Soft Tissue Atrophy Related to Corticosteroid Injection: Review of the Literature and Implications for Hand Surgeons

Pace, Collier S.; Blanchet, Nadia P.; Isaacs, Jonathan

doi:10.1016/j.jhsa.2018.03.004

Cited by 26 publications

(32 citation statements)

References 46 publications

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“…In our study, all patients suffered skin change after injection within 5 months, particularly 1‐3 months at most (80.00%), and the duration was all within 5 months, particularly 1‐2 months at most (85.00%). Skin changes may occur after injection of different steroids . However, depigmentation was more likely with triamcinolone acetonide compared with other steroids .…”

Section: Discussionmentioning

confidence: 99%

“…The incidence rate of depigmentation after local corticosteroid injection is 1.3%‐4% . Most of these patients were female, especially family women and manual operators .…”

Section: Discussionmentioning

confidence: 99%

“…Intra‐articular and intralesional corticoids injections are commonly used by dermatologists, orthopedic surgeons, and rheumatologists because of their advantages over oral or parenteral dosage forms. Yet, there are a limited number of case reports describing cutaneous hypopigmentation and atrophy as adverse effects . In very rare cases, the linear lesions have also been reported .…”

Section: Introductionmentioning

confidence: 99%

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Reflectance confocal microscopy and histological features of depigmentation after local corticosteroid injection

Zhang

Liu

et al. 2019

Skin Res Technol

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Background Clinically, depigmentation after local corticosteroid injection is not rare. But there are less articles about its reflectance confocal microscopy (RCM) and histological features. This study aimed to define the RCM features and histopathologic findings of hypopigmentation after local corticosteroid injection and to analyze the correlations between the above two methods. Methods Forty cases with hypopigmentation after local corticosteroid injection were used to analyze the clinical and RCM features. Subsequently, for 20 of 40, an excision biopsy of the same imaged areas for histopathologic examination was executed. Results Our results showed that all 40 cases had round or ellipse hypopigmented macules with obscure boundary and 26 of 40 lesions’ long diameter went along limbs. The RCM features and the histological findings revealed all patients had variable degrees of epidermal thinning, flattening rete ridges, reduced melanin, and no inflammatory cell infiltration. MART‐1 analysis revealed the number of melanocytes was normal but with no or less melanin by Fontana‐Masson staining. Conclusions Depigmentation after local corticosteroid injection was a kind of disease with intact melanocytes, whose function was impaired. RCM features offer a high consistency with histopathologic findings. It thus constitutes a promising adjuvant tool for its diagnosis and for therapeutic follow‐up.

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Section: Discussionmentioning

confidence: 99%

“…The incidence rate of depigmentation after local corticosteroid injection is 1.3%‐4% . Most of these patients were female, especially family women and manual operators .…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reflectance confocal microscopy and histological features of depigmentation after local corticosteroid injection

Zhang

Liu

et al. 2019

Skin Res Technol

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“…Minor adverse effects that could occur include disturbance in menstruation, steroid flare, milder soft tissue alteration, and skin rash. 17 Frequently used corticosteroids are methylprednisolone, triamcinolone, dexamethasone, and betamethasone. Each preparation differs in potency, cost, and corticosteroid related reactions, and the duration of action.…”

Section: Discussionmentioning

confidence: 99%

Hypopigmentation and subcutaneous fat atrophy associated with corticosteroid injection: a case report

Prihatsari¹,

Hidayati²,

Damayanti³

et al. 2021

Anaesth. pain intensive care

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Corticosteroid injections have been shown to be an effective treatment modality in many of the musculoskeletal and rheumatologic conditions. Yet, the potential adverse effects of corticosteroid injections have not been given much attention. One of the potential adverse effects that should be considered by clinicians is skin hypopigmentation and subcutaneous fat atrophy. Although it is a rare side effect, it may have cosmetically unpleasant effect. The aim of this case report is to highlight the importance of providing adequate information to the patients regarding these dermal adverse effects of corticosteroid injections. We report the case of a 31-year-old female who suffered from skin hypopigmentation and subcutaneous fat atrophy after triamcinolone injection given for de Quervain’s tenosynovitis. Key words: de Quervain’s tenosynovitis; Fat atrophy; Hypopigmentation; Corticosteroid injections; Adverse effects; Pain Citation: Prihatsari F, Hidayati HB, Damayanti D, Budisulistyo T. Hypopigmentation and subcutaneous fat atrophy associated with corticosteroid injection: a case report. Anaesth. pain intensive care 2021;25(6):807–811; DOI: 10.35975/apic.v25i6.1708

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“…The literature suggests that there is no difference in success rates between extra-sheath and intra-sheath injection techniques. 32 -34 Since the depth of injection is inversely related to subcutaneous atrophy, 2,35 we prefer using the intra-sheath technique to minimize this risk. There were no reported serious adverse events such as tendon ruptures or deep tissue infection in this study.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Different Dosages and Volumes of Triamcinolone in the Treatment of Stenosing Tenosynovitis: A Prospective, Blinded, Randomized Trial

Leung

Hill

2020

Plast Surg (Oakv)

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Background: Stenosing tenosynovitis is a condition due to a size mismatch between the flexor tendons and the first annular pulley. Corticosteroid injection is the mainstay treatment. The purpose of this study is to compare different dosages and volumes of triamcinolone in the treatment of primary stenosing tenosynovitis. Methods: Patients with primary Quinnell grades 1 or 2 stenosing tenosynovitis were recruited in this prospective, blinded, randomized trial. Patients were randomized into 1 of 2 groups. Group A received 0.25 mL of triamcinolone 40 mg/mL, mixed with 0.25 mL of 1% lidocaine with epinephrine (10 mg of triamcinolone, 0.5 mL in total volume). Group B received 0.5 mL of triamcinolone 40 mg/mL, mixed with 0.5 mL of 1% lidocaine with epinephrine (20 mg of triamcinolone, 1 mL in total volume). Patients were assessed by a blinded hand therapist at 2 and 4 weeks, and by a blinded hand surgeon at 6 weeks. The primary outcome was complete symptom resolution at 6 weeks. Both per-protocol and intention-to-treat analyses were performed. Results: One hundred ninety-one patients were recruited from 2009 to 2018. Eighty-two and 77 patients had complete data in group A and B, respectively. There was no difference in success rates in complete symptom resolution at 6 weeks between group A (59.8%) and group B (62.3%). The mean visual analogue pain scores on injection were 4.31 ± 2.11 for group A and 4.30 ± 2.09 for group B. Conclusions: Triamcinolone 10 mg was as effective as 20 mg in the resolution of symptoms of Quinnell grade 1 or 2 stenosing tenosynovitis at 6 weeks.

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Soft Tissue Atrophy Related to Corticosteroid Injection: Review of the Literature and Implications for Hand Surgeons

Cited by 26 publications

References 46 publications

Reflectance confocal microscopy and histological features of depigmentation after local corticosteroid injection

Reflectance confocal microscopy and histological features of depigmentation after local corticosteroid injection

Hypopigmentation and subcutaneous fat atrophy associated with corticosteroid injection: a case report

Comparison of Different Dosages and Volumes of Triamcinolone in the Treatment of Stenosing Tenosynovitis: A Prospective, Blinded, Randomized Trial

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