Local injection of triamcinolone acetonide in the management of certain skin conditions. Preliminary report.

WITHN THE last few months there has been an increasing interest in the use of intracutaneous injection of steroids. In 1953, Hollander' reported the advantages of intra-articular injection of hydrocortisone into inflamed joint, bursa, or tendon sheath in a large series observed. Subsequently this has been accepted, advisedly, as a routine procedure in the local management of rheumatic diseases. This was soon followed by intralesional injection of hypertrophic or infiltrated skin lesions, utilizing hydrocortisone, prednisone and prednisolone. The introduction of triamcinolone, 9-alpha-fluoro163-alpha-hydroxyprednisolone, resulted in reports by Kanee2 and Hollander,3 as well as Greenlee and Epstein,4 indicating that its therapeutic effects orally on certain skin eruptions were superior to those of previous corticosteroids. Inevitably this new drug was destined for intracutaneous use. Triamcinolone acetonide (Kenalog), after assays of comparative biological activity with other available steroids, as well as preliminary clinical trials, had been carried out, became available as Kenalog Parenteral which provides an aqueous suspension of benzyl alcohol, sodium chloride, sodium carboxymethylcellulose and polysorbate 80. It is sufficiently stable to require no refrigeration. It may be administered5 intradermally or in the subcutis by a tuberculin syringe fitted with a 23-25 gauge needle. This allows for precise dosage and minimal discomfort to the patient. Vibra puncture has been advocated by Aaron,6 but this would seem to the author to be a formidable and expensive procedure for the advantages obtained. Use of pre-injection sedation or local Freon anesthetic spray may be as acceptable to the sensitive patient, and with experience depth dosage may be satisfactorily acquired. Stoughton,7 after summarizing many reports, has listed the diseases of the skin in which intracutaneous administration of steroids has given good results. The first published report on the use of parenteral triamcinolone was by James8 of Toledo, Ohio, which appeared in the Journal of Investigative Dermatology (March 1960). The same author, in a presentation before the Pan-American Medical Association Congress in New Mexico City, Mexico, May 3, 1960, presented further favourable findings, including those of his collaborators. In