A linear forehead lesion caused by intralesional injection of triamcinolone acetonide and treated with hyaluronic acid filler: Case report

Abstract

Intralesional steroid injection is a treatment method frequently used to resolve a large number of orthopedic, rheumatological, dermatological, and neurological disorders. Although this treatment is very effective, it is not without possible side effects, both systemic and local, among which we can mention pain, bleeding, ulceration, atrophy, pigmentary changes, calcification, secondary infections, formation of granulomas, allergic reactions and, in very rare cases, the development of linear atrophy, and hypopigmentation. Here, we present a case of frontal linear skin atrophy after intralesional steroid injection for the treatment of alopecia areata (AA) in a 29 yearold patient, successfully treated with a hyaluronic acid filler.

Linear frontal lipoatrophy secondary to intralesional steroid injection simulating linear scleroderma in a 6 year‐old female

“…6-10 If atrophy persists more than 1 year, fat or hyaluronic acid filler may be considered. 5 In our case, at 18 month follow-up the atrophic plaque was almost imperceptible. It is important to recognize this infrequent complication secondary to intralesional steroid injection in order to avoid potential misdiagnosis and possible indication of systemic therapy.…”

“…Cases of linear cutaneous hypopigmentation and atrophy secondary to intralesional steroid injection have been reported in the literature. [5][6][7][8][9][10] The depth and concentration of the steroid injection determines the site of atrophy. Regarding pathogenesis, it is believed that insoluble steroid crystals move along lymphatic vessels and cause localized lipolysis and skin depigmentation along the perilymphatic skin.…”

Local steroid hormone injections into hypertrophic scars resulted in depression of the lesion site and radiated linear depigmentation and atrophy surrounding the lesion: A case report

“…Steroid hormone is not only used for intra‐scar injections with good efficacy, but is also very important in the treatment of some diseases in rheumatology and orthopedics, which can provide good therapeutic effects locally 4 . Local side effects related to this treatment may occur, including pain, bleeding, ulceration, atrophy, pigmentation changes, calcification, secondary infection, granuloma formation, and allergic reactions 5 . Here, we present a rare adverse reaction with depressed subcutaneous tissue at the site of the lesion, radial stripe‐like pigment loss and atrophy around the lesion, and topical drug treatment did not return the skin to its normal state.…”

“…A patient with retinoblastoma was reported to have linear pigment loss and atrophy around the orbit after injection, probably due to corticosteroid crystals deposited in the conjunctival lymphatics causing lipolysis and pigment loss in the skin distributed along the lymphatics 8 9 and de Quervain tendonitis 10 of the forearm, and alopecia areata, 5 etc. Kikuchi and Horikawa (1975) demonstrated a link between these linear lesions and lymphatic vessels after injecting Evans blue into atrophic lesions 11 .…”

“…4 Local side effects related to this treatment may occur, including pain, bleeding, ulceration, atrophy, pigmentation changes, calcification, secondary infection, granuloma formation, and allergic reactions. 5 Here, we present a rare adverse reaction with depressed subcutaneous tissue at the site of the lesion, radial stripe-like pigment loss and atrophy around the lesion, and topical drug treatment did not return the skin to its normal state.…”