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 such as itch or pain. 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 work in several different ways, but it is their effects on suppressing inflammation and on reducing the amount of collagen in the skin that are particularly useful 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 only affect the area in which it is injected rather than have 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 other skin conditions, including discoid lupus erythematosus and sarcoidosis.
What does the procedure involve?
Intralesional injection of a steroid is done in the clinic, with no special preparation involved. You should tell the doctor if you have any allergies or problems with your 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 injection of local anaesthetic. Depending on the size of the area to be treated, several 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 not usually too uncomfortable, although injections into certain parts of the body, such as the palms and soles, can be more uncomfortable, and keloid injection can be painful
- Bleeding - spots of blood may occur at the injection sites
- Infection - occasionally infection can be introduced by the injections, and this may rarely develop into an abscess, requiring antibiotic therapy
- Allergic reaction - this is very uncommon, but may occur 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 site may lighten or rarely darken 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 site of injection
- Mood changes or insomnia may rarely 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 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 (email@example.com).
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
REVIEW DATE JANUARY 2018