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?
It is a treatment to reduce excess scar tissue (hypertrophic or keloid scars), improve acne cysts, and induce hair regrowth in alopecia areata (a form of hair loss). In this therapy, a steroid solution is injected directly into the affected area of skin or immediately below the skin surface. The aim is to improve the appearance of the affected area 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”.
What is a steroid?
Steroids are natural or man-made medicines used to boost the naturally occurring chemicals in the body, produced mainly by the adrenal glands in the abdomen (belly area). 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. They are particularly useful in the treatment of skin conditions because they can help calm the inflammation and reduce the amount of collagen (protein) in the skin.
The injection of a steroid directly into the affected area of skin has two advantages over topical corticosteroids and oral steroid treatment. Firstly, it will often be more effective in treating deep-seated skin conditions than a steroid cream or ointment (topical treatment). Secondly, it will only affect the area of skin where the steroid is injected rather than the whole body being affected if a steroid tablet (oral treatment) is 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 carried out in the clinic, with no special preparation involved. Please tell the doctor 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 of skin to be treated can be numbed with a local anaesthetic, this is not normally necessary. The discomfort of a steroid injection is very similar to that caused by the injection of a local anaesthetic. Depending on the size of the skin area to be treated, several injections may be needed in the same area. 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 areas of the body, such as the palms of the hands and soles of the feet, can be more uncomfortable. An injection into a keloid (raised scar) can be painful, but can be relieved by taking painkillers such as paracetamol after the injection.
- Bleeding - spots of blood may occur at the place of injection. Applying firm pressure can effectively stop the bleeding.
- Infection - occasionally infection can happen in the injected skin area, and this may rarely develop into an abscess, requiring antibiotic treatment. Therefore, if there is excessive swelling of the injection area, significant redness, pain or abnormal discharge, you should seek advice from your doctor.
- Allergic reaction - this is very uncommon but may occur if you are sensitive to one of the ingredients of the steroid preparation.
Subsequent side effects:
- Atrophy (thinning of the skin) - this is limited to the area that has been injected, and results in a slight dent in 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 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 highly 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. This means that the risk of the steroid being absorbed into the bloodstream in sufficient amounts to produce side effects within the body is extremely low.
Where can I get more information about intralesional steroid therapy?
Web links to detailed leaflets:
Please note that the BAD provides web links to additional resources to help people access a range of information about their treatment or skin condition. The views expressed in these external resources may not be shared by the BAD or its members. The BAD has no control of and does not endorse the content of external links.
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, NOVEMBER 2022
NEXT REVIEW DATE | NOVEMBER 2025