INTRODUCTION
Intralesional steroid injections are used to treat a variety of
dermatologic conditions. Intralesional steroids (ILS) can be
an effective therapy when topical steroids fail and systemic
steroid therapy is not indicated.1 In trials and large reviews, ILS
has shown efficacy in treating keloids, hypertrophic scars, acne,
alopecia areata, hemangiomas, psoriasis, granuloma annulare,
and hidradenitis suppurativa. ILS has also been reported to be
efficacious in other dermatoses such as pyoderma gangrenosum,
sarcoidosis, and discoid lupus.2
Manuskiatti and Fitzpatrick demonstrated clinical improvement
of keloidal and hypertrophic scars with ILS treatment.3
Levine and Rasmussen effectively treated nodulocystic acne
with intralesional triamcinolone (TAC), reporting equal efficacies
at concentrations of 0.63 mg/mL, 1.25 mg/mL, and 2.50
mg/mL.4 Porter and Burton reported significant hair regrowth
within steroid-injected sites of patients with alopecia areata.5
Recently, Nantel-Battista et al confirmed intralesional triamcinolone
as a safe and effective treatment of nail psoriasis in
a clinical trial of 17 patients.6 In 45 patients with granuloma
annulare, Sparrow and Abell demonstrated complete clearance
of nearly 70% of granuloma annulare lesions treated
with ILS compared with 44% lesion clearance with normal
saline injections.7 Scheinfeld reviewed the use of multiple
therapies in over 350 hidradenitis suppurativa patients, finding
that ILS decreases pain and inflammation by collapsing
sinus tracts within active lesions.8
Hughes et al demonstrated efficacy of intralesional triamcinolone
into the ulcer margin of peristomal pyoderma
gangrenosum in 2 patients.9 Sullivan et al explored the injection
of hydrocortisone and cortisone into papules of cutaneous
sarcoidosis, revealing unequivocal regression in all treated lesions
vs no observable change in controls.10
Cutaneous T-cell lymphoma (CTCL) is a cancer of skin-homing
T cells; mycosis fungoides (MF) is the most common variant.11
Treatments for MF include multiple modalities that range from
topical steroids to systemic chemotherapy. Resistant cutaneous
MF nodules can be especially challenging because typical topical
therapies often fail to penetrate thick lesions, and increasing
systemic therapy brings added risk of undesired side effects.
We now report successful ILS treatment for resistant MF lesions
in 4 consecutive patients with such lesions. Our first patient
was a 57-year-old Caucasian female with a 2-year history of
MF who presented to an academic outpatient dermatology
clinic for further management. The patient was treated with
