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Intralesional Steroids: When and How to Inject?

  • Rodrigo Pirmez
Chapter

Abstract

Intralesional steroid (IL-S) injections have been used to treat a variety of dermatological and nondermatological diseases. In the treatment of alopecias, IL-S are an important therapeutic tool for many types of both scarring and nonscarring hair loss. This chapter covers practical topics such as the type and concentration of the steroid to be injected, indications, technique of injection, potential local and systemic adverse effects, and how to prevent them.

Keywords

Alopecia Steroids Intralesional Triamcinolone Betamethasone Atrophy Hair Alopecia areata Cicatricial alopecias Acne keloidalis Discoid lupus Lichen planopilaris Dissecting cellulitis Folliculitis decalvans Adrenal suppression 

References

  1. 1.
    Firooz A, Tehranchi-Nia Z, Ahmed AR. Benefits and risks of intralesional corticosteroid injection in the treatment of dermatological diseases. Clin Exp Dermatol. 1995;20(5):363–70.CrossRefGoogle Scholar
  2. 2.
    Melo DF, Dutra TBS, Baggieri VMAC, Tortelly VD. Intralesional betamethasone as a therapeutic option for alopecia areata. An Bras Dermatol. 2018;93(2):311–2.  https://doi.org/10.1590/abd1806-4841.20187423.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Strazzulla LC, Wang EHC, Avila L, Lo Sicco K, Brinster N, Christiano AM, et al. Alopecia areata: an appraisal of new treatment approaches and overview of current therapies. J Am Acad Dermatol. 2018;78(1):15–24.  https://doi.org/10.1016/j.jaad.2017.04.1142.CrossRefPubMedGoogle Scholar
  4. 4.
    Richards RN. Update on intralesional steroid: focus on dermatoses. J Cutan Med Surg. 2010;14(1):19–23.CrossRefGoogle Scholar
  5. 5.
    Pirmez R, Abraham LS, Duque-Estrada B, Damasco P, Farias DC, Kelly Y, et al. Trichoscopy of steroid-induced atrophy. Skin Appendage Disord. 2017;3(4):171–4.  https://doi.org/10.1159/000471771.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Ustuner P, Balevi A, Özdemir M. Best dilution of the best corticosteroid for intralesional injection in the treatment of localized alopecia areata in adults. J Dermatolog Treat. 2017;28(8):753–61.  https://doi.org/10.1080/09546634.2017.1329497.CrossRefPubMedGoogle Scholar
  7. 7.
    Jarratt MT, Spark RF, Arndt KA. The effects of intradermal steroids on the pituitary-adrenal axis and the skin. J Invest Dermatol. 1974;62(4):463–6.CrossRefGoogle Scholar
  8. 8.
    Pirmez R, Price VH, Cuzzi T, Trope BM. Acne keloidalis nuchae in renal transplant patients receiving tacrolimus and sirolimus. Australas J Dermatol. 2016;57(2):156–7.  https://doi.org/10.1111/ajd.12271.CrossRefPubMedGoogle Scholar
  9. 9.
    Porter D, Burton JL. A comparison of intra-lesional triamcinolone hexacetonide and triamcinolone acetonide in alopecia areata. Br J Dermatol. 1971;85(3):272–3.CrossRefGoogle Scholar
  10. 10.
    Shapiro J, Price VH. Hair regrowth. Therapeutic agents. Dermatol Clin. 1998;16(2):341–56.CrossRefGoogle Scholar
  11. 11.
    Kassim JM, Shipman AR, Szczecinska W, Siah TW, Lam M, Chalmers J, et al. How effective is intralesional injection of triamcinolone acetonide compared with topical treatments in inducing and maintaining hair growth in patients with alopecia areata? A critically appraised topic. Br J Dermatol. 2014;170(4):766–71.  https://doi.org/10.1111/bjd.12863.CrossRefPubMedGoogle Scholar
  12. 12.
    Donovan JC, Samrao A, Ruben BS, Price VH. Eyebrow regrowth in patients with frontal fibrosing alopecia treated with intralesional triamcinolone acetonide. Br J Dermatol. 2010;163(5):1142–4.  https://doi.org/10.1111/j.1365-2133.2010.09994.x.CrossRefPubMedGoogle Scholar
  13. 13.
    Chu TW, AlJasser M, Alharbi A, Abahussein O, McElwee K, Shapiro J. Benefit of different concentrations of intralesional triamcinolone acetonide in alopecia areata: an intrasubject pilot study. J Am Acad Dermatol. 2015;73(2):338–40.  https://doi.org/10.1016/j.jaad.2015.04.049.CrossRefPubMedGoogle Scholar
  14. 14.
  15. 15.
    Narahari SR. Comparative efficacy of topical anthralin and intralesional triamcinolone in the treatment of alopecia areata. Indian J Dermatol Venereol Leprol. 1996;62:348–50. qtd in Kassim JM, Shipman AR, Szczecinska W, et al. How effective is intralesional injection of triamcinolone acetonide compared with topical treatments in inducing and maintaining hair growth in patients with alopecia areata? A Critically Appraised Topic. Br J Dermatol. 2014;170(4):766–71.  https://doi.org/10.1111/bjd.12863.CrossRefPubMedGoogle Scholar
  16. 16.
    Kumaresan M. Intralesional steroids for alopecia areata. Int J Trichology. 2010;2(1):63–5.  https://doi.org/10.4103/0974-7753.66920.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Rodrigo Pirmez
    • 1
  1. 1.Department of Dermatology Santa Casa da MisericordiaRio De JaneiroBrazil

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