Ultrasound-assisted intralesional corticosteroid infiltrations for patients with hidradenitis suppurativa

Abstract

Corticosteroid infiltrations of lesions in hidradenitis suppurativa (HS) appear to be beneficial to acute flares. The aim of this study is to evaluate the effectiveness and safety of ultrasound-assisted intralesional corticosteroid infiltrations to HS lesions. Prospective cohort study between February 2017 and February 2019 on patients with mild to severe HS and one or more inflammatory lesions. The study intervention was ultrasound-assisted intralesional infiltration of triamcinolone acetonide 40 mg/ml. The main outcome was the complete response rate of infiltrated lesions versus non-infiltrated lesions. Two hundred and forty-seven infiltrated inflammatory lesions and 172 non-infiltrated lesions were included. At week 12, 81.1% (30/37) of nodules, 72.0% (108/150) of abscesses and 53.33% (32/60) of draining fistulas presented complete response versus 69.1% (47/68), 54.3% (38/70) and 35.3% (12/34) respectively for the non-infiltrated lesions. The Hurley stage negatively correlated with complete response for abscesses and draining fistulas at − 0.17 (SD 0.06) p < 0.01 and − 0.30 (SD 0.13) p < 0.02 respectively. Ultrasound-assisted corticosteroid infiltration is a useful technique for the treatment of inflammatory HS lesions, with high and sustained response rates, especially for abscesses and small to medium-size simple draining fistulas. The likelihood of response correlates negatively with the Hurley stage.

Ultrasound‐guided injection of intralesional steroids in acute hidradenitis suppurativa lesions: A prospective study

“…In the study was used a high potency corticoid such as triamcinolone acetonide, placed appropriately by ultrasounds. The maximum amount of triamcinolone acetonide administered per session was 40 mg. Two adverse events were reported: an alteration on glycemic imbalance in a patient with type I diabetes and a change in behavior in another patient 15 …”

“…In literature only two studies investigate the efficacy and safety of ultrasound‐assisted infiltrations to HS lesions. In the first study authors conclude that ultrasound‐assisted injections of triamcinolone acetonide 40 mg/ml are useful for the treatment of abscesses and small to medium‐size simple draining fistulas 15 . In the other study lincomycin was added to triamcinolone with a significant improvement of the HS lesions after the combined intralesional treatment 16 …”

Hidradenitis suppurativa: Topical and intralesional treatment options

“…In fact, patients with acute flares and higher inflammation obtained the greatest antiinflammatory results. 20 Another open-label study of 46 patients assessed the efficacy of 0.5 ml of 40 mg/ml of triamcinolone.…”

Tiltak ved akutt forverring av hidrosadenitt

“…I et randomisert forsøk ble det gitt 0,1 mL legemiddel svarende til 1 og 4 mg triamcinolon, uten at man så bedre effekt enn i placebogruppen (11). I tre andre studier ble det injisert inntil 1 mL triamcinolon i konsentrasjon 20-40 mg/mL, avhengig av lesjonens størrelse (9,12,13). Man så da en signifikant reduksjon av lesjoner og smerter, noe som kan tyde på at høyere doser steroid trengs for god effekt, og at en individuell vurdering av lesjoner er viktig.…”

“…Behandlingen gjennomføres ved å trekke triamcinolon (40 mg/mL) opp i en sprøyte. Det aktuelle hudområdet desinfiseres, og kanylen stikkes så vinkelrett inn i huden på siden av nodulen og rettes på skrå inn mot senter av lesjonen, hvorpå 0,2-0,5 mL av medikamentet deponeres (13). Injeksjon av inntil 1 mL er å anse som trygt, men er sjeldent nødvendig (12).…”