Intralesional Steroid Therapy

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.

This therapy involves injecting a steroid solution directly into the skin lesion or immediately below the skin to improve its appearance and/or reduce 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.”

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 a “corticosteroid.” Triamcinolone acetonide is one of the corticosteroids. Corticosteroids work in several different ways, but they are particularly useful in treating 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 happens when a steroid tablet (oral treatment) is taken by mouth.  

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

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 anesthetic, this is not usually necessary; the discomfort of the steroid injection is very similar to that caused by the injection of a local anesthetic.

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, several weeks apart.

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, the 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 injected and resulted 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 color, 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 shallow.