A-Z OF SKIN

Intralesional Steroids

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Intralesional steroids are injected under the surface of the skin by the treating doctor. They include triamcinolone acetonide and betamethasone acetate. This treatment is chosen when the main problem is deeper in the skin or when the top layer of the skin is very thickened, preventing penetration of creams and ointments. It allows a strong treatment to be delivered just to the area where it is needed with minimal effects on the rest of the body.

Intralesional steroids may be used for skin conditions such as:

Allergic reactions are rare. You should tell your doctor if you have had an allergic reaction to a steroid medication in the past.

Monitoring is not usually required.

If large amounts of intralesional steroids are injected frequently, the medication can potentially have the same side effects as systemic steroids. However, the injections are used in relatively small amounts and only every 3 to 4 weeks or so.

Many people who become infected with HPV quite rapidly develop immunity and so do not develop any warts or other symptoms.

The appearance of warts will differ in certain body sites.

  • Common warts are often found on the hands and feet. However, they can also occur in other areas such as the elbows or knees. Common warts have a characteristic cauliflower-like or spiky surface. They are typically rough, hard and raised above the surrounding skin.
  • Flat warts are most commonly found on the arms, face or forehead. They can be numerous and are typically flatter than the common wart.
  • Plantar warts occur on the soles of the feet and may be painful with pressure (e.g. walking or standing).
  • Subungual or periungal warts form under the fingernail (subungual), around the fingernail or on the cuticle (periungual). They may be more difficult to treat than warts in other locations.
  • Mucosal warts can appear on the lips, inside the cheeks and nose, the airway and in genital areas.

The intralesional steroid must be spread out over the affected areas of skin. This means that the injection is not as quick as a vaccination injection and sometimes multiple small injections are necessary.

At the time of the injection, there can be:

  • stinging or pain, similar to when a local anaesthetic is injected
  • a small amount of bleeding.

Subsequent side effects can include:

  • infection (rare)
  • thinning of the skin. This particularly affects the fatty layer of the skin and can cause an indentation. This usually disappears over time.
  • broken capillaries. This is more likely to happen with repeated injections.
  • skin colour change. Darkening or lightning of the skin colour may occur. This is usually temporary. It is important to remember that some skin diseases can also leave temporary or permanent discolouration.
  • increased hair growth in the area treated (rare).

Very rarely:

  • Your doctor will use extra caution when using intralesional steroids in the eye area as the steroid can unexpectedly enter eye blood vessels and result in blindness (very rare).

For a full list of known side effects, please refer to the product information leaflet provided with the medication.

This information has been written by Dr Jenny Byth

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