Intralesional steroid injection

An intralesional steroid injection involves a corticosteroid such as triamcinolone acetonide injected directly into a lesion on or immediately below the skin.

The Science

One of the main uses of IL steroid is for abnormal scar formation (hypertrophic and keloid scar). Abnormal scars happen due to a dysregulation of the normal healing process, resulting in excessive production of collagen, elastin, proteoglycans, and extracellular matrix proteins. There is also an increase in the number of fibroblasts and a type of inflammatory cell called mast cells.

Growth factors and cytokines are altered in keloid scars, with increased amounts of TNF alpha, interferon-beta, and interleukin 6. IL steroid delivers collagen-reducing substances to the scar. Other inflammatory skin conditions can also be treated with IL steroid due to its anti-inflammatory actions.

What it treats

Keloid/hypertrophic scar
Acne cysts and inflamed epidermoid cysts (so-called “blind pimple”)
Alopecia areata – hair loss due to an autoimmune reaction
Inflammatory skin disorders like eczema, discoid lupus erythematosus, psoriasis, hypertrophic lichen planus, lichen simplex chronicus
Other granulomatous disorders such as cutaneous sarcoidosis or granuloma faciale, granuloma annulare
Musculoskeletal disorders like tendonitis, arthritis, synovitis

Suitability

Intralesional steroid injection is NOT suitable for individuals who meet one or more of these criteria:

Active skin infection
Triamcinolone (steroid) allergy or allergy to the preservative used (benzyl alcohol)
Active tuberculosis or systemic fungal infection
Active peptic ulcer disease
Uncontrolled diabetes, heart failure, or severe hypertension
Severe depression or psychosis
Extensive plaque psoriasis

Side Effects

Common Expected Side Effects (INCLUDING DELAYED SIDE EFFECTS)

Swelling, redness, tenderness, bruising to treated areas for 2-24 hours.
Cutaneous lipoatrophy - skin indentations or dimples around the injection sites a few weeks after treatment
White marks (hypopigmentation) or brown marks (post-inflammatory hyperpigmentation) at the site of injection or spreading from the site of injection
Telangiectasia at the site of injection (broken, visible blood vessels)
Localized hypertrichosis (hair growth)
Localized or distant steroid acne: steroids increase growth hormone, leading to increased oil production by the sebaceous glands

Uncommon Side Effects:

Infection
Contact allergic dermatitis due to the preservative, benzyl alcohol
Impaired wound healing
Sterile abscess
Systemic steroid effects like mood changes, insomnia, irritability, Cushing's Disease -very rare unless very high doses are used

What's Involved

A pain block cream is applied to aid comfort. Intralesional steroid is injected directly into the skin lesion using a fine needle after cleaning the site of injection with alcohol or antiseptic solution.

Pre and Post Procedure Care

Pre-Procedure Care:

N/A

Post-Procedure Care:

Avoid touching the treated areas for 2 hours to allow for injection sites to heal. Use a gentle cleanser and moisturizer twice daily and avoid picking at the treated areas.

Benefits

The injection of a corticosteroid directly into the lesion bypasses the barrier of thickened skin to treat scarring, inflammatory skin conditions, granulomatous and musculoskeletal disorders more effectively.

Long term after recommended course of treatments.

2-6 treatments spaced 1 month apart.

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Intralesional steroid injection

Common Expected Side Effects (INCLUDING DELAYED SIDE EFFECTS)

Uncommon Side Effects:

Pre-Procedure Care:

Post-Procedure Care:

Benefits

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