Intralesional Steroid Injection: Fast Relief For Skin Lesions
Targeted corticosteroid injections for effective treatment of inflammatory skin lesions like acne cysts and keloids.
An
intralesional steroid injection
involves injecting a corticosteroid, such as triamcinolone acetonide, directly into a lesion on or immediately below the skin surface to target inflammation precisely. This method delivers high concentrations of the medication to the affected area, minimizing systemic exposure compared to oral or topical steroids.What is an intralesional steroid injection?
Intralesional steroid injections administer corticosteroids percutaneously into skin lesions, achieving higher local concentrations without significant absorption into the bloodstream. Shorter-acting preparations like dexamethasone or betamethasone acetate may be combined with triamcinolone for enhanced effects. Unlike topical applications, which struggle with epidermal barrier penetration, or systemic steroids affecting the entire body, this technique treats dermal inflammation directly and efficiently.
Who gets intralesional steroid injections?
This procedure suits patients with localized, inflammatory, or hypertrophic skin conditions unresponsive to topical therapies. Common candidates include those with elevated scars, painful acne nodules, smooth bald patches from alopecia, or thick itchy plaques. It forms part of comprehensive plans potentially combining creams, tablets, or phototherapy.
- Individuals with cystic acne, keloid scars, or lichen planus seeking rapid relief.
- Patients avoiding systemic steroid side effects like weight gain or hirsutism.
- Those with deep dermal issues where topical steroids fail.
What conditions are treated by intralesional steroid injection?
Intralesional steroids effectively manage various dermatoses by reducing inflammation, flattening lesions, and promoting hair regrowth where applicable.
- Cystic acne: Rapidly resolves deep, tender nodules unresponsive to topicals.
- Alopecia areata: Stimulates regrowth in localized bald patches.
- Keloid and hypertrophic scars: Flattens raised scars and reduces symptoms.
- Lichen planus, granuloma annulare: Treats inflamed or nodular lesions.
- Psoriasis plaques, lichen simplex chronicus, nodular prurigo: Addresses thick, itchy areas.
Table 1 outlines typical conditions and responses.
| Condition | Typical Response | Evidence Level |
|---|---|---|
| Cystic acne | Rapid nodule flattening in 3-5 days | High |
| Keloids | Scar softening and reduction | High |
| Alopecia areata | Hair regrowth in 4-8 weeks | Moderate-High |
| Granuloma annulare | Lesion resolution | Moderate |
Benefits of intralesional steroids
Intralesional delivery targets the lesion specifically, avoiding widespread effects of oral steroids. It penetrates deeper skin layers effectively, outperforms topicals in hypertrophic conditions, and provides quick symptom relief like reduced redness, swelling, and pain. Systemic absorption is minimal (<10% of IV dose), reducing risks like Cushing’s syndrome. As an outpatient procedure, it’s cost-effective and accessible globally.
- Localized high-dose therapy without body-wide impact.
- Minimally invasive with excellent success rates.
- Supplements systemic treatments safely when needed.
Procedure for intralesional steroid injection
The procedure is straightforward, performed in-clinic by dermatologists.
- Clean the site with alcohol or antiseptic to prevent infection.
- Apply topical anesthetic if needed for comfort.
- Inject intradermally (not subcutaneously) using a fine needle (e.g., 30G) to avoid dents.
- Distribute 0.1-0.2 mL per cm² evenly via fanning technique.
- Apply plaster post-injection; repeat every 4-8 weeks as needed.
Video demonstrations show precise technique for optimal results.
Dosage of intralesional steroids
Dosages vary by condition, lesion size, and steroid strength; total per session should not exceed 1-2 mL. Triamcinolone acetonide (TAC) is most common, diluted with saline or anesthetic.
| Condition | Triamcinolone Concentration | Volume per Site |
|---|---|---|
| Acne cysts | 2.5 mg/mL | 0.05-0.1 mL |
| Keloids | 10-40 mg/mL | 0.1-0.2 mL/cm² |
| Alopecia areata | 5 mg/mL | 0.1 mL/cm² |
| Hypertrophic scars | 10 mg/mL | Up to 20 mg/lesion |
| Granuloma annulare | 5-10 mg/mL | 0.1 mL/cm² |
Repeat monthly for active lesions; adjust based on response.
Preparations used
Common agents include:
- Triamcinolone acetonide (Kenalog®): 10 mg/mL or 40 mg/mL, versatile for dilution.
- Dexamethasone or betamethasone: For shorter action, combined use.
Dilutions ensure safety; full strength for resistant lesions.
Side effects of intralesional steroid injection
Generally safe with low systemic risks, but local effects occur.
- Common: Pain at injection, temporary hypopigmentation, skin atrophy (dent).
- Rare: Telangiectasia, striae, infection, bleeding.
- High-dose risks: Cushing-like features if >40 mg/session.
Risks rise with high concentrations, large volumes, or superficial injection; mitigate by proper technique.
Contraindications and cautions
Avoid in:
- Patients with active infections at site.
- Those prone to atrophy (thin skin areas).
- Uncontrolled diabetes, glaucoma, or immunosuppression.
- Large doses mimicking systemic steroids (avoid in peptic ulcers, osteoporosis).
Use cautiously in children or facial lesions.
Frequently Asked Questions (FAQs)
Q: How quickly do intralesional steroids work for acne cysts?
A: Improvement often seen in 24-72 hours, with full flattening in 3-5 days.
Q: Can intralesional steroids cause skin lightening?
A: Yes, temporary hypopigmentation may occur, especially in darker skin; usually resolves.
Q: How often can injections be repeated?
A: Every 4-8 weeks, depending on response; not exceeding safe total doses.
Q: Are they safe for keloid scars on the face?
A: Yes, with diluted concentrations (e.g., 10 mg/mL) and careful technique to avoid atrophy.
Q: Do they cause weight gain?
A: No, due to minimal systemic absorption with proper dosing.
References
- Intralesional Steroid Reading – Treatment at Derma Reading — Derma Reading. 2023. https://www.dermareading.co.uk/intralesional-steroid
- Intralesional Steroid Injections — Heights Dermatology. 2023. https://www.heightsskin.com/intralesional-steroid-injections
- Intralesional Agents in Dermatology: Pros and Cons — PMC – NIH. 2021-11-01. https://pmc.ncbi.nlm.nih.gov/articles/PMC8611707/
- Intralesional steroid injection — DermNet NZ. 2024. https://dermnetnz.org/topics/intralesional-steroid-injection
- Dermatologist Use of Intralesional Triamcinolone in the Treatment of Acne — Journal of Clinical and Aesthetic Dermatology. 2022. https://jcadonline.com/intralesional-triamcinolone-acne-treatment/
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