Infection Rate of Intralesional Triamcinolone and the Safety of Compounding in Dermatology for Intradermal and Subcutaneous Injection

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

• Of 4370 intralesional triamcinolone injections administered, 64% were compounded in office. A total of 11 suspected localized infections were reported (0.25%), 4 from the compounded group and 7 from the noncompounded group. The infection rates were 0.14% (4 of 2780) in the compounded group versus 0.44% in the noncompounded group (P = .111). All suspected infections in the compounded group occurred with an "inflamed cyst."

• Increased regulation of in-office compounding due to concerns of contamination may lead to limited options and increased costs for patients. Fortunately, in-office compounded intralesional triamcinolone did not have an increased risk of infection compared with noncompounded triamcinolone in this large retrospective study. Therefore, the authors support continuing in-office compounding to enhance the ability to provide individualized and low-cost treatments for patients.

– InYoung Kim, MD, PhD

Written by

 

 

Shruti Agrawal MD

Written by

 

 

Kenneth J. Tomecki MD

Regarding in-office compounding in dermatology...yea or nay? The answer should be "yea," but regulators still disagree. This manuscript should help. The authors produced a solid retrospective review of 4300+ patients who received intralesional triamcinolone (2/3 compounded with bacteriostatic saline) during a 30-day period at two institutions. Suspected infection occurred in only 11 patients (0.25%), 7 of whom had inflamed cysts. The take-home message is clear—in-office compounding is a safe, efficacious, and cost-effective treatment modality in the outpatient clinic when sterile products are used. This is consistent with similar observations at other institutions in the last decade.

Intralesional triamcinolone is a widely used, effective modality for many skin conditions, including alopecia areata, hidradenitis suppurativa, prurigo nodularis, and lichen simplex chronicus. Dermatologists need this treatment option for patients; anything less compromises patient care, potentially affects quality of life, and increases the cost of healthcare. Given this convincing and substantive report, we encourage dermatologists to be vocal and assertive with local and state regulatory agencies that oversee compounding. Press the issue; don't relent. If successful, patients will benefit.

Abstract

BACKGROUND

Intralesional injection of sterile medications remains a mainstay in dermatology, enabling a tailored, low-cost, in-office therapy. Following the 2012 United States outbreak of fungal meningitis from contaminated intrathecally administered corticosteroids, there has been increased regulation of in-office compounding, regardless of administration route. Studies demonstrating the safety data of in-office corticosteroid compounding for intradermal or subcutaneous use are lacking.

OBJECTIVE

To assess the incidence of infection caused by compounded in-office intralesional triamcinolone.

METHODS

A retrospective chart review identified subjects that received in-office intralesional corticosteroid injections in 2016. Medical documentation within 30 days of injection was reviewed for suspected infection.

RESULTS

Charts of 4370 intralesional triamcinolone injections were assessed, 2780/4370 (64%) being compounded triamcinolone with bacteriostatic saline. Eleven suspected localized infections (0.25%) were identified, with 4/11 in the compounding cohort. Of these, 7/11 occurred after injection of an "inflamed cyst." No hospitalizations or deaths occurred. No temporal/locational relationships were identified.

LIMITATIONS

This study was limited to two academic institutions. A 30-day post injection time frame of was used.

CONCLUSION

In-office compounding for intralesional dermal and subcutaneous administration is safe when sterile products are used by medical practitioners. There is no increased risk of compounded triamcinolone relative to non-compounded triamcinolone.

Journal of the American Academy of Dermatology

The Infection Rate of Intralesional Triamcinolone and the Safety of Compounding in Dermatology for Intradermal and Subcutaneous Injection: A Retrospective Chart Review

J Am Acad Dermatol 2020 May 19;[EPub Ahead of Print], CA Luther, JL Griffith, E Kurland, R Al Shabeeb, M Eleryan, K Redbord, DM Ozog 

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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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