Intralesional Corticosteroids

Compare To Other Treatments

The charts below show the chances of developing various side effects from intralesional corticosteroids.1,2,4,5 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.4
    • 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 Fitzpatrick3
    • 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.4

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.3

Systematic review and meta-analysis: In 2021, Zhuang and colleagues published a systematic review and meta-analysis in the journal Burns that looked at 15 clinical trials to evaluate the efficacy and safety of intralesional corticosteroid treatment for hypertrophic and keloid scars. They found that patients treated with intralesional corticosteroids can experience thinning of the skin (skin atrophy) or spider veins (telangiectasia). However, these side effects were rare and not severe.5

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. 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).
  4. 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).
  5. Zhuang Z, Li Y, Wei X. The safety and efficacy of intralesional triamcinolone acetonide for keloids and hypertrophic scars: A systematic review and meta-analysis. Burns. 47(5), 987-98 (2021).

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