Letter: Treatment of Local, Persistent Cutaneous Atrophy After Corticosteroid Injection with Normal Saline Infiltration

Abstract

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Saline in Dermatology: A literature review

“…Regarding the technique of injection, it is important to achieve tumescence and blanching but to stop infiltration just before the development of intolerable pain. This is important to create a good suspension suitable to take the steroids crystals back 42,51 Regarding the interval between sessions, the studies that use more than one-week interval had comparable results to studies with one-week interval, but the patients take longer time for complete resolution if longer intervals are considered. 52,53 The longer intervals have the benefit of low burden of pain for patients with less hospital visits.…”

“…Shiffman preferred the 1-month interval, explained as that fat cells need 3-4 weeks to rebuild fat, hence the efficacy of treatment. 51…”

Reversal of steroid‐induced lipoatrophy with serial injections of isotonic saline in a child

“…The exact underlying pathogenesis is not known. Shiffman MA proposed that the steroid deposited does destroy the fat cells but allows the escape of fat (triglycerides) from cells through enlargement of the cell pores 4 . Hence, the most effective way to reverse this effect would be to remove the deposited steroid to prevent the escape of fat.…”

Successful treatment of lipoatrophy with normal saline

“…It is hypothesized that injecting saline where steroid crystals lie would put them back into suspension, where the crystals could then be recognized as foreign bodies and naturally removed from the body. 13 Further studies may help elucidate the mechanism of action and are needed to better characterize optimal treatment dose and frequency.…”