Intramuscular Steroids in the Treatment of Dermatologic Disease: A Systematic Review

March 2018 | Volume 17 | Issue 3 | Original Article | 323 | Copyright © March 2018


Logan W. Thomas MS4,a Ashley Elsensohn MD MPH,a Aaron Secrest MD PhD,b Terese Bergheim MD,a Jessica Shiu MD PhD,a Anand Ganesan MD PhDa

aDepartment of Dermatology, University of California Irvine, Irvine, CA bDermatology and Population Health Sciences, University of Utah, Salt Lake City, UT

Abstract
IMPORTANCE: Intramuscular (IM) steroids can be used to treat a wide variety of dermatologic diseases. Although seemingly effective and safe, this form of corticosteroid therapy may be underused amongst dermatologists. OBJECTIVE: The objective of this review is to determine the evidence regarding the efficacy and side effect profile of intramuscular triamcinolone in the treatment of dermatologic disease. EVIDENCE REVIEW: A PubMed search engine was used for this study. Inclusion criteria were studies that examined human subjects, reported clinical outcomes and side effects of intramuscular steroids for the treatment of dermatologic disease, cutaneous disease where steroids remain an accepted standard of care, studies published after 1980, and English language articles. FINDINGS: A total of 62 papers were reviewed. Six papers met criteria. They looked at alopecia areata, (2) systemic lupus erythematosus (1), Behcets disease (1), and nail lichen planus (2). Collectively, the studies included 342 patients. Study types included case series (1), retrospective observational (2), randomized prospective (2), and double-blind placebo controlled (1) studies. In this systematic review, intramuscular steroids were found to have comparable efficacy and side effect profile alone or in comparison with other steroid modalities for the select number of dermatoses investigated. CONCLUSIONS AND RELEVANCE: We conclude that intramuscular steroids can be regarded as having comparable efficacy to other steroid modalities in the treatment of steroid responsive dermatoses; and also appear to be safer in most instances with the exception of dysmenorrhea in females. Additional studies are greatly needed.

J Drugs Dermatol. 2018;17(3):323-329.

INTRODUCTION

BackgroundIntramuscular (IM) steroids, most notable triamcinolone acetonide (TAC; Brand Name, Kenalog) can be used to treat a wide variety of dermatologic diseases. A recent prospective observational study by Reddy et al conducted at Boston University gave preliminary evidence of the efficacy and safety of IM triamcinolone for several steroid-responsive dermatological diseases.1 Although seemingly effective and safe, this form of corticosteroid therapy has been underused amongst dermatologists, especially compared to oral steroid counterparts.2,3 The reasons for deterred use of IM steroids are potentially numerous, including a lack of knowledge on effectiveness in treating various dermatological diseases, current lack of recommendations on use, and concern for side effects with a longer duration of action than oral (PO) steroids. The objective of this review is to determine the evidence regarding the efficacy and side effect profile of intramuscular triamcinolone in the treatment of dermatologic disease.Historical PerspectiveSystemic steroids have been used to treat inflammatory cutaneous disease since 1949.4 Intramuscular steroids were first used in the late 1950s and were formally approved for the treatment of dermatologic diseases by the United States Food and Drug Administration in 1962.4,5 During the 1960s, IM triamcinolone gained wide popularity in the dermatology community. In 1962, Sherwood reported treating 106 patients with a variety of dermatologic conditions with IM triamcinolone— 88% had good or excellent clinical response. Conclusions drawn from the study were that IM triamcinolone had rapid onset (6 In 1970, Rosten reported 98 dermatology patients treated with IM triamcinolone— 70% showed good or excellent clinical response.7 A 1974 survey of the San Francisco Dermatology Society showed 85-90% of dermatologists were using IM triamcinolone in their practice.8 This trend began to change, when, in 1979 in the Journal of the American Academy of Dermatology, Storrs published a seminal review article entitled the “Use and abuse of systemic corticosteroids.” Part of this outlined the dangers of IM triamcinolone use, recommending that it be avoided for the treatment of chronic dermatoses.4 In the early 1980s, there was a shift to a more skeptical and conservative use of IM steroids. Many opinion articles were
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