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High-dose intralesional triamcinolone can be considered for acute hidradenitis suppurativa lesions

Key clinical point: A significant proportion of patients reported improvements in disease state, quality of life, and overall satisfaction following treatment with high-dose intralesional triamcinolone (ILTAC).

Major finding: 76.9% of patients were very satisfied or satisfied with high-dose ILTAC therapy. 92.6% reported improvements in disease state, and 75.9% reported improved quality of life. 86.3% of patients said they were willing to receive additional injections of high-dose ILTAC, if needed. No adverse effects were reported.

Study details: The data come from a retrospective chart review and telephone questionnaire involving patients with HS (n = 54) treated using high-dose ILTAC (20 and 40 mg/mL).

Disclosures: No funding source was provided. The authors declared no conflicts of interest.

Commentary

“The authors report findings from an uncontrolled retrospective chart review evaluating the utility of “high-dose” (20 or 40mg/mL) intralesional triamcinolone injections for the management of inflammatory hidradenitis suppurativa lesions. High rates of satisfaction and improvement in various secondary outcomes like drainage and physical mobility, as well as willingness of most patients to receive injections in the future, suggests the intervention may be beneficial, even among patients with severe, Hurley stage III disease, who comprised the majority of the cohort.

These findings notwithstanding, it is important to note that inflammatory HS lesions frequently improve or resolve with time regardless of intervention and that recall bias could play a significant role in the reported findings, which were obtained retrospectively via telephone interview. Without standardized response criteria or a control / placebo population to which to compare, the true efficacy of high-dose intralesional triamcinolone injections in HS is difficult to assess.

Prior work has similarly suggested that treatment of inflammatory lesions with intralesional triamcinolone (usually at a concentration of 10mg/mL) is beneficial for reduction of pain and inflammation. The technique is widely used for HS and is included in the North American hidradenitis suppurativa management guidelines. Nevertheless, prospective controlled studies are needed to determine the true utility of the intervention. One recently published double-blind, randomized, placebo-controlled trial of 32 subjects found no statistically significant difference in the response to intralesional therapy with 10mg/mL triamcinolone, 40mg/mL triamcinolone, or normal saline.”

Robert G. Micheletti, MD

Assistant Professor of Dermatology and Medicine

Perelman School of Medicine, University of Pennsylvania

References:
Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: topical, intralesional, and systemic medical management. J Am Acad Dermatol 2019; 81: 91–101.
Alvarez P, Garcıa-Martınez FJ, Poveda I, et al. Intralesional triamcinolone for fistulous tracts in Hidradenitis suppurativa: an uncontrolled prospective trial with clinical and ultrasonographic follow-up. Dermatology 2020; 236: 46–51.
Fajgenbaum K, Crouse L, Dong L, et al. Intralesional triamcinolone may not be beneficial for treating acute Hidradenitis Suppurativa lesions: a double-blind, randomized, placebo-controlled trial. Dermatol Surg 2020; 46: 685–689.
Riis PT, Boer J, Prens EP, et al. Intralesional triamcinolone for flares of Hidradenitis Suppurativa (HS): a case series. J Am Acad Dermatol 2016; 75: 1151–1155.

Citation:

Garelik J et al. Int J Dermatol. 2020 Aug 17. doi: 10.1111/ijd.15124.