2. Efficacy and safety of needle free jet injector assisted intralesional treatments in dermatology—a systematic review. 42 Scars and keloids Seven studies, investigated jet injections to treat various scar types (Table 1).20–28 Compared to baseline, spring-loaded jet injections with triamcinolone acetonide (TCA) and silicone sheets showed significant scar thickness reduction in hypertrophic scars, while silicone sheets alone did not (3–5 treatments; p < 0.05; p > 0.05).21 Moreover, pneumatic jet injector-assisted treatment with a mixture of hyaluronic acid and hypertonic glucose led to a reduction in mean scar volume of 0.4 mm3 compared to the untreated side in atrophic facial acne scars (single treatment; p < 0.05).23 Spring-loaded jet injections with bleomycin in keloids and hypertrophic scars led to reduced pain and pruritus with respectively 88% and 89% (2–6 treatments; no comparative intervention; no statistical analyses reported).26 Furthermore, pneumatic jet injections with 5-fluorouracil (5-FU) diluted in corticosteroids (TCA or methylprednisolone acetate) and lidocaine led to a significant reduction of pain and pruritus in patients with keloids, with respectively 69% and 79% compared to baseline (7 treatments; no comparative intervention; p < 0.01; p < 0.05).27 Pneumatic jet injections of hypertonic glucose resulted in a mean Global Aesthetic Improvement Scale (GAIS) of 2.3 ± 0.8 in atrophic scars, striae, and wrinkles compared to baseline (1–5 treatments; no comparative intervention; no statistical analyses).24 In comparison, jet injections with non-crosslinked and crosslinked hyaluronic acid injections in acne and hypertrophic scars resulted in overall GAIS of 1.9 and 1.8 respectively (mean 2.5 treatments; no statistical analyses).25 Jet injections (unknown injector type) with triamcinolone hexacetonide resulted in “good,” “acceptable,” and “negative” results in respectively 68.2%, 15.9%, and 15.9% of children with burn scars (1– 4 series, no comparative intervention; no statistical analyses).28 Local anesthesia Three studies investigated local anesthesia administered by a spring-loaded jet injector before suturing or performing dermatological surgery (Table 2).48–50 Jet injections with mepivacaine chloride resulted in “no pain” in 79.6% of the lesions during surgery (no comparative intervention; no statistical analyses).50 Lidocaine administered with a jet injector compared to injections with a hypodermic needle resulted in a mean anesthesiarelated Visual Analogue Scale (VAS) score of 1.1 vs. 4.4 respectively (p < 0.0001), while
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