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Wright JA, Wenz JA, Madrigal GJ. Dermal Discoloration Secondary to Triamcinolone Acetonide Injection Observed in Patients with Autoimmune Disorders. J Am Podiatr Med Assoc 2021; 111:470048. [PMID: 34478539 DOI: 10.7547/20-210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Triamcinolone acetonide is a synthetic glucocorticoid used to treat numerous acute and chronic inflammatory conditions. The various side effects of this drug from parenteral administration are well documented in the literature. In this study, three patients present with a rare side effect of violaceous dermal pigmentation. To the best of the authors' knowledge, this finding is rarely presented in the current literature. The purpose of this study is to provide awareness of a less-documented, delayed side effect from triamcinolone acetonide administration. Although all patients presenting in this study had a known history of autoimmune disease (eg, lupus, psoriatic arthritis) further research is needed to suggest a possible association between dermal violaceous change and the use of triamcinolone.
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Musculoskeletal Corticosteroid Injection during COVID-19 Pandemic in Sabah: Is It Safe? Adv Orthop 2021; 2021:8863210. [PMID: 33824767 PMCID: PMC8006753 DOI: 10.1155/2021/8863210] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/08/2021] [Accepted: 03/17/2021] [Indexed: 12/15/2022] Open
Abstract
Musculoskeletal corticosteroid injection is commonly used as an adjunct to help patients in pain management. In this current COVID-19 pandemic, many clinicians would differ from this treatment as steroid is considered an immunosuppressive drug and could risk the patient of developing severe adverse effects if contracting COVID-19. This is a retrospective study based in Sabah, Malaysia, examining the prevalence of COVID-19 infection following musculoskeletal corticosteroid injection from 1 December 2019 until 30 June 2020 in the sports medicine clinic and the orthopedic clinic. Patients who received musculoskeletal corticosteroid injection were called by telephone and asked about visits to the emergency department or government health clinic for influenza-like illness symptoms or severe acute respiratory infection that would require screening of COVID-19. Thirty-five patients who responded to the call were included, with mean ages of 47.9 years ± 15.1. 52% were male respondents, while 48% were female. 25% of them were diabetics, and 2.9% of them had a history of lymphoproliferative disorders. The mean pain score before injection was 6.74 ± 1.03 and after injection pain was 2.27 ± 1.63. In this study, there were 11.4% (n = 4) with minor complications of steroid injection, that is, skin discoloration. Nonetheless, there were no severe complications due to corticosteroids reported. There were no reported cases of COVID-19 among the respondents following corticosteroid injection. Musculoskeletal pain would affect a person's well-being and activities; thus, its management requires that careful consideration with risk-benefit analysis be made before administering musculoskeletal corticosteroid injection during COVID-19 pandemic.
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Abstract
Osteoarthritis is a common condition that affects many individuals resulting in pain, reduced mobility, and decreased function. Corticosteroids have been a mainstay of osteoarthritis treatment. Studies have shown that they provide short-term pain improvement and can be used for osteoarthritis flares. Hyaluronic acid injections have extensively been studied in knee osteoarthritis but to a lesser degree in other joints. Despite some debate between societies, a large number of recent studies have shown hyaluronic acid to be a viable treatment option showing longer-term improvement in both pain and function.
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Affiliation(s)
- Nina A Yaftali
- Primary Care Sports Medicine, Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 West Harrison, 3rd Floor, Chicago, IL 60612, USA
| | - Kathleen Weber
- Department of Orthopaedics, Rush University Medical Center, Midwest Orthopaedics at Rush, 1611 West Harrison, 3rd Floor, Chicago, IL 60612, USA.
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Salvatierra ARA, Alweis R. Permanent hypopigmentation after triamcinolone injection for tennis elbow. J Community Hosp Intern Med Perspect 2016; 6:31814. [PMID: 27406460 PMCID: PMC4942522 DOI: 10.3402/jchimp.v6.31814] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/02/2016] [Indexed: 12/03/2022] Open
Affiliation(s)
| | - Richard Alweis
- Department of Internal Medicine, Reading Health System, West Reading, PA, USA
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Kwon HH, Suh DH. Linear extensions of hypopigmentation as a side effect of topical corticosteroid application. Int J Dermatol 2016; 55:e315-7. [PMID: 26756396 DOI: 10.1111/ijd.13154] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 06/29/2015] [Accepted: 07/10/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Hyuck Hoon Kwon
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea.,Acne and Rosacea Research Laboratory, Seoul National University Hospital, Seoul, Korea
| | - Dae Hun Suh
- Department of Dermatology, Seoul National University College of Medicine, Seoul, Korea. .,Acne and Rosacea Research Laboratory, Seoul National University Hospital, Seoul, Korea.
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Jacobs JWG, Michels-van Amelsfort JMR. How to perform local soft-tissue glucocorticoid injections? Best Pract Res Clin Rheumatol 2013; 27:171-94. [PMID: 23731930 DOI: 10.1016/j.berh.2013.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Inflammation of periarticular soft-tissue structures such as tendons, tendon sheaths, entheses, bursae, ligaments and fasciae is the hallmark of many inflammatory rheumatic diseases, but inflammation or rather irritation of these structures also occurs in the absence of an underlying rheumatic disease. In both these primary and secondary soft-tissue lesions, local glucocorticoid injection often is beneficial, although evidence in the literature is limited. This chapter reviews local injection therapy for these lesions and for nerve compression syndromes.
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Affiliation(s)
- J W G Jacobs
- Department of Rheumatology & Clinical Immunology, F02.127, University Medical Center Utrecht, Box 85500, 3508 GA Utrecht, The Netherlands.
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Shah CP, Rhee D, Garg SJ. Eyelid cutaneous hypopigmentation after sub-tenon triamcinolone injection after retinal detachment repair. Retin Cases Brief Rep 2012; 6:271-272. [PMID: 25389730 DOI: 10.1097/icb.0b013e3182278843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Cutaneous hypopigmentation has been reported after steroid injection. Sub-Tenon triamcinolone injection is often administered to control or prevent ocular inflammation. METHODS Observational case report. RESULTS Lower eyelid cutaneous hypopigmentation developed 6 weeks after sub-Tenon triamcinolone injection administered at the conclusion of scleral buckle and vitrectomy for retinal detachment repair. The hypopigmentation eventually resolved at 7 months postoperatively. CONCLUSION Sub-Tenon triamcinolone injection at the conclusion of retinal surgery can cause temporary cutaneous hypopigmentation of the eyelid. This risk should be explained preoperatively to patients, particularly those who are more heavily pigmented.
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Affiliation(s)
- Chirag P Shah
- *Ophthalmic Consultants of Boston, Boston, Massachusetts †MidAtlantic Retina, The Retina Service of Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Schreiber NTN, Mobley SR. Elegant Solutions for Complex Paramedian Forehead Flap Reconstruction. Facial Plast Surg Clin North Am 2011; 19:465-79. [DOI: 10.1016/j.fsc.2011.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jang WS, Park J, Yoo KH, Han TY, Li K, Seo SJ, Hong CK. Branch-shaped Cutaneous Hypopigmentation and Atrophy after Intralesional Triamcinolone Injection. Ann Dermatol 2011; 23:111-4. [PMID: 21738379 DOI: 10.5021/ad.2011.23.1.111] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 04/28/2010] [Accepted: 05/14/2010] [Indexed: 11/08/2022] Open
Abstract
Cutaneous changes after local corticosteroid administration may include dermal atrophy, hyperpigmentation, alopecia, and hypopigmentation. Linear hypopigmentation and atrophy after intralesional injection of triamcinolone acetonide has been reported in the literature as a very rare side effect. A 30-year-old woman visited our dermatology department for a linear hypopigmented patch with atrophy from her left foot to the lower margin of the knee. The lesion developed after injection of an intralesional corticosteroid. The patient was diagnosed with linear hypopigmentation and atrophy secondary to the triamcinolone injection.
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Affiliation(s)
- Woo Sun Jang
- Department of Dermatology, College of Medicine, Chung-Ang University, Seoul, Korea
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Brinks A, Koes BW, Volkers ACW, Verhaar JAN, Bierma-Zeinstra SMA. Adverse effects of extra-articular corticosteroid injections: a systematic review. BMC Musculoskelet Disord 2010; 11:206. [PMID: 20836867 PMCID: PMC2945953 DOI: 10.1186/1471-2474-11-206] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 09/13/2010] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To estimate the occurrence and type of adverse effects after application of an extra-articular (soft tissue) corticosteroid injection. METHODS A systematic review of the literature was made based on a PubMed and Embase search covering the period 1956 to January 2010. Case reports were included, as were prospective and retrospective studies that reported adverse events of corticosteroid injection. All clinical trials which used extra-articular corticosteroid injections were examined. We divided the reported adverse events into major (defined as those needing intervention or not disappearing) and minor ones (transient, not requiring intervention). RESULTS The search yielded 87 relevant studies:44 case reports, 37 prospective studies and 6 retrospective studies. The major adverse events included osteomyelitis and protothecosis; one fatal necrotizing fasciitis; cellulitis and ecchymosis; tendon ruptures; atrophy of the plantar fat was described after injecting a neuroma; and local skin effects appeared as atrophy, hypopigmentation or as skin defect. The minor adverse events effects ranged from skin rash to flushing and disturbed menstrual pattern. Increased pain or steroid flare after injection was reported in 19 studies. After extra-articular injection, the incidence of major adverse events ranged from 0-5.8% and that of minor adverse events from 0-81%. It was not feasible to pool the risk for adverse effects due to heterogeneity of study populations and difference in interventions and variance in reporting. CONCLUSION In this literature review it was difficult to accurately quantify the incidence of adverse effects after extra-articular corticosteroid injection. The reported adverse events were relatively mild, although one fatal reaction was reported.
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Affiliation(s)
- Aaltien Brinks
- Department of General Practice Erasmus Medical Center PO Box 2040, 3000 CA, The Netherlands.
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Saglam N, Akpinar F. Intratendinous septic abscess of the Achilles tendon after local steroid injection. J Foot Ankle Surg 2009; 48:565-8. [PMID: 19700119 DOI: 10.1053/j.jfas.2009.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Indexed: 02/03/2023]
Abstract
UNLABELLED In the treatment of pathological processes of the skeletal system, local injection of corticosteroid has become a common form of treatment. Although rare, pyogenic abscess can develop secondary to local corticosteroid injection. In this article, we describe the case of a patient who presented with pain, swelling, and hyperemia following local infiltration of corticosteroid about the Achilles tendon. Magnetic resonance image scanning of the Achilles tendon revealed a smoothly shaped intratendinous mass 3 x 1 cm in diameter, extending to the posterosuperior aspect of the calcaneus. A needle aspiration of the suspected abscess revealed S aureus, and subsequent surgical drainage and debridement revealed chronic inflammation secondary to infection at the site of previous local corticosteroid injection. Antibiotic therapy was used following incision and drainage, and recurrence of infection was not detected throughout the duration of follow-up. LEVEL OF CLINICAL EVIDENCE 4.
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Affiliation(s)
- Necdet Saglam
- Department of Orthopaedic Surgery, Teaching and Researching Hospital of Umraniye, Istanbul, Turkey.
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Khan UD. Bilateral areoleor depigmentation after augmentation mammoplasty: a case report and literature search. Aesthetic Plast Surg 2008; 32:143-6. [PMID: 17786509 DOI: 10.1007/s00266-007-9002-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Accepted: 05/10/2007] [Indexed: 10/22/2022]
Abstract
Breast augmentation is by far one of the most common aesthetic procedures performed by plastic surgeons, and silicone implants are the most common prostheses used. Complications arising from the procedure are broadly categorized as either surgery or prosthesis related. Most of the complications are well known and have been documented, but areolar depigmentation after silicone gel prosthesis has not been reported to date.
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Affiliation(s)
- Umar D Khan
- Belvedere Private Hospital, Abbeywood, Kneehill SE2 0GD, UK.
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Shapiro PS, Rohde RS, Froimson MI, Lash RH, Postak P, Greenwald AS. The effect of local corticosteroid or ketorolac exposure on histologic and biomechanical properties of rabbit tendon and cartilage. Hand (N Y) 2007; 2:165-72. [PMID: 18780047 PMCID: PMC2527227 DOI: 10.1007/s11552-007-9042-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2007] [Accepted: 04/05/2007] [Indexed: 10/23/2022]
Abstract
Tendonitis, tenosynovitis, and the arthritides are clinical problems commonly encountered in daily orthopaedic practice. Systemic anti-inflammatories, physical therapy, and local corticosteroid injections all are used as nonoperative treatments of these conditions. Systemic anti-inflammatory agents and local corticosteroid agents, however, can be associated with adverse effects that render them intolerable to some patients. As a preliminary study assessing the feasibility of local injection of nonsteroidal anti-inflammatory medication, the histological and biomechanical effects of local exposure of rabbit cartilage and tendon to injectable steroidal (corticosteroid) and injectable nonsteroidal anti-inflammatory agents (ketorolac tromethamine, KT) were determined. Thirty rabbits underwent bilateral knee joint, patellar tendon, and Achilles tendon injections with either normal saline, corticosteroid, or KT. Mechanical and histologic evaluation of the tissues was performed at 6 and 15 weeks after injection. Gross tendon adhesions were observed in more corticosteroid-treated specimens than those exposed to normal saline or KT. Microscopic evaluation of tendons revealed no significant differences among the three groups. Mild cartilage degenerative changes were noted across all groups. Evidence of cartilage necrosis was noted for the corticosteroid-treated group only. Tendons exposed to corticosteroid or KT demonstrated increased load and energy to failure, but exhibited no difference in material stiffness or strain. The use of an injectable nonsteroidal anti-inflammatory agent may be safe and even pose less threat to local tissues after intra-articular and peri-tendinous administration.
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Affiliation(s)
- Paul S. Shapiro
- Department of Orthopaedic Surgery, William Beaumont Hospital, 3535 West Thirteen Mile Road, Suite 744, Royal Oak, MI 48073 USA
| | - Rachel S. Rohde
- Department of Orthopaedic Surgery, William Beaumont Hospital, 3535 West Thirteen Mile Road, Suite 744, Royal Oak, MI 48073 USA
| | - Mark I. Froimson
- Department of Orthopaedic Surgery, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195 USA
| | | | - Paul Postak
- Orthopaedic Research Laboratories, Lutheran Hospital,Cleveland Clinic Health System, 1730 West 25th Street, Cleveland, OH 44113 USA
| | - A. Seth Greenwald
- Orthopaedic Research Laboratories, Lutheran Hospital,Cleveland Clinic Health System, 1730 West 25th Street, Cleveland, OH 44113 USA
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