Anaphylaxis following intralesional triamcinolone acetonide (Kenacort) injection

Abstract

Intralesional triamcinolone acetonide injection is indicated for multiple skin conditions such as keloid scars, alopecia areata, and hypertrophic lichen planus. Immediate hypersensitivity reaction remains uncommon. We report on a 24-year-old woman who had received multiple intralesional injections with triamcinolone acetonide (Kenacort) plus lidocaine for keloid scar treatment without any reaction for the previous 10 years. The immediate reaction occurred 15 minutes after injection, with numbness on her face and 5 minutes later with urticaria on her chest wall and upper extremities, together with hypotension (blood pressure of 90/60 mmHg). Allergology workup revealed positive skin prick test for triamcinolone acetonide (Kenacort). Skin tests for other corticosteroids (hydrocortisone, methylprednisolone, and dexamethasone), excipients (carboxymethylcellulose, benzyl alcohol, and polysorbate 80) and lidocaine were negative, including subcutaneous challenge for lidocaine and oral challenge for carboxymethylcellulose. IgE-mediated hypersensitivity reaction must be considered in cases of multiple applications of triamcinolone acetonide injection.

Gangrenous Keloid of the Ear Pinna Following Intralesional Triamcinolone Injection: Proper Consent Is Essential

“…Complications encountered post steroid injection are generally mild such as skin hypopigmentation, hyperpigmentation, pain, pruritus, skin atrophy, and telangiectasia [17]. Nonetheless, severe reactions such as anaphylaxis following TCA injection over keloid scar have been reported [8].…”

Foreign body reaction due to intralesional steroid injection in treatment of alopecia areata

“…Several case reports on triamcinolone acetonide hypersensitivity have been published, in which the culprit was either the corticosteroid or its excipients, including CMC, benzyl alcohol, and polysorbate 80. 4 In a report, a case of dermal titanium dioxide deposition associated with intralesional triamcinolone injections for management of alopecia areata. 5 In our case, triamcinolone acetonide and lidocaine were taken into account for the reaction at the first episode.…”

Intralesional corticosteroid injection as an effective treatment method for oral lesions: a meta-analysis

“…However, in cases wherein high or repeated doses of injection are required, systemic corticosteroid considerations such as hypertension, heart failure, uncontrolled diabetes, acute peptic ulcer, depression, severe psychosis, and active fungal and bacterial infections must be taken into account. In addition, the ICSI is preferable to the topical corticosteroids such as creams, ointments, mouthwashes, gels, and foams due to bypassing of mucous membranes, reduced risk of mucosal atrophy, higher drug concentrations, and longer durability in lesion sites (Laisuan et al, 2017). Nowadays, various medications are available for the ICSIs; however, physicians commonly prescribe triamcinolone and betamethasone derivations.…”

“…Immediate side effects of the injection include pain, bleeding, infection, and allergic reaction, as well as delayed complications including atrophy of skin or mucous membranes, and hyper-or hypo-pigmentation of the lesion site (Saravanan et al, 2014;Laisuan et al, 2017). Although these indications are not very common, the possible cause of complications is the lymphogenous spread of corticosteroid suspension, which brings about dermal and epidermal changes such as thinning of the epithelium, loss of rete ridges, necrosis of epithelial and small blood vessels, interference with synthesis of melanin from melanocytes, reduction of mucopolysaccharides, and loss of elastic properties of tissues.…”