Intralesional Injection Of Triamcinolone Acetonide Research Articles

Cicatricial alopecia.

In the classification of the North American Hair Research Society, primary cicatricial alopecias (PCA) are divided into four groups according to their prominent inflammatory infiltrate: PCAs with lymphocytic, neutrophilic, mixed or nonspecific cell inflammation pattern. The hair loss can begin subclinically and progress slowly so that the exact onset of the disease is often difficult to determine. The diagnosis is often delayed. While most forms of cicatricial alopecia can be clearly diagnosed based on clinical presentation in the acute disease stage, diagnosis can be challenging in the subacute, early or late disease stages. At first presentation, a detailed patient history and dermatological examination of the body, including trichoscopy, should be performed. In clinically unclear cases, a biopsy should be performed. Due to the scarcity of primary cicatricial alopecia, there is little evidence on the efficacy of the various therapies. The aims of treatment are to stop or at least delay hair loss and progression of the scarring process, reduce clinical inflammation signs as well as to alleviate subjective symptoms. Hair re-growth in already scarred areas should not be expected. Anti-inflammatory treatment with topical corticosteroids class III to IV and / or with intracutaneous intralesional triamcinolone acetonide injections can be considered in most of the primary cicatricial alopecias. The choice of systemic therapy depends on the type of predominant inflammatory infiltrate and includes antimicrobial, antibiotic or immunomodulating/immunosuppressive agents. Psychological support and camouflage techniques should be offered to the patients.

The efficacy of intralesional triamcinolone acetonide (20mg/ml) in the treatment of keloid

Background: Management of keloid is difficult as well as challenging. Intralesional triamcinolone acetonide (TAC) injections have remained a gold standard in non-surgical management of keloid. TAC is generally used in the concentration of 40mg/ml, which causes adverse effects such as local dermal atrophy and hypopigmentation. Aim was to study efficacy and adverse effects of TAC in treatment of keloid, in a lesser concentration of 20mg/ml.Methods: An open label study was conducted from November 2015 to May 2017 on 25 subjects of either gender, in the age group 11-55 years, at a medical college hospital. Intralesional injection TAC 20 was administered in the keloid at an interval of 3 weeks, for a total of 6 sessions, over a period of 18 weeks. Vancouver scar scale (VSS) was used to assess the improvement and SPSS 21 for statistical analysis.Results: Mean age of keloid subjects was 30.72 years and median duration of keloid was 8 months. The mean VSS score before treatment was 8.36 which reduced to 3.20 after treatment. Mean percentage change in VSS score was 62.79%, which was very highly significant (p <0.001). Physician’s assessment was ‘Very Good’ in 52.0% and ‘Excellent’ in 5 (20%). Adverse effect of atrophy was seen in 3 (12%), hypopigmentation in 11 (44%) and telangiectasia in 4 (16%).Conclusions: Intralesional injection triamcinolone acetonide 20mg/ml gives very good to excellent improvement in the majority of patients of keloid. Local adverse effects seen were hypopigmentation, atrophy and telengiectasia.

Preoperative intralesional injection of triamcinolone acetonide for a large head and neck lymphangioma in a baby: a case report

Lymphangiomas (LMs) are uncommon congenital malformations of the lymphatic system, with an estimated incidence of one in 2,000 to 4,000 live births.1 About half of these lesions are diagnosed at birth, and by two years of age, 90% of those with lesions have been diagnosed.2 Histologically, LMs are benign lesions; however, they can pose a serious threat to the patient due to possible growth into surrounding structures, sometimes causing life-threatening complications. Treatment of large head and neck lymphangiomas in young infants is very challenging, due to the risk of surgical complications. Further challenges include the limited volume of blood loss that infants can tolerate, the lack of the option for radiotherapy or radiosurgery, and the high chance of life-threatening complications if the LM is not treated. Here, we report a case of a two-month-old baby girl presenting with a large head and neck lymphangioma. She was successfully treated with intralesional triamcinolone acetonide injections, followed by surgical resection of the lesion.

Preoperative intralesional injection of triamcinolone acetonide for a large head and neck lymphangioma in a baby: a case report

Lymphangiomas (LMs) are uncommon congenital malformations of the lymphatic system, with an estimated incidence of one in 2,000 to 4,000 live births.1 About half of these lesions are diagnosed at birth, and by two years of age, 90% of those with lesions have been diagnosed.2 Histologically, LMs are benign lesions; however, they can pose a serious threat to the patient due to possible growth into surrounding structures, sometimes causing life-threatening complications. Treatment of large head and neck lymphangiomas in young infants is very challenging, due to the risk of surgical complications. Further challenges include the limited volume of blood loss that infants can tolerate, the lack of the option for radiotherapy or radiosurgery, and the high chance of life-threatening complications if the LM is not treated. Here, we report a case of a two-month-old baby girl presenting with a large head and neck lymphangioma. She was successfully treated with intralesional triamcinolone acetonide injections, followed by surgical resection of the lesion.

Bacillus Calmette-Guerin polysaccharide nucleic acid extract versus triamcinolone acetonide intralesional injection in the treatment of oral lichen planus: a comparative study

Background Oral lichen planus (OLP) is a chronic inflammatory disease of unknown etiology and pathogenesis with frequent relapses. OLP has several patterns; some are asymptomatic whereas others may affect patient’s quality of life. Corticosteroids (CS) (either topical, intralesional, or systemic) are the cornerstone in OLP treatment. Unfortunately, CS are associated with variable local and systemic adverse effects; therefore, other therapeutic modalities have been tried for OLP treatment. Among these modalities was the Bacillus Calmette-Guerin polysaccharide nucleic acid extract (BCG-PSN). Aim The aim of this study was to evaluate the efficacy, safety, and recurrence after intralesional BCG-PSN injection in comparison with intralesional triamcinolone acetonide (TA) injection in treatment of OLP. Patients and methods BCG-PSN was extracted from BCG vaccine in the Immunology Research Laboratory, Department of Microbiology and Immunology, Zagazig University. A total of 26 patients with clinically proved OLP were enrolled in the study. They were divided into two groups (group A and group B). Group A included 13 patients with OLP who were treated with two intralesional injections of TA (20 mg/ml) once weekly for 2 weeks. Group B included 13 patients with OLP who were treated with six intralesional injections of BCG-PSN, 0.5 ml every other day for 2 weeks. The responses of OLP lesions to intralesional injection of BCG-PSN and TA were evaluated based on reduction in their surface area. A semiquantitative (reticulation/erythema/ulceration) scoring system was used for monitoring the response of OLP lesions. Pain was assessed using a numerical rating scale. Results No statistically significant differences were found between the groups in the reduction of erosion areas (t=7.10, P=0.47), reticulation/erythema/ulceration scores (t=80.5, P=0.83), and numerical rating scale scores (t=80.0, P=0.81). There was no statistically significant difference between both groups regarding the response to therapy (χ2=1.87, P=0.39). Nonsignificant difference was found in the occurrence of adverse effects between the groups (P=0.500). There was nonsignificant difference in the recurrence rate (77.8 vs. 71.4%, P=0.61) between the two groups. Conclusion Intralesional BCG-PSN injection can be used as an effective alternative to intralesional TA in the treatment of OLP especially in patients resistant to or with contraindications for CS.

A Retrospective Analysis of Efficacy and Safety of Intralesional Triamcinolone Injections in the Treatment of Frontal Fibrosing Alopecia Either as Monotherapy or as a Concomitant Therapy.

Context:Frontal fibrosing alopecia (FFA) is a primary cicatricial alopecia characterized by progressive recession of frontal, and often temporoparietal, hairline mainly in postmenopausal women. Currently, there are no guidelines or proposed evidence-based treatment for FFA.Aims:The aim of this study was to retrospectively evaluate the effect and safety of intralesional triamcinolone acetonide injections (ITAIs) either as monotherapy or as concomitant treatment in the management of hairline recession in FFA.Subjects and Methods:All patients with FFA, who visited our specialist hair clinic from July 2012 to October 2016 and were treated with ITAI either as monotherapy or as concomitant treatment, were enrolled in our study. Measurements were performed from five different points on the scalp. The analysis of data included demographics, associated symptoms, clinical and dermoscopic findings, comorbidities, family history of FFA, concomitant medication, treatment outcome, and recording of adverse events.Statistical Analysis:Statistical analysis was performed using the Statistical Package for the Social Sciences, version 22.0.Results:A total of 40 patients, all females were enrolled in our study. The mean age of the patients was 65.88 ± 8.18 whereas the mean age of the diagnosis was 61.24 ± 7.4. A total of 39 patients were treated with a combination of treatments, including ITAI, and only one with ITAI as monotherapy. There was a halting of the progress of the disease, and no significant adverse events were noted, apart from mild pain.Conclusions:A halting in the progression of FFA was achieved, with unremarkable adverse events. ITAI could serve as an effective and safe option for the treatment of FFA, although difficult to assess it as monotherapy. Further randomized controlled trials are needed to evaluate its efficacy and safety as the sole treatment in the management of FFA.

Case Report: New Surgical Approach option for Keloid in Ear

Introduction: Crossing centuries, great inquiries are still portrayed in medicine. Abnormal healing becomes one of these mysteries not completely unraveled. Keloid and hypertrophic scars are characterized by abnormal responses to the healing process. They present intense production and deposition of collagen and glycoproteins in the dermis, with consequent development of a pathological scar. Keloid and hypertrophic scars arouse an important aesthetic and psychological appeal, especially when present in regions such as the face, causing embarrassment and changes in social relationships. Due to this, when carrying out a review of the literature, there are many papers talking about the subject keloid, being at experimental or clinical level, however there is no consensus on which method is best done in its handling and treatment. Objective: Describe a new approach to keloid resection preserving its epithelium and dermis as cover in cases where transplantation would be necessary. Method: Report three cases of keloid in ear in young patients, one in the lobe and two in the ear helix, all with low or absent clinical activity (hyperemia, pain and/or pruritus and absence of growth). In the first case, the patient was previously treated with intralesional corticoid injections, surgical resection and radiotherapy, but recurred with keloid formation predominantly in the ear lobe. On this time, it was treated with the technique described by Kim DY et al. as keloid fillet flap added to adjuvant beta-therapy, with no signs of recurrence until the present moment of follow-up and with a tension-free primary closure. In the second case, the patient presented keloid formation in the upper extremities of ears after performing otoplasty. Such patient was treated with intralesional injections of corticoid (triamcinolone acetonide) followed by surgical procedure, also with cited technique, and adjuvant beta-therapy, providing a primary closure of the lesion without tension. The third case, reports about a keloid recurrence in upper auricular helix after two procedures of excision and local skin grafting. In this case it was also made intralesional injections of triamcinolone acetonide, followed by a surgical approach with the keloid fillet flap technique and beta-therapy adjuvant also carried out tension-free primary closure. Results: In the short follow-up period, no recurrences, suture dehiscence, hematomas / seromas, or areas of tissue necrosis were observed. Patients remain without clinical signs of keloid activity. Conclusion: Cases where clinical signs of keloid activity, hyperemia, pruritus, local pain and growth are not observed, as well as areas where there is no possibility of primary closure after complete resection, including large masses, conservative surgical approach provides a very pertinent alternative. Techniques that cause minor morbidities to the patients and preserve the local anatomy after resection of the lesions and that do not increase the rates of recurrence and/or complications, are portrayed as ideal. Thus, these reports corroborate a new approach to some forms of keloid lesions with the objective of better patient outcomes and without the need for skin grafts or distant flaps.

Combined oral propranolol with intralesional injection of triamcinolone acetonide in treatment of infantile periocular hemangiomas.

AimTo evaluate the clinical effectiveness of combined oral propranolol with intralesional injection of triamcinolone acetonide in the treatment of infantile periorbital capillary hemangioma.Patients and MethodsThis prospective interventional study included children diagnosed with periocular infantile hemangiomas in the proliferative phase with vision-threatening lesions. The children presented to the oculoplastic unit in Sohag University Hospital in the period between January 2016 and February 2017 and were treated with a combined intralesional injection of triamcinolone acetonide with oral propranolol, with a follow-up period of 6 months. Treatment response was evaluated according to the size of the tumor (horizontal diameter); additionally, complications of both treatment methods were recorded.ResultsThis study included 33 infants: 21 females (64%) and 12 males (36%). The mean age at the time of injection was 4.9±2.6 months. The study included three modes of treatment response: regression of the tumor, 28 patients (85%); stabilization, three patients (9%); and failure, two patients (6%), which necessitated repeated intralesional injection of triamcinolone but with minimal response. Regarding complications, only one patient reported with subconjunctival hemorrhage during intralesional injection of steroids; there were no recorded cases of hypotension, bradycardia, or hypoglycemia during the course of oral propranolol treatment. After the end of the follow-up period, there were no reported cases of recurrent increase in the size of the regressed group of infantile hemangiomas with stable tumor size.ConclusionCombined oral propranolol with intralesional injection of triamcinolone acetonide is the effective method of treatment for infantile periorbital capillary hemangioma with minimal adverse effects.

Comparison of Intralesional Triamcinolone Acetonide, 5-Fluorouracil, and Their Combination for the Treatment of Keloids.

Objective: Despite the myriad options available, there is no universally accepted treatment for keloids. Our objective was to compare three regimens and establish superiority in terms of objective and subjective outcomes. Approach: In this randomized parallel group study, 60 patients were enrolled and randomly allocated to three groups. Patients received intralesional injections of triamcinolone acetonide (TAC) in Group TAC, 5-fluorouracil (5FU) in Group 5FU, and a combination in Group T + F every 3 weeks till 24 weeks or till the keloid resolved. Results: There was a reduction in all parameters at every successive assessment in all three groups. Improvement in terms of height, vascularity, and pliability was fastest with 5FU, TAC, and T + F group, respectively, which was statistically significant. Decrease in pigmentation was significantly faster with T+F. Reduction in pruritus, however, was significantly faster with 5FU than the other groups, but the difference in reduction of pain among the three groups was not significant. Telangiectasias and skin atrophy were seen most commonly in TAC group, while skin ulceration was a common problem in 5FU group. Conclusion: TAC, 5FU, and their combination are all effective in keloid scars. A combination of TAC +5FU seems to offer the balanced benefit of faster and more efficacious response with lesser adverse effects when compared to individual drugs.

Efficacy of perilesional and intralesional triamcinolone acetonide injections in pemphigus vulgaris lesions of the scalp: an effective therapeutic option.

The scalp is a common location for pemphigus vulgaris (PV), and scalp lesions may be resistant to standard treatment. Perilesional/intralesional triamcinolone acetonide (TA) injections have been used successfully to treat oropharyngeal and ocular involvement in PV. Data on the efficacy of perilesional and intralesional triamcinolone acetonide injections in scalp lesions in PV are lacking. We report two patients with immunopathologically and histopathologically confirmed PV and residual scalp lesions resistant to standard treatment, who were treated with perilesional and intralesional injections of TA 10 mg/mL. Clearance of scalp lesions was achieved after one after, respectively, one and two perilesional and intralesional injections. Perilesional and intralesional TA injections may serve as an effective and safe treatment for recalcitrant scalp lesions in pemphigus.

Clinical Assessment of the Efficacy and Safety of Intralesional Injection of Triamcinolone Acetonide for Treatment of Chronic Radio Dermatitis

Clinical Assessment of the Efficacy and Safety of Intralesional Injection of Triamcinolone Acetonide for Treatment of Chronic Radio Dermatitis

Fractional carbon dioxide laser in combination with topical corticosteroid: An innovative treatment for hypertrophic lichen planus

Hypertrophic lichen planus (HLP) is a treatment-resistant variant of lichen planus. 1 Atzmony L. Reiter O. Hodak E. Gdalevich M. Mimouni D. Treatments for cutaneous lichen planus: a systematic review and meta-analysis. Am J Clin Dermatol. 2016; 17: 11-22 Crossref PubMed Scopus (41) Google Scholar No treatment option has been found to be universally effective in HLP. Intralesional injections of triamcinolone acetonide have been found to be effective, but the treatment is associated with significant pain. We describe the novel use of fractional CO2 laser–assisted corticosteroid delivery into treatment-resistant HLP, leading to complete resolution of the lesions.

THE USE OF INJECTABLE TRIAMCINOLONE IN THE TREATMENT OF EROSIVE ORAL LICHEN PLANUS

Oral lichen planus (OLP) is a relatively common chronic disease of the mucous membranes that may have more transient cutaneous manifestations. It has a number of well-recognized clinical signs and a wide range of symptoms, ranging from none through mild discomfort to severe debilitating intra-oral erosions and ulceration. Efforts have been made in a continued searching for new therapies for symptomatic OLP; among them, an intralesional injection of triamcinolone acetonide (TA). This study aimed to evaluate the efficacy and safety of intralesional TA injection for ulcerative OLP in a black male patient, 64 years old, who attended the Oral Medicine Clinic complaining about painful lesions of erosive OLP. Intralesional TA injection in ulcerative OLP was effective and safe in achieving lesion and pain regression.

Best dilution of the best corticosteroid for intralesional injection in the treatment of localized alopecia areata in adults

Purpose: To evaluate and compare the clinical efficacy, dermoscopic results and safety of triamcinolone acetonide (TA) and betamethasone dipropionate (BD) injections at different concentrations in localized scalp and beard alopecia.Methods: Intralesional injection of BD or TA in three different dilutions; 1/4, 1/8, 1/12 (BD1, BD2, BD3, TA1, TA2, TA3) and Saline (control) was randomly applied to a total of 231 alopecia patches in 83 patients every four weeks in a maximum of six sessions until a hair regrowth score of 4 was achieved. The number of required sessions, sixth-month hair regrowth scores, treatment success rates and dermoscopic data were investigated.Results: The mean number of required sessions were similar and significantly lower in BD1 and TA1 being 4.21 ± 1.12 and 3.74 ± 0.99, respectively. Dermoscopic examinations revealed similar terminal hair growth rations in Saline (30.3%), BD1 (44.4%) and TA1 (42.9%). However, sixth-month hair regrowth scores, overall treatment success rates and percentage of terminal hair regrowth were similar in BD1 and TA1. However, adverse effects were more common in TA groups (24.3%) than in BD groups (10.6%) at the sixth month.Conclusions: BD ¼ dilution (1.25 mg/dL) seems best corticosteroid for intralesional injection in the treatment of localized alopecia areata in adults.

Vibration Anesthesia for Pain Reduction During Intralesional Steroid Injection for Keloid Treatment.

Patients suffer significant pain during intralesional steroid injection treatment for keloids and hypertrophic scars. Vibration anesthesia has been shown to effectively and safely alleviate pain sensations, likely by reducing pain transmission from peripheral receptors to the brain. The objective was to evaluate the efficacy, safety, and patient satisfaction associated with vibration anesthesia for reducing pain during intralesional corticosteroid injection. The authors recruited 40 patients with 58 keloids who were scheduled to undergo intralesional triamcinolone acetonide (TA) injections. Half of each keloid was injected with concomitant vibration anesthesia, whereas the other half was injected without vibration anesthesia. Pain experienced by patients during both procedures was assessed according to visual analog scale (VAS) score. The authors also assessed procedure safety. The mean VAS score during intralesional TA injection therapy without vibration was 5.88 ± 2.34. By contrast, the same patients yielded a mean VAS score during intralesional TA injection therapy with vibration of 3.28 ± 1.85; the difference between the mean scores was significant (p < .05). Thirty-nine (97.5%) patients tolerated this therapy well. Vibration anesthesia is a promising option for reducing pain during keloid treatment with intralesional steroid injection.

Anaphylaxis following intralesional triamcinolone acetonide (Kenacort) injection

Intralesional triamcinolone acetonide injection is indicated for multiple skin conditions such as keloid scars, alopecia areata, and hypertrophic lichen planus. Immediate hypersensitivity reaction remains uncommon. We report on a 24-year-old woman who had received multiple intralesional injections with triamcinolone acetonide (Kenacort) plus lidocaine for keloid scar treatment without any reaction for the previous 10 years. The immediate reaction occurred 15 minutes after injection, with numbness on her face and 5 minutes later with urticaria on her chest wall and upper extremities, together with hypotension (blood pressure of 90/60 mmHg). Allergology workup revealed positive skin prick test for triamcinolone acetonide (Kenacort). Skin tests for other corticosteroids (hydrocortisone, methylprednisolone, and dexamethasone), excipients (carboxymethylcellulose, benzyl alcohol, and polysorbate 80) and lidocaine were negative, including subcutaneous challenge for lidocaine and oral challenge for carboxymethylcellulose. IgE-mediated hypersensitivity reaction must be considered in cases of multiple applications of triamcinolone acetonide injection.

Efficacy of oral colchicine with intralesional hyaluronidase or triamcinolone acetonide in the Grade II oral submucous fibrosis.

Background and Objectives:Oral submucous fibrosis (OSMF) is a potentially malignant disorder of oral mucosa affecting mainly population in South and Southeast Asia. The aim of this study is to compare the effectiveness of oral colchicine with intralesional injection of hyaluronidase or injection triamcinolone acetonide in patients with Grade II OSMF.Materials and Methods:The study included thirty patients of clinically diagnosed Grade II OSMF. Patients were divided randomly into two groups: Group A patients were treated by administrating tablet colchicine 0.5 mg twice daily with an intralesional injection of hyaluronidase 1500 IU with 0.5 ml of lignocaine hydrochloride at weekly interval for 12 weeks. Group B patients were treated by administering tablet colchicine 0.5 mg twice daily with an intralesional injection of triamcinolone acetonide 10 mg/ml at weekly interval for 12 weeks. Clinical diagnosis was based on burning sensation in mouth, blanching of mucosa, presence of vesicles or ulceration in oral cavity, and reduced mouth opening. Outcome assessment was done at intervals of 3 weeks, 6 weeks, 3 months, and 6 months.Results:Improvement in mouth opening and reduction in burning sensation was seen more in Group A patients. Improvement in blanching of mucosa was seen in both the groups.Conclusion:In conclusion, use of injection hyaluronidase with oral colchicine gave better results in terms of increase in mouth opening and improvement in burning sensation without notable side effects. However, for a definite conclusion, further study with large sample size and long follow-up is required.

Hypopigmentation After Local Corticosteroid Injection for De Quervain Tenosynovitis

The clinical presentation hypopigmentation is a rare complication after intralesional injection of triamcinolone acetonide. A 32-year-old female, yellow race, visited our dermatology department for a hypopigmented patch in right dorsum of her right thumb. The lesion developed after injection of an intralesional corticosteroid. The patient was diagnosed with hypopigmentation secondary to the triamcinolone injection. Three months after injection, her hypopigmentation showed improvement upon physical examination. Hypopigmentation is a very rare side effect of intralesional triamcinolone injection, which may be associated with gender. The mechanism is unknown, need for further study.

A Topical Anesthetic and Lidocaine Mixture for Pain Relief During Keloid Treatment: A Double-Blind, Randomized Controlled Trial

Keloids are abnormal overgrowth of collagen fibers, and the first-line treatment includes intralesional injection of triamcinolone acetonide (TA), which is associated with pain. To study the benefit of applying topical anesthetics or a 1:1 mixture of 1% lidocaine and TA at the TA injection site to alleviate pain during keloid treatment. A double-blind, randomized controlled trial was conducted. Four TA injection methods were tested: control, lidocaine, topical, and combined. A visual analog scale (VAS) was used to assess needle-stick and injection pain. Data on pain duration after injection were also collected. Forty patients were enrolled (mean age, 37.1 years). The VAS scores of needle-stick pain in the control, lidocaine, topical, and combined groups were 4.18 ± 2.12, 3.82 ± 2.48, 2.03 ± 2.02, and 2.20 ± 1.99, respectively. Pain statistically decreased in the topical and combined groups. Intralesional injection pain (VAS) scores in the control, lidocaine, topical, and combined groups were similar as follows: 4.97 ± 2.50, 4.97 ± 2.79, 4.10 ± 2.80, and 4.43 ± 2.68, respectively. Application of topical anesthetics significantly relieved needle-stick pain, especially at sternum and auricular keloids; administration of a lidocaine mixture did not alleviate pain during injection.

Cutaneous pseudolymphoma: An enigma

Cutaneous pseudolymphoma, also called lymphoid infiltrates of the skin mimicking lymphomas, is defined as reactive polyclonal benign lymphoproliferative process predominantly composed of either B-cells or T-cells, localized or disseminated. A 62-year-old male presented with multiple asymptomatic swellings over the posterior aspect of the left ear of 1-year duration. On examination, multiple nodules were present over the left retroauricular area, 2 of which were skin colored, firm, and nontender. Histopathology revealed pseudolymphoma with the features of a dense diffuse and nodular infiltrate of small and large lymphocytes and histiocytoid cells involving the whole of reticular dermis and extending to subcutis. A patch test was done using Indian standard battery series showed positive reaction - 2+ for paraphenylenediamine. A diagnosis of cutaneous pseudolymphoma was made. The lesions were treated with intralesional Triamcinolone acetonide injection 10 mg/ml for 2 sittings, 3 weeks apart following which there was remission of the nodules. Pseudolymphomas are benign but persistent lymphoid proliferations in the dermis, which may be difficult to distinguish from a low-grade malignant lymphoma. Pseudolymphomas are classified according to the histological components into B-cell and T-cell variants. So far no case of cutaneous pseudolymphoma suggestive of insect bite with coincidental paraphenylenediamine allergy has been reported. Hence, this case is reported as its histopathology was suggestive of pseudolymphoma secondary to insect bite reaction.