2. Efficacy and safety of needle free jet injector assisted intralesional treatments in dermatology—a systematic review. 50 the jet injections much better and cause less anxiety than conventional hypodermic needle injections. Importantly, we strongly recommend the use of protective safety measures such as smoke evacuators and face masks due to the potential formation of harmful aerosols, especially when antineoplastic drugs such as bleomycin or 5-FU are administered.9 Moreover, caution should be taken when using spring-loaded jet injectors in anatomical areas around large vessels, nerves, and bone, because potential damage can be inflicted with this type of fixed-setting jet injectors.32 Contemporary deficiencies of modern jet injectors include drug spill (residual fluid on the skin surface and formation of potentially harmful airborne small-droplet aerosols). Also, gas-compressed energy-based jet injectors create a relatively loud noise during the injection phase which may lead to anxiety in some patients.6, 12, 58, 59 Therefore, opportunities for improvement of the needle-free injection technology in the future will lie in optimizing the injection efficiency, creating less noisy (smaller) devices, and the development of new technology to reduce the production or capture potentially harmful aerosols. Moreover, with respect to future research, good quality RCTs investigating the efficacy and safety of jet injectors in dermatology are highly needed to conduct a metaanalysis and produce stronger evidence that can be used to provide solid evidence-based recommendations for the use of jet injectors in clinical practice. In conclusion, this systematic review presents an overview and methodological quality assessment of clinical data on the efficacy and safety of intralesional jet injection treatments for dermatological indications. Limited good quality data suggest that intralesional jet injection treatments with 5-FU and TCA in hypertrophic scars and with saline in atrophic acne scars are efficacious and well-tolerated.20,22 In addition, some evidence suggests that jet injector treatment might be less painful for patients than conventional needle injections for certain indications. More high-quality randomized controlled trials are needed to provide future evidence-based recommendations for clinical practice.
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