There are different kinds of steroids, but the type most commonly used to treat skin conditions is known as a corticosteroid. Corticosteroids are useful in the treatment of skin conditions since they can suppress the immune system and reduce the amount of inflammation in the skin.
Intralesional steroid therapy allows the dermatologist to send concentrated steroids into deeper layers of the skin to treat a variety of skin conditions, such as cystic acne, alopecia areata, keloid scars, and lichen planus.
Intralesional steroid injection is a safe procedure, and does not cause increases in weight or the development of excess hair. The amount of steroid injected at any one time is small and the risk of the steroid being absorbed into the bloodstream and causing internal side effects is very low.
The injection of a steroid directly into the affected area of skin can offer significant advantages over topical and oral steroid treatment, but it is not suitable for every condition or for every patient.
What are the benefits of intralesional steroid therapy?
Intralesional steroid therapy is usually more effective in treating conditions where issues arise from deeper layers of the epidermis (skin).
By administering corticosteroids through injection, the dermatologist can treat the issue efficiently and effectively while the patient is in the clinic.
In contrast to a cream or ointment where steroids would be applied topically, steroids administered through injection:
- Bypass the barrier of skin that has thickened due to the condition (also called a thickened stratum corneum)
- Reduce the risk of skin thinning (epidermal atrophy)
- Deliver steroids in higher concentration, over a shorter period of time
Intralesional Steroid
Who is intralesional steroid therapy suitable for?
Intralesional steroid therapy may also be administered as part of a comprehensive treatment plan that could include other measures, like creams, tablets, or phototherapy, depending on the condition and the individual patient.
Intralesional steroid injections may be used to treat a variety of skin conditions, such as:
- Alopecia areata
- Keloid or hypertrophic scarring
- Lichen planus
- Cystic acne
- Other localised inflammatory skin conditions
During your consultation with the dermatologist, you will be able to ask if intralesional steroid therapy is a suitable treatment for your skin condition.
There are factors that mean some patients are not suitable for intralesional steroid therapy treatment. These could include:
- Certain medications;
- The use of topical treatments;
- Allergies;
- Certain types of psoriasis;
- Underlying medical conditions;
- Certain fungal infections that affect the whole body;
- Some mental health conditions.
For more information, or to book an appointment with Derma, please call us or contact us via email.
What is the process of intralesional steroid therapy?
Most people don’t need to prepare for intralesional steroid therapy, but if you are taking certain medications, or have underlying medical conditions, your dermatologist will advise you of any special considerations during consultation.
Some people may be uncomfortable or anxious about needles, or have a history of reactions like dizziness or fainting when they have previously had injections. If this is the case, it will be helpful to advise the dermatologist beforehand, so that they can make you more comfortable.
The dermatologist may administer an anaesthetic, either as a cream, or as a very quick injection, in order to numb the area before treatment. This is usually not necessary. If anaesthetic is needed via an injection then most people experience this as a slight pricking sensation, or a sharp scratch, but it could be a little sore, especially if there is inflammation. Any soreness will go away very quickly (within seconds) as the area becomes numb.
Once the anaesthetic has taken effect, the dermatologist will then clean the area to be treated with an antiseptic wipe, to reduce the risk of infection.
Depending on the size of the lesion being treated, it may be necessary to have more than one injection during the appointment.
Once the injection has been administered then a plaster will be applied to keep the site clean.
While patients can usually leave the clinic straightaway after the treatment, the condition may require subsequent injections at regular intervals – either several weeks or months, so you may have some follow-up appointments. You will be provided with follow-up care information so that you know what to do, and what to avoid after treatment.
What are the risks and complications of intralesional steroid therapy?
If you have underlying medical conditions or are regularly taking medications, it is essential that you let your dermatologist know when they take your medical history during the consultation, since they might mean you are more susceptible to bleeding, dizziness or bruising.
Some people may experience more dizziness than others, and it may be beneficial to rest in the waiting room or have a cup of tea following your injections until you feel better.
You may have more or less bruising or bleeding afterwards than other people who’ve had intralesional steroid therapy – this is usually dependent on how your skin typically bruises, but can also be influenced by underlying health conditions or medications, which the dermatologist will advise you about beforehand.
There are some side-effects that may appear later, such as:
- Thinning of the skin at the site of injection;
- A change in the skin’s pigment at the site of injection, usually more common in people with darker skin tones;
- Blood vessels near the site of injection becoming more visible than usual;
- Acne-like spots appearing near the site of injection.
Following the injections, it is possible to experience rare complications like infection or an allergic reaction to the steroid.
It is important to contact the clinic if you are experiencing any of these complications or unexpected pain or discomfort, whether they present immediately or in the days or weeks following the treatment.
Further reading: Patient leaflet from the British Association of Dermatologists
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