Topical corticosteroids and intralesional injections

While topical corticosteroids and intralesional injections are often recommended as first-line treatment for the cutaneous manifestations of sarcoidosis,12,14,15,30 little evidence is presented regarding their efficacy for this indication. Khatri et al.80 describe a case of lupus pernio which improved with topical 0-05% halobetasol propionate twice daily for 10 weeks. Volden et al.81 describe three cases of cutaneous sarcoidosis that went into remission within 3-5 weeks of treatment with once-weekly clobetasol propionate covered with hydrocolloid dressing. The use of intralesional hydrocortisone and cortisone were reported in 1953 by Sullivan et al. 82 Eighteen skin lesions in five patients with cutaneous sarcoidosis were injected with 2-5 mg doses of hydrocortisone. All lesions developed evidence of regression by 14 days after the injection, with no evidence of recurrence 14 weeks later. Seven skin lesions in four patients were injected with 2-5 mg cortisone. All lesions improved but not to the same extent as was noted with intralesional hydrocortisone. Liedtka reported on a sarcoid patient who had cutaneous lesions affecting the face, back and upper extremities that responded to multiple injections of chloroquine hydrochloride, 50 mg/ml.83

Harms

No major side-effects were reported in any of the study participants. Post-inflammatory hypopigmentation and hyperpigmentation were noted after the intralesional hydrocortisone injections in the review of Sullivan et al82 Minimal bleeding from the needle puncture, and cutaneous atrophy from the steroids are inherent risks to intralesional steroid injections.84

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