Intralesional Corticosteroids

The charts below show the chances of developing various side effects from intralesional corticosteroids.1-5 It should be noted that the side effects of intralesional corticosteroids are dose-dependent–in other words, the risk of side effects increases with the dose of corticosteroids.1

Certain/Likely Side Effects (% = Incidence)

SHORT TERM Mild to moderate pain
during injection
up to 100%

Possible/Rare Side Effects

SHORT TERM or LONG TERM Skin
lightening (hypopigmentation)
up to 20%
LONG TERM Spider veins (telangiectasia)up to 20%
SHORT TERM or LONG TERM Thinning of
the skin (skin atrophy)*
up to 10%

*Thinning of the skin (atrophy): Thinning of the skin after intralesional corticosteroid therapy makes the skin look sunken in, and usually resolves between 6 months and 1 year after treatment. In some cases, this side effect may take longer to disappear.

Studies:   

Two studies have looked at the side effects of intralesional corticosteroid treatment.

  • Study 1:

    • Authors: Darzi et al.5
    • Total # of patients: 25
    • # of female patients: (not reported)
    • # of male patients: (not reported)
    • Age of patients: (not reported)
    • Drug and dose: Triamcinolone acetonide, 20-120 mg depending on lesion size
    • Duration of treatment and follow-up: 4 treatments, follow-up for 10 years
    • Side effects: Atrophy (thinning) of the skin: 4%
  • Study 2:

    • Authors: Manuskiatti and Fitzpatrick4
    • Total # of patients: 10
    • # of female patients: 6
    • # of male patients: 4
    • Age of patients: 25-74
    • Drug and dose: Triamcinolone (TAC), 20 mg/ml
    • Duration of treatment and follow-up: 6 treatments, follow-up every 8 weeks for 32 weeks
    • Side effects:

      • Mild to moderate pain during injection: 100%
      • Hypopigmentation (skin lightening): 20%
      • Telangiectasia (spider veins): 20%
      • Skin atrophy (thinning of the skin): 10%

Study 1: In a study published in 1992 in the British Journal of Plastic Surgery, Darzi and colleagues treated 25 patients with keloids and hypertrophic scars with intralesional triamcinolone acetonide. The patients received 4 injections at 1- to 2-week intervals. The total dose varied depending on the size of the lesions:

  • 20-40 mg for lesions of 1-2 cm2
  • 40-80 mg for lesions of 2-6 cm2
  • 80-120 mg for lesions of 6-12 cm2

The researchers regularly followed the patients for nearly 10 years. Skin atrophy (thinning) was a side effect in 4% of the patients.5

Study 2: In a study published in 2002 in the journal Archives of Dermatology, Manuskiatti and Fitzpatrick treated 10 patients with keloids and hypertrophic scars with intralesional triamcinolone. The patients received 20 mg/ml of triamcinolone every 4 weeks for 6 sessions. Half of the patients reported side effects from the triamcinolone treatment.4

References
  1. Levy LL, and Zeichner JA. Management of acne scarring, part II. A comparative review of non-laser-based, minimally invasive approaches. Am J Clin Dermatol. 13(5), 331-340 (2012).
  2. Ledon JA, Savas J, Franca K, Chacon A, and Nouri K. Intralesional treatment for keloids and hypertrophic scars: a review. Dermatol Surg. 39(12), 1745-57 (2013).
  3. Uptodate.com. Management of acne scars. Available from: https://www-uptodate-com.eresources.mssm.edu/contents/management-of-acne-scars?source=search_result&search=management%20of%20acne%20scars&selectedTitle=1~27. Last retrieved on 24 October, 2017.
  4. Manuskiatti W, and Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments. Arch Dermatol. 138(9), 1149-55 (2002).
  5. Darzi MA, Chowdri NA, Kaul SK, and Khan M. Evaluation of various methods of treating keloids and hypertrophic scars: a 10-year follow-up study. Br J Plast Surg. 45(5), 374-9 (1992).