Infiltración con Triamcinolona en HS

Intralesional Triamcinolone May Not Be Beneficial for Treating Acute Hidradenitis Suppurativa Lesions

Dermatologic Surgery

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• In this randomized, double-blinded, placebo-controlled trial, 32 patients with a total of 67 acute inflammatory hidradenitis suppurativa (HS) lesions were treated with bacteriostatic normal saline or intralesional triamcinolone 10 mg/mL or 40 mg/mL. The average number of days to resolution of the lesions did not significantly differ among the three groups (9.35 vs 10.78 vs 10.85; P=.44). The average pain score reduction at day 5 also did not differ among the groups (2.63 vs 2.00 vs 2.30; P=.77). All interventions were reported to be "a little bit helpful" to "moderately helpful" by the patients, with no difference among the groups (P=.54).

• Intralesional triamcinolone is commonly used for treatment of acute HS lesions. However, this study suggests that, compared with placebo, this treatment may be less effective than previously assumed. Considering these findings, potential discomfort, side effects, and monetary cost, intralesional steroid injections may not be justified for all patients with HS.

– Margaret Hammond, MD

Written by

 

 

Paul G Hazen MD

In this study, the authors evaluated the use of intralesional triamcinolone for the management of acute inflammatory lesions of hidradenitis suppurativa. Intralesional steroids have been commonly used in the management of acute lesions; however, controlled studies are lacking. This study was designed to fill that void. Overall, 32 subjects and a total of 67 lesions were evaluated using normal saline, triamcinolone 10 mg/cc, or triamcinolone 40 mg/cc as a single injection. The results indicated that there were no differences in the rates of inflammatory lesion clearance, pain reduction, or patient satisfaction, with gradual clearing taking place over about 10 days. These results are fascinating and appear to contradict past observations.

Several features, however, might have influenced the observed results. In our experience, large abscesses or lesions with significant fibrotic inflammatory features do not generally respond well to intralesional steroids. Consideration may suggest that large lesions may have greater dilution of the injectable material. Because of inadequate response to intralesional steroids, our patients with large, solitary, cavitary lesions are often treated using unroofing/deroofing, or we may aspirate some of the liquid abscess contents before placement of the intralesional agent.

The distinction between nodular versus abscess lesions of HS may also be important. Multilocular/nodular lesions with scarring separating cavitary spaces are common in HS; however, scarring may compromise uniform intralesional delivery to nodular lesions. It would therefore be helpful to know if the treatment groups had comparable size and morphologies of lesions.

As the authors indicate, the numbers of patients within each treatment group were small, but result were still statistically significant. However, the quantity of injected agent and the type of lesion treated were not controlled. Also, the patient population was heavily weighted toward African American females, a group recognized to have potentially more severe disease. The distribution of patient characteristics in each treatment group may also be important to consider. In spite of these issues, this article is an important stimulus to determine if, and for what clinical circumstances, triamcinolone injections may help for acute lesions of HS.

Abstract

BACKGROUND

Hidradenitis suppurativa (HS) is a chronic, inflammatory condition characterized by recurrent nodules, sinus tracts, comedones, and scarring. Hidradenitis suppurativa is often associated with pain and decreased quality of life. Limited clinical trial data exist regarding the management of acute HS lesions, but clinical experience and a prospective case series suggest that intralesional triamcinolone may be useful.

OBJECTIVE

To compare the efficacy of intralesional triamcinolone to placebo for the treatment of HS inflammatory lesions.

MATERIALS AND METHODS

This is a double-blind, randomized, placebo-controlled trial comparing intralesional triamcinolone 10 mg/mL, triamcinolone 40 mg/mL, and normal saline (NS). Thirty-two subjects at University of North Carolina Dermatology and Skin Cancer Centers were enrolled for a total of 67 lesions. Subjects reported pain scores, days to resolution, and satisfaction on a standardized survey over a 14-day period.

RESULTS

When intralesional injections of triamcinolone 10 mg/mL, triamcinolone 40 mg/mL, and NS were compared, no significant difference was found for days to HS inflammatory lesion clearance, pain reduction at Day 5, or patient satisfaction.

CONCLUSION

No statistically significant difference was found between varying concentrations of triamcinolone and NS for the treatment of HS lesions. Steroid injections may be less effective for the management of acute HS than typically presumed.

Dermatologic Surgery

Intralesional Triamcinolone May Not Be Beneficial for Treating Acute Hidradenitis Suppurativa Lesions: A Double-Blind, Randomized, Placebo-Controlled Trial

Dermatol Surg 2019 Sep 02;[EPub Ahead of Print], K Fajgenbaum, L Crouse, L Dong, D Zeng, C Sayed 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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