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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 tells you 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 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”.

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”.

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.  

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 localised inflammatory disorders, including discoid lupus erythematosus and sarcoidosis.

What does the procedure involve?

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 anaesthetic, this is not normally necessary; the discomfort associated with the steroid injection is very similar to that caused by an injection of local anaesthetic. 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.

What are the 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. Veryrarely, 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.

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: its contents, however, may occasionally differ from the advice 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

REVIEW DATE OCTOBER 2014

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