2. Efficacy and safety of needle free jet injector assisted intralesional treatments in dermatology—a systematic review. 43 2. 2. suturing-related pain was not significantly different (p > 0.05).48 Lidocaine administered with a jet injector vs. needle injections resulted in “no pain” during suturing in respectively 94% vs. 83% of the children.49 Aesthetics Six studies investigated intralesional pneumatic jet injections in the face or neck for aesthetic purposes (Table 2).51–56 Jet injections with hypertonic glucose compared to isotonic glucose improved GAIS with a mean score of respectively 2.5 ± 0.7 vs. 3.1 ± 0.9 (3 treatments; p = 0.005).51 To compare, jet injections with non-crosslinked hyaluronic acid resulted in “improved” and “much improved” GAIS in 42.9% and 57.1% of the patients respectively (5 treatments; no comparative intervention; no statistical analyses).54 Crosslinked hyaluronic acid using jet injections reduced mean Fitzpatrick–Goldman Wrinkle Classification with 21.2% and 27.6%, respectively in the neck and face (1–4 treatments; no comparative intervention; p < 0.05; p < 0.05).56 Hyaluronic acid with jet injections or multi-needle injections and placebo with jet injections or multi-needle injections reduced Wrinkle Severity Rating Scale compared to baseline with 1.0 ± 0.6 vs. 1.5 ± 0.6 vs. 0.5 ± 0.8 vs. 0.5 ± 0.6, respectively (3 treatments; p < 0.05; p < 0.01; p > 0.05; p > 0.05).52 Jet injections with hyaluronic acid reduced Mean Lemperle Rating Score with one point in all areas (2.5 treatments; no comparative intervention; no statistical analyses).53 Jet injections with hypertonic glucose showed “slight” or “notable” improvement in 91% of the patients (1 treatment; no comparative intervention; no statistical analyses).55 Adverse reactions The majority of the adverse reactions were mild and the most common were local erythema, pain, hypo- and hyperpigmentation, bruising, hematoma, atrophy, swelling, and itching (Tables (Tables 1 and and2). No serious adverse events were reported. However, two studies that investigated bleomycin or interferon alfa-n2 delivered with a spring-loaded jet injector for palmar and plantar warts reported severe events including cellulitis, lymphangitis, and large hematomas, which needed surgical drainage and debridement.42, 43 Also, TCA administered by a spring-loaded jet injector for the
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