Benefits and risks of intralesional corticosteroid injection in the treatment of dermatological diseases

Abstract

Intralesional corticosteroid (CS) injections have been used to treat a variety of dermatological and non-dermatological diseases with variable results. The purpose of the injection is to attain a high concentration of the drug at the diseased site, with minimal systemic absorption. Several CS preparations are available for intralesional injection, although triamcinolone derivatives have gained the widest usage in dermatology. The dose and the interval between injections depend on the type, size and severity of the lesion as well as the response to the previous injections. The most critical issue in the efficacy and also in the development of complications of the injections, is the method of injection. Several local and systemic side-effects have been reported following intralesional injections, but most of them are rare or acceptable. Thus intralesional CS injection is an integral part of the clinical practice of dermatology. Since their introduction in 1951, intralesional CS injections have become an integral part of clinical practice in dermatology. They are used alone or in combination with other therapeutic modalities in the treatment of many skin diseases. The purpose of the injection is to attain a high local concentration of the CS at the diseased site, without significant systemic absorption, thus avoiding the numerous side-effects associated with systemic administration. Intralesional CS injection may be a valuable therapeutic modality in situations where topical CS are not suitable for use, either because of low potency and inefficient epidermal barrier penetration or in clinical conditions associated with epidermal atrophy.

Branch-shaped Cutaneous Hypopigmentation and Atrophy after Intralesional Triamcinolone Injection

“…These effects then produce local tissue atrophy, or, in extreme cases, necrosis 2 . Although the exact pathogenesis of hypopigmentation is unknown, the corticosteroid may reduce the number or activity of melanocytes 1 . Corticosteroids might also alter melanocyte function by inhibiting prostaglandin or cytokine production in various epidermal cells, and may suppress secretory metabolic products from melanocytes without causing their destruction 6 .…”

“…The exact pathogenesis of linear hypopigmentation or atrophy is also unknown. The most widely accepted mechanism is the lymphatic spread of the corticosteroid suspension and resulting linear hypopigmentation or atrophy of skin tissues 1 . After injecting Evans Blue Dye or Alphazurine 2 G (Patent Blue) into atrophic lesions, Kikuchi and Horikawa 7 concluded that the lesions were related to lymphatic vessels.…”

“…Intralesional triamcinolone injections have been used to treat several different kinds of conditions including dermatologic (acne, alopecia areata, hypertrophic or keloid scarring), rheumatologic (rheumatoid arthritis, osteoarthritis), neurologic (multiple sclerosis), ophthalmologic (periocular capillary hemangioma, chalazion) and otolaryngologic (allergic rhinitis, nasal polyp) conditions 1 .…”

Nasal Pseudolymphoma

“…Atrophy and pigment changes can regress in weeks or they may become permanent for a long time or even completely. Even systemic side effects may very rarely occur, such as Cushing's syndrome, allergic reactions, adrenal suppression, syncope, ptosis, blindness, and hyperglycemia (9).…”

“…The most common side effects are local side effects, such as atrophy, hypopigmentation, pain, bleeding, telangiectasia, hypertrichosis, folliculitis, delay in wound healing, ulcers, secondary infections, perilesional linear atrophy and hypopigmentation, allergic reactions, calcifications, and granuloma formation (8,9). Atrophy and pigment changes can regress in weeks or they may become permanent for a long time or even completely.…”