Intralesional steroid therapy

Intralesional steroid therapy

Is a procedure involving the injection of a steroid solution into abnormal skin, with the aim of improving its appearance or reducing symptoms. The steroid preparation most frequently used in this procedure is called triamcinolone acetonide, and you may hear the procedure referred to as “intralesional triamcinolone”.

Steroids are

Steroids are naturally-occurring chemicals, produced mainly by the adrenal glands in the abdomen. There are different types of steroids, and the type most commonly used to treat skin problems is known as a “corticosteroid”. Corticosteroids have a variety of properties, but it is their effects on suppressing inflammation and on reducing the amount of collagen in the skin that are particularly utilized in the treatment of skin conditions.

The injection of a steroid into the skin has two advantages over topical and oral steroid treatment: firstly, it will often be more effective in treating deep-seated conditions than a steroid cream or ointment; and secondly, it will have only a local effect rather than the general effects of a steroid taken by mouth.

Conditions best treated with intralesional steroid

The most common uses of intralesional steroid therapy are in the treatment of excess scar tissue (hypertrophic or keloid scars), cystic acne and alopecia areata (a form of hair loss). However, your dermatologist may recommend it for a variety of localized inflammatory disorders, including discoid lupus erythematosus and sarcoidosis.

The procedure involves

Intralesional injection of a steroid is done as an out-patient procedure, with no special preparation involved. You should tell the doctor if you have any allergies or problems with your general health. Although the area to be treated can be numbed with a local anesthetic, this is not normally necessary: the discomfort associated with the steroid injection is very similar to that caused by an injection of local anesthetic. Depending on the size of the area to be treated, a number of injections may be required.

Your doctor will probably place a small dressing over the injected site, and this can be removed after a few hours. Depending on the condition being treated, you may be offered further treatment sessions, at least several weeks apart.

Side effects of this treatment

Immediate side effects:

  • Pain: the procedure is usually well-tolerated, although injections into certain parts of the body, such as the palms and soles, can be more uncomfortable.
  • Bleeding: spots of blood may occur at the injection sites.
  • Infection: occasionally infection can be introduced by the injections, and this may develop into an abscess, requiring antibiotic therapy.
  • Allergic reaction: this is very uncommon, but may occur to one of the constituents of the triamcinolone preparation.

Subsequent side effects:

  • Atrophy (thinning of the skin): this is confined to the area that has been injected, and results in a slight dimpling of the skin surface. Very rarely, the skin may ulcerate.
  • Telangiectasia: the small blood vessels within the treated area become much more visible than normal.
  • Pigmentation changes: the skin at and around the treatment site may lighten or darken in colour, especially in dark-skinned people.
  • Treatment may not be effective, or the condition may recur.

Intralesional steroid therapy is, by and large, a safe procedure, and will NOT cause you to put on weight or develop excess hair. The amount of steroid injected at any one time is small, and the risk of steroid being absorbed into the bloodstream in sufficient amounts to produce internal side effects is very low.