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.
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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)
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● 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 ([email protected]).
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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