Intralesional Steroids Injections
Intralesional injection is the direct delivery of medication percutaneously into skin lesions. Intralesional injections are effective for a wide range of indications, are easily performed, and are relatively safe.
The main aim for intralesional therapy is simple: to deliver a medication directly into a specific skin lesion or immediately beneath the skin to treat local tissues with minimal systemic effects. The skin also serves as a reservoir, allowing medication deposited in the dermis to be delivered over a period of time, resulting in prolonged therapy while avoiding or minimizing the adverse effects of systemic therapy.
The drugs primarily used for intralesional injections are corticosteroids, but in recent years bleomycin, 5-fluorouracil, methotrexate, chloroquine, and interferons also have been dispensed in this manner.
Triamcinolone acetonide and triamcinolone diacetate are the most widely used intralesional corticosteroids, although many other steroids including dexamethasone, depo medrol betamethasone are used by most dermatologists.
Indications for intralesional corticosteroid therapy are acute and chronic inflammatory skin conditions; hyperplastic and hypertrophic skin disorders, and conditions that typically have a favorable response to systemic and topical corticosteroids.
Hypertrophic (hyperplastic) or thickened types of lesions includes hypertrophic scars and keloids, lichen simplex chronicus, hypertrophic discoid lupus erythematosus, psoriasis, and cutaneous sarcoidosis.
Inflammatory lesions that can be treated includes alopecia areata, other inflammatory types of hair loss, granuloma annulare, acne cysts, localised psoriasis amongst many.
Side effects and risks of intralesional triamcinolone may be separated into early and delayed effects.
Early effects tend to be self-limited. They include mainly pain, bleeding, bruising, contact allergic dermatitis, itching, sometimes infections or sterile abscess formation.
Delayed adverse effects include thinning of the skin around the area of injection appearing as indentation or dimples or whitening of the skin. Small thin veins can also be visible at the injection site. These side effects may persist or resolve after a few months.
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