Intra-Lesional Therapy

Intralesional therapy implies injecting a drug directly into the skin lesion for faster action & better results. The concept of intralesional injection is to let the drug pass the barrier zone and establish a sub-epidermal depot thus allowing a higher concentration of the drug to act at the site of the disease.

A variety of drugs such corticosteroids, bleomycin, 5-flurouracil, interferons and stibogluconate can be used. Corticosteroid intralesional therapy is widely practiced.

Which steroids can be used ?

Triamcinolone acetonide (TA), triamcinolone hexacetonide, hydrocortisone acetate, methylprednisolone, betamethasone sodium phosphate and betamethasone acetate suspensions can be used. TA is most commonly used among them all. It is used in concentrations ranging from 2mg/ml to 40mg/ml depending on the requirement.

What are the indications of intralesional therapy ?

Intralesional therapy is indicated in the following conditions:

• alopecia areata

• keloid

• hypertrophic scar

• cystic acne

• oral lichen planus

• psoriatic nail

• post herpetic neuralgia

• vitiligo

• lichen simplex chronicus

• onychomycosis

When is intralesional therapy not done ?

It is not performed when the patient is suffering from a debilitating disease, diabetes or has infection at the site of disease.

What are the advantages ?

It is an out door procedure and does not need admission. It eliminates the need of long term oral or topical therapy. It has negligible side effects. It is very effective as the injection works deep into the tissue where topical medications would not penetrate. It can be combined with cryotherapy to give excellent results in cases of keloids etc.

Are there any side effects ?

Slight swelling may be observed. One or more sittings may be required to achieve the desired results.