Cutaneous Changes Following Local Injection of Triamcinolone

Abstract

Injection of triamcinolone diacetate at a high intradermal site results in persistent scarring secondary to local vesiculation and ulceration. Histologically, early changes included necrosis of the epidermis, the small blood vessels, and the appendages; late changes included thinning of the epidermis, loss of rete peg formation, and vascular and collagen proliferation. Injection at a low intradermal site resulted in atrophy, pigmentary changes, and telangiectasia appearing as early as 14 days and lasting as long as ten months, depending on anatomical site. In the skin of the arms and back these changes occurred on the average at one month, lasting usually six months. In the skin of a calf these began as late as two months, lasting eight months or more. In skin of the scalp, these occurred at three weeks, lasting only three months. The histopathological changes consisted primarily of a decrease in mucopolysaccharide, which was associated with loss of elastic tissue, homogenization of collagen, epidermal atrophy, and degenerative changes in the appendages. These changes were reversible. Injection at a high subcutaneous site usually resulted in no cutaneous change clinically. A few sites developed mild transient reversible changes both histologically and clinically similar to those seen with low intradermal injections. No differences due to race were detected in this study. Likewise, differences attributable to age were not conclusive. The development of triamcinolone-induced atrophy is dependent upon the anatomical level of the injection within the skin as well as the local concentrations achieved. Consideration of depth of injection and of concentration should minimize the degree of atrophy resulting.