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Intralesional steroid therapy

INTRALESIONAL STEROID THERAPY

What are the aims of this leaflet?

This leaflet has been written to help you understand more about intralesional steroid therapy. It explains what intralesional steroid therapy is, what is involved and what the potential side effects are.

What is intralesional steroid therapy?

This is a procedure involving the injection of a steroid solution directly into the skin lesion or immediately below the skin, with the aim of improving its appearance and/or reducing symptoms such as itch or pain. The steroid preparation most frequently used in this procedure is called triamcinolone acetonide, and is sometimes referred to as “intralesional triamcinolone”.

What is a steroid?

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”. Triamcinolone acetonide is one of the corticosteroids.

Corticosteroids work in several different ways, but they are particularly useful in the treatment of skin conditions because they can help suppress inflammation and reduce the amount of collagen in the skin.

The injection of a steroid directly into the affected area of 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 (topical treatment) and, secondly, it will only affect the area of skin in which it is injected rather than affecting the whole body which is what happens when a steroid tablet (oral treatment) is taken by mouth. 

What conditions can be treated with intralesional steroid?

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

What does the procedure involve?

Intralesional injection of a steroid is carried out in the clinic, with no special preparation involved. The doctor should be informed if you have any allergies, problems with general health or if you are taking a blood-thinning medication such as aspirin or warfarin.

Although the area to be treated can be numbed with a local anaesthetic, this is not normally necessary; the discomfort of the steroid injection is very similar to that caused by the injection of a local anaesthetic. Depending on the size of the area to be treated, several injections may be needed at the same time. After the injection the doctor may place a small dressing over the affected area of skin which can be removed after a few hours. Depending on the skin condition being treated further treatment sessions may be offered, at least several weeks apart.

What are the side effects of this treatment?

Immediate side effects:

  • Pain - the procedure is not usually too uncomfortable, although injections into certain parts of the body, such as the palms and soles, can be more uncomfortable, and an injection into a keloid (raised scar) can be painful
  • Bleeding - spots of blood may occur at the injection sites
  • Infection - occasionally infection can happen in the injected skin area and this may rarely develop into an abscess, requiring antibiotic therapy
  • Allergic reaction - this is very uncommon, but may occur if you are sensitive to one of the ingredients of the triamcinolone

Subsequent side effects:

  • Atrophy (thinning of the skin) - this is limited to the area that has been injected, and results in a slight indentation of the skin surface. Very rarely, the skin may ulcerate (become raw)
  • Telangiectasia - the small blood vessels within the treated area become more visible than normal
  • Pigment change - the skin at and around the treatment area may lighten or rarely darken in colour, especially in dark-skinned people
  • Treatment may not be effective, or the condition may recur
  • If steroid is injected near the face, acne-like spots may develop in the nearby skin
  • Rarely, there may be temporary increased hair growth at the area of the injection
  • Rarely, mood changes or insomnia may occur in patients who are very sensitive to the effects of steroids

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

For details of source materials used please contact the Clinical Standards Unit (clinicalstandards@bad.org.uk).

This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor.

This leaflet has been assessed for readability by the British Association of Dermatologists’ Patient Information Lay Review Panel

BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED JULY 2008
UPDATED OCTOBER 2011, JANUARY 2015, NOVEMBER 2019
REVIEW DATE NOVEMBER 2022

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