question and answer
Steroid skin injections
December 2011
Other than for treatment of keloid scars, when might intralesional steroids be injected in a family doctor’s office? What’s the best drug, dosage, needle size and frequency of injection? Marni Goodman MD, New Minas, NS

Intralesional injection of corticosteroids can be a very effective treatment for a variety of cutaneous conditions. Examples include small plaques of lupus, very thick and itchy nodules of prurigo nodularis, and epidermoid cysts.

Since the vast majority of these lesions are superficial, I recommend using a tuberculin syringe and a 30 gauge needle. Regarding the type of corticosteroid, my favourite is triamcinolone acetonide, although some of my colleagues prefer betamethasone. As for concentrations, the majority of lesions seen in a family practitioner’s office can be handled with 10 mg/ml if on the body, and 4 mg/ml for the face. Inject into the lesion until the lesion blanches. It will usually last for about 4 weeks.

If the injection is too deep, and it goes into the subcutaneous fat, there will be some shrinkage of the fat, leading to a divot. However, these lesions are temporary when using these concentrations.

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