Intralesional steroid injection

What is an 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.

What are intralesional steroids used for?

An intralesional steroid injection may be indicated for the following skin conditions:

• Alopecia areata
• Discoid lupus erythematosus
• Keloid/hypertrophic scar
• Granuloma annulare
• Other granulomatous disorders such as cutaneous sarcoidosis or granuloma faciale
• Hypertrophic lichen planus
• Lichen simplex chronicus (neurodermatitis)
• Localised psoriasis
• Necrobiosis lipoidica
• Acne cysts (see nodulocystic acne) and inflamed epidermoid cysts
• Small infantile haemangiomas
• Other localized inflammatory skin diseases.

Hair regrowth after intralesional steroid into alopecia areata

What are the benefits of intralesional steroids?

Intralesional administration of corticosteroids treats a dermal inflammatory process directly. In contrast to topical steroids, intralesional steroids:

• Bypass the barrier of a thickened stratum corneum
• Reduce the chance of epidermal atrophy (surface skin thinning)
• Deliver higher concentrations to the site of the pathology.

Other uses for triamcinolone acetonide injection

Triamcinolone injection is also sometimes used intramuscularly (rather than as an intralesional injection) systemically as an alternative to oral corticosteroids

How is intralesional steroid administered?

Intralesional triamcinolone is injected directly into the skin lesion using a fine needle after cleaning the site of injection with alcohol or antiseptic solution. The injection should be intradermal, not subcutaneous, to avoid causing a dent in the skin.

The initial dose per injection site will vary depending on the lesion being treated. Generally, 0.1–0.2 mL is injected per square centimetre of involved skin. The total dose should not normally exceed 1–2 mL per dose. It can be repeated every 4–8 weeks.

The corticosteroid can be full strength (eg, triamcinolone 10 mg/mL or 40 mg/mL) or diluted with normal saline or local anaesthetic. Typical regimes for triamcinolone intralesional injections include:

The injections may be repeated monthly for a few months while the lesions are active.