الفهرس 
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Abstract
The arm of intralesional steroid injection is to attain high
concentration of steroids at the diseased site in the skin. Intralesional
steroid injection is used mainly for localized chronic lesions which
do not respond to topical steroids and/or wherever pre longed
systemic steroid therapy is undesirable.
In this study the adrenal functions was studied following
intralesional injection of diluted triamcinolone acetonide (10 mg/ml)
in doses of 0.5 ml in managing 10 cases with patchy alopecia areata,
1ml in managing 10 cases with localized chronic eczema, and 2ml in
managing 10 cases with localized plaque psoriasis.
All patients in this study had complete history taking, general
and local examination at the first visit and also at the follow up
visits. Intralesional injection of diluted triamcinolone acetonide was
done using insulin syrmge with a gauge of27-30 at the first visit,
after 3 weeks and 6 weeks.
The hypothalamic pituitary-adrenal axis function was
investigated by using long ACTH stimulation test (long synacethen
test) at 3 weeks and 6 weeks following intralesional injection of
diluted triamcinolone acetonide by taking blood samples from every
patient after intramuscular injection of /31-24 corticotrophin
(tetracosatide hexacetate) adsorbed to zmc phosphate which is
available as synathen depot, at 0, 1 hour, 4 hours, 8 hours and 24
hours both at 3 and 6 weeks for measuring serum cortisol level
which is done using immulite cortisol kits.
In the present study there was no statistically significant
suppression of the hypothalamic pituitary-adrenal axis in all patients
both at 3 and 6 weeks following intralesional injection of diluted
triamcinolone acetonide with a maximum dose of 2 ml (each ml
containing 10mg of triamcinolone acetonide) and minimum dose of
0.5 ml.
Clinical improvement occurred in all patients with no
statistically significant local adverse effects like atrophy,
hypopigmentation or telangiectasia or systemic side effects like
elevation of blood pressure, moon face, buffalo hump, striae
formation or menstrual irregularities among female patients in the
child bearing period in the form of change in frequency, duration or
amount of bleeding.
In conclusion, intralesional injection of diluted triamcinolone
acetonide in doses of 0.5 ml, l ml and 2ml with each ml containing
10 mg triamcinolone acetonide is an effective and safe procedure in
managing cases of patchy alopecia areata, localized chronic eczema
and localized plaque psoriasis respectively when given every 2-3
weeks for 3 times with no risk of systemic side effects or adrenal
suppression. This can be of clinical application as localized areas of
skin can be injected every visit which will decrease the burden on
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dermatologist who has a busy practice. Decreasing the number of
visits is financially useful for the patient. Also, in case of need for
injection on short intervals, in a patient who has to leave in a short
period, one can inject with a high safety profile. However, it is
advised to repeat the injections every 2-3 weeks because at that time
the patient will start to feel the improvement which will be a motive
for good compliance.
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