Intramuscular Steroid Injection Research Articles

Treatment of Local, Persistent Cutaneous Atrophy Following Corticosteroid Injection with Normal Saline Infiltration

Injections of corticosteroids are commonly used for a variety a dermatologic conditions but may cause local, persistent cutaneous atrophy, with few therapeutic options. To determine the effectiveness of bacteriostatic normal saline infiltration on the improvement of corticosteroid-induced cutaneous atrophy. Four patients with corticosteroid-induced atrophy of the skin, two caused by acneiform cysts and one from intramuscular steroid injection, were treated with weekly injections of normal saline directly into the atrophic site. The patients were seen on weekly follow-up visits, and improvement was documented. All four patients demonstrated complete resolution of skin atrophy and restoration of surface contour within 4 to 8 weeks of initial presentation. Injected volumes of normal saline ranged from 5 to 20 cm(3) per treatment session and three to six weekly treatments. The patients were completely satisfied with these results. Normal saline infiltration offers a safe, tolerable, relatively rapid, and effective treatment for local, persistent corticosteroid-induced atrophy.

Adverse Reactions to Permanent Eyeliner Tattoo

To report the potential for serious adverse reactions associated with permanent eyeliner tattoos. An observational case series was conducted on 4 patients who presented with inflammatory eyelid reactions after receiving permanent eyeliner tattoo. Clinically, the tattoo-associated lesions were typically firm, raised masses underlying the areas of pigmentation. Histopathologic analysis of tissue from all 4 patients demonstrated a granulomatous inflammatory response with negative cultures for any organisms. Treatment approaches varied between a combination of topical steroid creams, local steroid injections, local resection, intramuscular steroid injection, and systemic oral steroids. These treatments were successful in all 4 cases. An allergic granulomatous reaction is one of the adverse reactions seen after permanent eyeliner tattoo. Treatment can be challenging and may ultimately require excision of tattoo pigment to remove the inciting factor. Systemic steroids may aid in controlling the inflammation associated with reaction to the tattoo pigment.

A case of relapsing polychondritis involving the tragal and the conchal bowl areas with sparing of the helix and the antihelix

We describe a 65-year-old white man with a 21-year history of recurrent, afebrile episodes of painful, tragal, conchal bowl and eyelid swelling accompanied by occasional conjunctivitis. The remainder of the auricle was not involved. Episodes were both self-remitting and responsive to intramuscular steroid injections. Cutaneous and cartilaginous tissues were examined histologically following a therapeutic debulking procedure. The histologic features included dermal edema, vascular dilatation, and small vessel inflammation with a dense polymorphous inflammatory infiltrate rich in eosinophils. Perichondrial inflammation and cartilage degeneration with fibrosis were characteristically observed. Bacterial cultures demonstrated normal flora. This case fulfills the revised diagnostic criteria of relapsing polychondritis. It demonstrates an unusual presentation within the disease spectrum of relapsing polychondritis with tragal and conchal bowl involvement and sparing of the helix and the antihelix. (J Am Acad Dermatol 1999;41:299-302.)

Immunosuppression induces transcription of murine cytomegalovirus glycoprotein H in the eye and at non-ocular sites.

In these studies, DNA PCR was used to identify sites of murine cytomegalovirus (MCMV) latency after inoculation of virus into the supraciliary space of the eye. Reverse transcription (RT) PCR for an immediate early gene and a late gene was used to identify putative sites of virus reactivation after methylprednisolone (steroid)-induced immunosuppression. Ten weeks after inoculation of 5 x 10(2) PFU of MCMV, BALB/c mice were immunosuppressed by intramuscular injection of steroid. Control mice were infected but not immunosuppressed. Two weeks after initiation of immunosuppression, mice were sacrificed. DNA and RNA extracted from homogenized tissues were amplified for immediate early gene 1 (IE1) and late gene, glycoprotein H (gH), DNA and mRNA by PCR and RT-PCR, respectively. Replicating virus was detected in homogenized ocular and non-ocular tissues by plaque assay. In the latently infected PBS-treated control group, viral DNA was detected in the inoculated eye and in several non-ocular tissues; IE1 mRNA was found in most of the DNA-positive tissues, while gH mRNA was amplified only in a few of the MCMV DNA-positive tissues from a single mouse. After immunosuppression, viral DNA and IE1 mRNA were detected at a higher frequency in various tissues of steroid-treated mice. gH mRNA was detected in a significantly higher number of the inoculated eyes, salivary glands and other non-ocular tissues of steroid-treated mice. After immunosuppression, low titers of infectious virus were recovered from the salivary glands of steroid-treated mice, but infectious virus was not recovered from the inoculated eye of either steroid-treated of non-immunosuppressed mice. The DNA PCR results suggest that after inoculation of 5 x 10(2) PFU of MCMV into the supraciliary space of euthymic BALB/c mice, virus becomes latent in the inoculated eye, salivary gland and other extraocular tissues. The RT-PCR results suggest that latent MCMV can be reactivated in multiple tissues by immunosuppression.

Reduction of cortisol levels after single intra-articular and intramuscular steroid injection

This study was undertaken to determine the influence of single intra-articular or intra muscular injections of methylprednisolone acetate on the hypothalamic-pituitary-adrenal axis. Twenty-one patients with rheumatic disease who had never been treated with systemic glucocorticoids and had not received local injections of these agents for the preceding 2 months, were given 40 mg of methylprednisolone acetate. Group I (11 patients) received one intra-articular injection into the knee, and Group II (10 patients) received the same dose intramuscularly. In Group I, serum cortisol levels were significantly decreased 24 hours after injection (228.2 +/- 8.7 nmol/L versus 193 +/- 16.3 nmol/L; P < 0.05). Serum cortisol levels were decreased in 9 of the 11 patients, by an average of 21.5%. Two patients' levels were below 138 nmol/L, which is considered to be the lower limit of normal range. Serum cortisol levels were below normal range in 3 patients 72 hours after intra-articular steroid injection. In Group II, serum cortisol levels were significantly decreased at 72 hours after injection (239.6 +/- 10.3 nmol/L versus 175.6 +/- 21.4 nmol/L; P < 0.01). Three patients' levels were below normal. By 72 hours postinjection, serum cortisol concentrations in 9 of 10 patients were decreased by an average of 31% compared to preinjection values. The present study suggests that decreased adrenocortical secretion, as reflected in depressed cortisol levels, can result from a single, low-dose, intra-articular or intramuscular injection of depot corticosteroids.

Intramuscular Abscess.

In brief A 24-year-old man had been reusing needles to inject anabolic-androgenic steroids intramuscularly and developed a thigh abscess. He was treated with intravenous antibiotics, and the abscess was surgically drained. The case highlights the danger of intramuscular steroid injection and of reusing needles.

Acoustic rhinometry used as a method to monitor the effect of intramuscular injection of steroid in the treatment of nasal polyps

Acoustic rhinometry is a new method which describes the geometry of the nasal cavity and the epipharynx. The method, based on the reflection of an acoustic signal entered into the nasal cavity, can be used to evaluate the cross-sectional area of the nasal cavity as a function of distance from the nostril. The method has, together with nasal expiratory peak flow (NPF) and nasal index based upon a self assessment score, been used to evaluate, in an objective and dynamic way, the effect of systemic treatment of nasal polyps with steroids in a series of eight patients with recurrent nasal polyposis. The study shows a significant relationship between these three parameters before and after systemic treatment of nasal polyps with steroids. It is concluded that in this study acoustic rhinometry had an accurate and objective method for measuring the geometry of the nasal cavity before and after treatment for processes which block the nasal cavity.

The effect of intramuscular injection of steroid on posttreatment endodontic pain

Fifty patients participated in this controlled double-blind study. The results showed that, when compared with a placebo, injection of the steroid (dexamethasone, 4 mg) significantly reduced both the incidence and severity of pain at 4 h posttreatment and reduced pain at 24 h posttreatment. Other patient and treatment factors such as age, sex, tooth number, pulp and periapical status, and number of appointments had no effect on posttreatment pain. However, posttreatment pain did correlate with the presence of pretreatment pain in both incidence and severity. Fifty patients participated in this controlled double-blind study. The results showed that, when compared with a placebo, injection of the steroid (dexamethasone, 4 mg) significantly reduced both the incidence and severity of pain at 4 h posttreatment and reduced pain at 24 h posttreatment. Other patient and treatment factors such as age, sex, tooth number, pulp and periapical status, and number of appointments had no effect on posttreatment pain. However, posttreatment pain did correlate with the presence of pretreatment pain in both incidence and severity. Cincuenta pacientes participaron en este estudio controlado a doble ciego. Los resultados demostraron que, comparada con un placebo, la inyección de un esteroide (dexametasona 4 mg) redujo en forma significativa tanto la aparición o presencia del dolor como su severidad a las cuatro horas de realizado el tratamiento y redujo el dolor a las 24 hs posttratamiento. Otros factores propios del paciente y de las condiciones del tratamiento tales como edad, sexo, tipo de diente, estado pulpar y periapical, número de sesiones, no tuvieron importancia en el dolor post-tratamiento. Sin embargo, éste sí estuvo relacionado con la presencia de dolor antes del tratamiento, tanto en incidencia como en intensidad. Cincuenta pacientes participaron en este estudio controlado a doble ciego. Los resultados demostraron que, comparada con un placebo, la inyección de un esteroide (dexametasona 4 mg) redujo en forma significativa tanto la aparición o presencia del dolor como su severidad a las cuatro horas de realizado el tratamiento y redujo el dolor a las 24 hs posttratamiento. Otros factores propios del paciente y de las condiciones del tratamiento tales como edad, sexo, tipo de diente, estado pulpar y periapical, número de sesiones, no tuvieron importancia en el dolor post-tratamiento. Sin embargo, éste sí estuvo relacionado con la presencia de dolor antes del tratamiento, tanto en incidencia como en intensidad.