Linear cutaneous hypopigmentation and atrophy associated with intralesional steroid injection: A rarely described adverse reaction

Abstract

Intralesional steroid injection is a common and highly effective treatment procedure, which can be successfully used for several dermatologic, rheumatologic, and orthopedic disorders. However, it may be associated with various local side effects, such as pain, granulomatous reaction, allergic reactions, hypo or hyperpigmentation and, uncommonly, skin atrophy. A peculiar and rare side effect of steroid injection is linear hypopigmentation and atrophy, which is probably an expression of lymphatic spread of corticosteroid crystals. Here, we report a case of linear hypopigmentation and atrophy in a 26‐year‐old male patient.

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

“…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 This phenomenon has also been seen in keloids 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.…”

Effectiveness of Botulinum Toxin Type A Injection on Scars: A Systematic Review and Meta-analysis of Randomized Controlled Trials

“…41 Applying intralesional steroid injection may lead to many side effects, such as, pain, granulomatous reaction, and skin atrophy. 42 In addition, intravenous steroids might induce hyperglycemia and hypokalemia. 43 Furthermore, long-term steroid use can cause inadequate secretion of adrenocorticotropic hormone, leading to secondary adrenal insufficiency.…”

Autoimmune bullous disease in skin of color: A case series

“… 11 Importantly, potent corticosteroids can induce hypopigmentation, a side effect that can be more apparent in darker skin tones. 12 , 13 , 14 As well, because many cases of AIBD involve the scalp, dermatologists must understand the diversity of hair types and hair care practices in patients of color, which affect topical vehicle preference. 15 …”

“…11 Importantly, potent corticosteroids can induce hypopigmentation, a side effect that can be more apparent in darker skin tones. [12][13][14] As well, because many cases of AIBD involve the scalp, dermatologists must understand the diversity of hair types and hair care practices in patients of color, which affect topical vehicle preference. 15 To ensure physicians and other clinicians are competent to diagnose and treat conditions in people with skin of color, increased diversity in clinical (right) after treatment, all erosions on the back were fully healed, but significant hyperpigmented patches remained.…”