Department of Medicine (Dermatology), North York General Hospital, Toronto, ON, Canada.
J Cutan Med Surg. 2010 Jan-Feb;14(1):19-23. doi: 10.2310/7750.2009.08082.
Intralesional steroid (ILS; usually triamcinolone acetonide) is commonly used, and the literature contains much information about its use in keloids, hemangiomas, and alopecia areata. Little has been written about its use in inflammatory dermatoses such as psoriasis and localized dermatitis since the 1960s, the conditions for which it was originally most studied and used.
To clarify the use of ILS and to encourage its use in psoriasis and localized dermatitis.
Medline peer-reviewed literature in English (1956-2008) was searched for the use of ILS in all skin diseases. Six standard textbooks of dermatology were reviewed. Information as to how they used ILS was obtained from a questionnaire completed by 33 dermatologists and from personal discussions with 15 other dermatologists. Additional information was obtained from 40 years of personal ILS use and from observation of 42 dermatologists working intermittently in our office over the past 25 years. ILS product package inserts and company drug monographs were reviewed.
ILS is used by most dermatologists, but there are considerable divergences in technique and dosing. Current textbooks contain little on its use in psoriasis and localized dermatitis. There have been no clinical studies since the 1960s, and their end points and descriptions were somewhat vague by today's standards. Product package inserts are dated and not helpful. Nevertheless, the use of ILS is safe and economical, and the original authors and our office have found it consistently to be virtually 100% effective at 2.5 mg/mL in small plaques of psoriasis on the trunk and limbs and highly effective in localized dermatitis (such as lichen simplex chronicus, prurigo nodularis, and nonspecific eczema). Clinical studies indicate that we can safely increase our ILS from the usual 3 cc (7.5 mg) to 6 cc (15 mg) or even to 8 cc (20 mg) for patients over 50 kg every 3 to 4 weeks. Serum cortisol can be performed if there are concerns about adrenal suppression, with use in periorbital hemangiomas and with intranasal ILS. Blindness (from central artery occlusion) was reported with injections of ILS around the eyes wih older products during the early development stages; and more recently with the use of ILS for periorbital hemangiomas and with ILS used intranasally. It has never been reported with low pressure injections of ILS using triamcinalone acetonide at 2.5 mg around the eyes.
No formal clinical studies since the 1960s. Poor statistical end points.
ILS at 2.5 mg/cc is safe, economical, and effective and its greater use should be encouraged in inflammatory dermatoses such as psoriasis and localized dermatitis. Further well-designed research would be helpful.
病灶内类固醇（ILS；通常为曲安奈德丙酮）的应用较为常见，大量文献报道了其在瘢痕疙瘩、血管瘤和斑秃中的应用。自 20 世纪 60 年代以来，有关其在银屑病和局限性皮炎等炎症性皮肤病中的应用的报道较少，而这些疾病正是其最初研究和应用的主要领域。
阐明 ILS 的应用，并鼓励其在银屑病和局限性皮炎中的应用。
检索了 1956 年至 2008 年英语同行评议的 Medline 文献，以获取关于 ILS 在所有皮肤病中的应用。查阅了 6 本标准皮肤科教科书。通过对 33 名皮肤科医生进行问卷调查，并与 15 名其他皮肤科医生进行个人讨论，了解他们使用 ILS 的情况。从个人 40 年 ILS 使用经验和过去 25 年在我们办公室间歇性工作的 42 名皮肤科医生的观察中获取了其他信息。查阅了 ILS 产品说明书和公司药品专论。
大多数皮肤科医生都在使用 ILS，但在技术和剂量方面存在较大差异。目前的教科书对其在银屑病和局限性皮炎中的应用几乎没有涉及。自 20 世纪 60 年代以来，一直没有进行过临床研究，其终点和描述按今天的标准有些模糊。产品说明书已经过时，没有帮助。然而，ILS 的使用是安全且经济的，原始作者和我们的办公室发现，它在躯干和四肢小斑块银屑病中，以 2.5mg/ml 的浓度使用时，几乎 100%有效，在局限性皮炎（如单纯性慢性苔藓、结节性痒疹和非特异性湿疹）中非常有效。临床研究表明，我们可以安全地将 ILS 的用量从通常的 3 毫升（7.5 毫克）增加到 6 毫升（15 毫克），甚至增加到 8 毫升（20 毫克），对于 50 公斤以上的患者，每 3 至 4 周一次。如果对肾上腺抑制有担忧，可以进行血清皮质醇检查，也可以在眶周血管瘤和鼻内使用 ILS。早期开发阶段，使用旧产品在眼周注射 ILS 会导致失明（由中央动脉阻塞引起）；最近，在使用 ILS 治疗眶周血管瘤和使用 ILS 进行鼻内治疗时也会出现这种情况。在眼周使用曲安奈德丙酮 2.5mg/ml 的低压注射中从未报告过这种情况。
自 20 世纪 60 年代以来，一直没有进行过正式的临床研究。终点统计较差。
2.5mg/cc 的 ILS 安全、经济、有效，应鼓励其在银屑病和局限性皮炎等炎症性皮肤病中更广泛应用。进一步进行设计良好的研究将是有益的。
