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


Hypergranulation is a typical 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 introduced within the literature, much less invasive and aggravating remedy regimens are sometimes most well-liked 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 overview 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 of 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], Varied remedy choices have been introduced within the literature, resembling silver nitrate and surgical debridement, with none particular optimum possibility. [2], Nonetheless, much less invasive and fewer irritating remedy regimens are most well-liked 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 together with her mom, was introduced 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 introduced 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 occasions each day for doable an infection. After that she was referred for Pediatric Dermatology.

Throughout clinic follow-up, the affected person acknowledged 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 precise bodily examination and scientific 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 dad and mom postponed a biopsy instead of empirical remedy and adopted up six weeks later to re-evaluate scientific progress. In instances the place the prognosis is unclear or empirical remedy fails, nevertheless, a biopsy ought to be carried out to verify the prognosis. If there was scientific suspicion of a probably dangerous prognosis, resembling malignancy or an infection, a biopsy would have been beneficial. Moreover, if the affected person was not enhancing clinically at their six-week follow-up, a biopsy could be the following 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],

Standard remedies for HGT embrace 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, reaching an answer usually requires a number of remedies, which could be time-consuming and dear. Though not thought of a primary line, the usage of TCS has proven promise as an efficient and non-traumatic various. [6,7], The reported profitable remedies of pediatric HGT with TCS are summarized within the desk. 1 [3], A current overview of the literature, compiled in over 30 instances of each grownup and pediatric sufferers with HGT, exhibits decision of lesions with numerous TCs. [6],

affected person’s age mechanism of harm place remedy Outcome
3 12 months shave biopsy parietal cranium Clobetasol Ointment 0.05% Nearly full resolution 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 harm thumb Fluocinonide Ointment 0.05% Full decision in two weeks

When treating the pediatric inhabitants, nice consideration ought to be paid to choosing remedies which might be efficient whereas additionally inflicting little discomfort. This precept is adopted in different facets of pediatric dermatology, resembling within the remedy of molluscum contagiosum. Whereas remedy of molluscum contagiosum is an efficient remedy technique, it will probably trigger vital worry and ache in pediatric sufferers, and is due to this fact prevented. [8], Medicines resembling silver nitrate, surgical debridement and laser could be painful and painful for kids, and might go away them and their caregivers dissatisfied with their care. In distinction, TCS just isn’t painful and could be utilized at house by a caregiver to scale back trauma and worry within the baby. Whereas the vast majority of reported instances describe the usage of 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 negative 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 of as a remedy possibility within the pediatric inhabitants. Particular care ought to be taken when treating youngsters to keep away from discomfort whereas maximizing outcomes. In contrast to different customary remedies, TCS are painless and non-invasive, making them a extra palatable possibility for kids and their caregivers. This case report provides to the literature proof of decision of HGT tissue following the usage of 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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