Intralesional Triamcinolone May Not Be Beneficial for Treating Acute Hidradenitis Suppurativa Lesions: A Double-Blind, Randomized, Placebo-Controlled Trial

Abstract

BACKGROUND Hidradenitis suppurativa (HS) is a chronic, inflammatory condition characterized by recurrent nodules, sinus tracts, comedones, and scarring. Hidradenitis suppurativa is often associated with pain and decreased quality of life. Limited clinical trial data exist regarding the management of acute HS lesions, but clinical experience and a prospective case series suggest that intralesional triamcinolone may be useful.OBJECTIVE To compare the efficacy of intralesional triamcinolone to placebo for the treatment of HS inflammatory lesions.MATERIALS AND METHODS This is a double-blind, randomized, placebo-controlled trial comparing intralesional triamcinolone 10 mg/mL, triamcinolone 40 mg/mL, and normal saline (NS). Thirty-two subjects at University of North Carolina Dermatology and Skin Cancer Centers were enrolled for a total of 67 lesions. Subjects reported pain scores, days to resolution, and satisfaction on a standardized survey over a 14-day period.RESULTS When intralesional injections of triamcinolone 10 mg/mL, triamcinolone 40 mg/mL, and NS were compared, no significant difference was found for days to HS inflammatory lesion clearance, pain reduction at Day 5, or patient satisfaction.CONCLUSION No statistically significant difference was found between varying concentrations of triamcinolone and NS for the treatment of HS lesions. Steroid injections may be less effective for the management of acute HS than typically presumed.

Ultrasound-assisted intralesional corticosteroid infiltrations for patients with hidradenitis suppurativa

“…They did not find any difference in the number of days for lesion resolution, or any change in pain or patient-reported severity between the different tails of the study. We consider that this low effectiveness is due to an insufficient (0.1 ml) dose of corticosteroid and because the infiltrations were not assisted by ultrasonography 18 .…”

Efficacy of high‐dose intralesional triamcinolone for hidradenitis suppurativa

“…In an uncontrolled prospective case series, Riis et al 10 reported decreased erythema, edema, suppuration, lesion size, and pain in 36 patients using a single dose of ILTAC‐10 for acute HS flares. Earlier studies of high‐dose ILTAC therapy had contradictory conclusions, but widespread variations in study design may explain these differences 9,12 …”

Intralesional ultrasound‐guided combined treatment with triamcinolone plus lincomycin in hidradenitis suppurativa: A pilot study

“…[26][27][28] Recently, some authors described the efficacy of intralesional corticosteroid injection for the treatment of HS [10][11][12][13] while a placebocontrolled trial showed no statistically significant difference between triamcinolone and placebo infiltrated in 67 lesions of 32 HS patients. 14 Limitations of our study are the small sample size, the singlecenter study design, and the short follow-up period for clinical and QoL evaluation. A further limitation is the lack of a control group, for example, corticosteroids or antibiotics alone.…”

“…8 Intralesional injection of corticosteroids has been utilized for the treatment of inflammatory lesions of HS in a few case-series studies, in a placebo-controlled trial and it is mentioned in guidelines based on expert consensus. 1,[9][10][11][12][13][14] In particular, in 2016 Riis et al 10 reported 33 cases of HS in which nodular and abscess lesions were treated with intralesional infiltrations of triamcinolone with a significant reduction in lesion erythema, edema, suppuration, and size. Furthermore, a Canadian group reported the infiltration of corticosteroids in a third of their HS patients to successfully manage acute flare-ups of the disease and to reduce the use of systemic antibiotics.…”

“…13 On the other hand, no statistically significant difference was found between infiltration therapy of triamcinolone, at different doses, vs placebo in 67 lesions of 32 HS patients, in a double-blind, randomized, placebo-controlled clinical trial. 14…”