has proven promise as an efficient and non-traumatic different. [6,7], The reported profitable remedies of pediatric HGT with TCS are summarized within the desk. 1 [3], A latest assessment of the literature, compiled in over 30 instances of each grownup and pediatric sufferers with HGT, reveals decision of lesions with varied TCs. [6],

affected person’s age mechanism of damage place remedy End result
3 12 months shave biopsy parietal cranium Clobetasol Ointment 0.05% Nearly full answer in two weeks
8 years Excision parietal cranium Fluocinonide Ointment 0.05% Important enchancment in two weeks, full decision in two months
10 years crush damage thumb Fluocinonide Ointment 0.05% Full decision in two weeks

When treating the pediatric inhabitants, nice consideration ought to be paid to deciding on remedies which might be efficient whereas additionally inflicting little discomfort. This precept is adopted in different features of pediatric dermatology, similar to within the remedy of molluscum contagiosum. Whereas remedy of molluscum contagiosum is an efficient remedy technique, it may well trigger vital worry and ache in pediatric sufferers, and is subsequently prevented. [8], Medicines similar to silver nitrate, surgical debridement and laser might be painful and painful for youngsters, and may go away them and their caregivers dissatisfied with their care. In distinction, TCS shouldn’t be painful and might be utilized at dwelling by a caregiver to scale back trauma and worry within the little one. Whereas nearly all of reported instances describe using potent TCS within the remedy of HGT, much less efficiency TCS has additionally proven good efficacy. [9], Thus, it is suggested {that a} trial be performed with a decrease capability TCS earlier than continuing to extra highly effective choices. Moreover, no native or systemic unwanted side effects of TCS remedy for HGT have been reported within the literature. [6,9],

conclusion

In conclusion, excessive efficiency TCS is an efficient remedy for HGT and ought to be thought-about as a remedy possibility within the pediatric inhabitants. Particular care ought to be taken when treating kids to keep away from discomfort whereas maximizing outcomes. In contrast to different normal remedies, TCS are painless and non-invasive, making them a extra palatable possibility for youngsters and their caregivers. This case report provides to the literature proof of decision of HGT tissue following using clobetasol 0.05% ointment, with out the incidence of affected person discomfort. Additional research could also be wanted to check long-term outcomes and to check beauty outcomes with different, extra conventional remedy strategies.



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