Excision with Intralesional Corticosteroids

Compare To Other Treatments

The charts below show the chances of developing various side effects from excision with intralesional corticosteroid treatment.1-4 For some side effects, we currently do not have enough data to provide a percentage.

Certain/Likely Side Effects (% = Incidence)

SHORT TERM Painup to 100%
LONG TERM Purple/red discolored spots on the skin (purpura)*up to 100%
SHORT TERM Bruisingup to 75%
SHORT TERM or LONG TERM Scar regrowthup to 56%
LONG TERM Thinning of the skin (skin atrophy)**up to 52%
SHORT TERM Acne flare-upup to 8%
SHORT TERM Skin itchingincidence not known

* Purple/red discolored spots on the skin (purpura) completely resolved in all patients within 18 months after the last corticosteroid injection. 

** Thinning of the skin (atrophy): Thinning of the skin after excision and intralesional corticosteroid therapy makes the skin look sunken in and usually resolves within 18 months and after treatment.

Studies:

Three studies have looked at the side effects of excision with intralesional corticosteroid treatment.

  • Study 1:

    • Authors: Hayashi et al.1
    • Total # of patients: 24
    • # of female patients: 17
    • # of male patients: 7
    • Age of patients: 11-79
    • Treatment type: Excision followed by intralesional 20 mg/ml of triamcinolone 
    • Duration of treatment and follow-up: 9 treatments, follow-up for up to 57 months
    • Side effects:
      • Pain: 100%
      • Purple/red discolored spots on the skin (purpura): 100%
      • Bruising: 75%
      • Thinning of the skin (skin atrophy): 52%
      • Recurrence: 14.3%
      • Acne flare-up: 7.41%
  • Study 2:

    • Authors: Burusapat et al.2
    • Total # of patients: 34
    • # of female patients: 24
    • # of male patients: 10
    • Age of patients: 18-66
    • Treatment type: Excision followed by intralesional injections of 10 mg/ml triamcinolone 
    • Duration of treatment and follow-up: 1 treatment, follow-up for 6 months
    • Side effects:
      • Recurrence after 7 days delayed corticosteroid injection: 56.25%
      • Recurrence after immediate corticosteroid injection: 22.2%
  • Study 3:

    • Authors: Bijlard et al.3
    • Total # of patients: 5
    • # of female patients: 3
    • # of male patients: 2
    • Age of patients: 18-40
    • Treatment type: Excision followed by intralesional injection of 40 mg/ml of triamcinolone
    • Duration of treatment and follow-up: 1-3 treatments, follow-up for up to 1 year
    • Side effects:
      • Pain: (incidence not reported)
      • Itching: (incidence not reported)

Study 1: In a study published in 2012 in the Dermatological Surgery, Hayashi et al. performed excision of keloids in 24 patients and further treated them with 9 sessions of intralesional triamcinolone. The first 5 sessions were given in 2-week intervals while the other 4 were given in 4-week intervals. Patients were followed-up for up to 57 months. Pain at the injection site and purple/red discolored spots on the skin were seen in all patients while thinning of the skin (skin atrophy) occurred in 52% of treated patients. Purpura and skin atrophy were long-term effects and resolved within 18 months. In 2 patients (7.41%) acne flare-up happened and resolved after discontinuing the use of corticosteroids.1

Study 2: In a study published in 2021 in the journal Plastic and Reconstructive Surgery, Burusapat and colleagues treated 34 patients with keloid scars with excision followed by immediate or 7-days delayed intralesional injection of 10mg/ml of triamcinolone. The patients were followed-up for 6 months to see if the keloid scar would regrow. The authors reported that immediate intralesional injection of corticosteroids reduced the recurrence rate as only 22.2% of patients experienced scar regrowth after 3 to 6 months. In the group of patients that received intralesional corticosteroid 7 days after excision, scars re-occurred in 56.25% of patients after 2 months.2

Study 3: In a study published in 2018 in the Journal of Plastic, Reconstructive & Aesthetic Surgery, Bijlard and colleagues treated 5 patients with keloids with excision plus 1 to 3 sessions of 40mg/ml of intralesional triamcinolone depending on the scar size. The first injection was given 2 weeks after the excision, the second injection was applied 8 weeks after, and the third 12 weeks after the scar removal. Patients were followed up for a year and reported side effects. Only pain and itching were recorded as common, unpleasant adverse effects.3

References
  1. Hayashi, Toshihiko, et al. “A new uniform protocol of combined corticosteroid injections and ointment application reduces recurrence rates after surgical keloid/hypertrophic scar excision.” Dermatologic surgery 38(6), 893-7 (2012).
  2. Burusapat C, Wanichjaroen N, Wongprakob N, Sapruangthong R. The Effectiveness of Immediate Triamcinolone Acetonide Injection after Auricular Keloid Surgery: A Prospective Randomized Controlled Trial. Plast Reconstr Surg Glob Open. 9(8), e3729 (2021).
  3. Bijlard, Eveline, et al. “Intralesional cryotherapy versus excision with corticosteroid injections or brachytherapy for keloid treatment: Randomised controlled trials.” Journal of Plastic, Reconstructive & Aesthetic Surgery 71(6), 847-56 (2018).

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