Steroid Preparations Research Articles

CNS-targeted glucocorticoid reduces pathology in mouse model of amyotrophic lateral sclerosis.

BackgroundHallmarks of CNS inflammation, including microglial and astrocyte activation, are prominent features in post-mortem tissue from amyotrophic lateral sclerosis (ALS) patients and in mice overexpressing mutant superoxide dismutase-1 (SOD1G93A). Administration of non-targeted glucocorticoids does not significantly alter disease progression, but this may reflect poor CNS delivery. Here, we sought to discover whether CNS-targeted, liposomal encapsulated glucocorticoid would inhibit the CNS inflammatory response and reduce motor neuron loss. SOD1G93A mice were treated with saline, free methylprednisolone (MP, 10 mg/kg/week) or glutathione PEGylated liposomal MP (2B3-201, 10 mg/kg/week) and compared to saline treated wild-type animals. Animals were treated weekly with intravenous injections for 9 weeks from 60 days of age. Weights and motor performance were monitored during this period. At the end of the experimental period (116 days) mice were imaged using T2-weighted MRI for brainstem pathology; brain and spinal cord tissue were then collected for histological analysis.ResultsAll SOD1G93A groups showed a significant decrease in motor performance, compared to baseline, from ~100 days. SOD1G93A animals showed a significant increase in signal intensity on T2 weighted MR images, which may reflect the combination of neuronal vacuolation and glial activation in these motor nuclei. Treatment with 2B3-201, but not free MP, significantly reduced T2 hyperintensity observed in SOD1G93A mice. Compared to saline-treated and free-MP-treated SOD1G93A mice, those animals given 2B3-201 displayed significantly improved histopathological outcomes in brainstem motor nuclei, which included reduced gliosis and neuronal loss.ConclusionsIn contrast to previous reports that employed free steroid preparations, CNS-targeted anti-inflammatory agent 2B3-201 (liposomal methylprednisolone) has therapeutic potential, reducing brainstem pathology in the SOD1G93A mouse model of ALS. 2B3-201 reduced neuronal loss and vacuolation in brainstem nuclei, and reduced activation preferentially in astrocytes compared with microglia. These data also suggest that other previously ineffective therapies could be of therapeutic value if delivered specifically to the CNS.

Limited therapeutic benefits of intra-articular cortisone injection for patients with femoro-acetabular impingement and labral tear

Intra-articular (IA) hip cortisone injection is commonly performed as a therapeutic modality in patients with femoral acetabular impingement (FAI). To our knowledge, there is no published data evaluating the clinical benefit of these injections. The purpose of this study was to assess the efficacy of therapeutic IA cortisone injection in these patients. At our institution, patients with FAI and labral tear prospectively recorded their numerical rating scale (NRS) pain scores pre-injection, during post-injection anaesthetic phase, and at 14 days post-injection. From this cohort, all patients treated with guided IA cortisone injection, no radiographic evidence of arthritis (Tönnis grade 0 or 1) and pain relief during the anaesthetic phase of the IA injection were included. An absolute change of two points on the NRS score was considered the minimal amount of clinically significant pain relief. Pain scores were compared between the different types of steroid injected. Fifty-four patients (35 females, 19 males) with a mean age of 32 ± 12 years were included. Average median pre-injection NRS score was 7.0 (range 2.5-10.0), post-injection anaesthetic phase was 1.0 (range 0.0-5.0), and 14 day post-injection was 5.0 (range 0.0-10.0). As a group, NRS scores significantly diminished from post-injection anaesthetic phase to 14 days post-injection (p < 0.001). At 14 days post-injection, only 20 patients (37 %) and at 6 weeks, only 3 patients (6 %) reported a clinically significant decrease in pain. Average duration of pain relief was 9.8 days. There was no difference in pain reduction between steroid preparations. In patients with symptomatic FAI and labral tear, intra-articular cortisone injection has limited clinical benefit as a therapeutic modality. However, anaesthetic-only IA injections for patients who may be candidates for hip arthroscopy can be a useful diagnostic tool.

Imatinib causing drug rash with eosinophilia and systemic symptoms: A rare cutaneous reaction.

Imatinib causing drug rash with eosinophilia and systemic symptoms: A rare cutaneous reaction.

Drug utilization pattern in acne vulgaris in skin outpatients department of a tertiary care teaching hospital at Dehradun, Uttarakhand

Background: Irrational prescription of drugs is a common occurrence in clinical practise. Aims & Objective: The principal aim of drug utilization studies is to facilitate the rational use of drugs in population. Materials and Methods: A total of 238 prescription of patients of acne vulgaris were analyzed for 6 months in Dermatology OPD by Pharmacology department of SGRRIM & HS, Dehradun to study the drug utilization pattern, using WHO drug use indicator. Results: A total of 238 prescriptions were analysed, male: female ratio was 1:1.07, mean age was 21.67 ± 0.51 years, majority of the patients were unmarried 153 (64.28%), students 192 (80.68%), non-vegetarian 121 (50.84%), belongs to middle socio-economic group 213 (89.49%). Total 1135 drugs were used, oral formulations 471 (41.50%), topical 664 (58.50%), 35 (3.08%) FDCs (fixed dose combination) were prescribed. 4.76 drugs per prescription were prescribed. Antibiotics 204(43.31%) were most commonly used oral drugs. 620 (93.37%) single topical preparations and 44 (6.63%) topical combination preparations of steroids, antibiotics and antifungals were prescribed. All drugs were prescribed in brand names. Conclusion: The prescriptions revealed polypharmacy. This study can help to provide feedback to the prescribers, thereby increase in awareness and improve patient care by rational utilisation of drugs.

Pain Management With Intrathecal Clonidine In Colon Cancer Patient With Opioid Hyperalgesia: Case Presentation

Hyperalgesia is normally an increase in the response to a painful stimulant. Opioid-induced hyperalgesia (OIH) is a situation frequently encountered in algology clinics. Its treatment is complicated and problematic and often requires alternative methods. A 40-year-old male patient 45 kg weighing had been diagnosed with stage IV colon cancer 2.5 years ago. He had used non-steroid antiinflammatory drugs, opioid analgesics and steroid preparations casually for his increased pain without any monitoring for one year. He was admitted five times for pain control. In the last visit, he complained of severe abdominal, pubic and rectal pain (visual analogue scale [VAS] 8), which was unresponsive to epidural analgesic, and later presented to the algology clinic; he was sleep-deprived, restless and in a panic state. Intrathecal morphine (1 mg) was applied considering his opioid tolerance. Because of increased pain (VAS 8-9) one hour after surgery for abscess in the liver and peritonea, the patient was given intravenous dexketoprofen trometamol and diazem considering his OIH. Then, bolus dexmedetomidine (1 µg/kg) followed by dexmedetomidine infusion (0.2 µg/kg/h) was started. Three days later, diagnostic intrathecal clonidine (30 µg) was applied, and the patient's complaints regressed. With the patient reporting relaxed pain (VAS 1-2) after 30 minutes, an intrathecal port was placed. Both cancer pain and OIH were controlled with clonidine 90 µg/day. He was more relaxed, and his pain was tolerable until his death. Intrathecal clonidine administration may be an effective method for the treatment of OIH.

PReS13-SPK-1253: Challenges in nursing care with the new biologics for JIA

Sam was diagnosed with extended oligoarticular Juvenile Idiopathic Arthritis at the age of 18 months. He began Etanercept at the age of 10 years old in March 2007 after an inadequate response to non-steroidal medications, methotrexate and numerous steroid preparations. Seventeen months later he was switched to Adalimumab with the expectation that this would have an improved response for Sam hated Adalimumab and was struggling to tolerate the injections. Encouraging Sam to persevere was difficult but he did so. After seven months, Sam refused anymore Adalimumab and had fourteen months only on Methotrexate, with numerous joint injections and intravenous steroid pulses. He was then commenced on Abatacept. Sam was seen every 4 weeks and his active joint disease remained apparent. By this time Sam had stopped playing football, socialising with his friends and was feeling frustrated with the limitations his arthritis posed on his daily life. After eleven months Sam was offered his 4th Biological therapy - Tocilizumab. Whilst Sam has not got systemic disease, the options available were fast decreasing. His family were encouraging about a new therapy that like the others might just be the one for him. Sam on the other hand was reluctant and needed persuasion. After some response, the decision was made to increase the dose past the recommended dose. This medication like the others had challenges with it for Sam; such as rashes, low neutrophils, and when he became unwell at home, this was not escalated appropriately as his ESR and CRP were normal in the absence of fever. There have also been issues for the health professionals in his care; applying to begin the medication, needing a fortnightly day-case bed, abnormal blood parameters and the concern about how to control Sam's disease. Still requiring frequent joint injections and occasional intravenous pulses of steroids when he allows it, Sam is getting very fed up with the fortnightly infusion and the associated day out of school. Now at 16 years of age and struggling with his GCSE exams, Sam wants to know what will work for Despite his parent's strong reluctance, Sam wants to know if he can have a bone marrow transplant and believes the quoted 10% risk of mortality is worth it. Sam's case is not unique but it does highlight many issues with these newer 'biological' therapies. This presentation will highlight many of these issues including injection site reactions, adverse events, changing therapies and perhaps most importantly; managing patient expectations.

P-025 Corticosteroid Use in A Prospective, Community-Based Cohort of Newly Diagnosed Inflammatory Bowel Disease Patients

Previous population-based studies report corticosteroid (CS) exposure rates that range from 39% to 75% within the first year of diagnosis with surgical resection rates as high as 13%–18% in the same timeframe.1–2 These reports represent an older cohort of patients enrolled over prolonged periods of time and do not necessarily reflect current treatment approaches. In this study, we examine CS use during the first year of IBD diagnosis in a novel, inception cohort. Data were derived from the Ocean State Crohn’s and Colitis Area Registry (OSCCAR), a prospective inception cohort of IBD patients who are residents of Rhode Island. Participants are enrolled within 12 months of diagnosis and complete follow-up assessments quarterly over the course of the first year. Participants who had been enrolled within 3 months from the date of diagnosis and had a confirmed diagnosis based on the NIDDK IBD Genetics Consortium criteria were included in current analyses. Table 1 outlines baseline clinical characteristics of patients included in our analyses (N = 272). Overall, 60% of Crohn’s disease (CD) and 57% of ulcerative colitis (UC) patients were exposed to at least one course of systemic CS during year 1.83% of patients treated with CS received their first course within 3 months of enrollment. Twenty-seven percent were exposed to topical steroid preparation (budesonide or rectal steroids) in year 1. Of the 66 patients with CD and 45 with UC not exposed to CS, 18 (27%) and 8 (18%) were treated with a topical steroid, respectively. Table 2 summarizes clinical outcomes. Five patients (2%) required a surgical resection in year 1.17% of all patients were treated with a biologic in year 1.26% of CD and 17% of UC patients exposed to systemic CS during year 1 were ultimately treated with a biologic. However, 17% of CD patients not exposed to CS during year 1 were treated with a biologic. All UC patients treated with a biologic were exposed to CS at some point during year 1. As of April 2013, 84 of the 272 (31%) patients included in our analyses had been treated with a biologic and 15 (6%) ultimately required a surgical resection. In this community-based cohort, 59% were exposed to at least one course of CS during their first year of enrollment. In contrast to previous studies, OSCCAR represents a more modern cohort of patients. While steroid exposure rates were similar or slightly higher than in previous reports, we observed a low rate of surgical resection. Future analysis will focus on how the effects of more contemporary treatments may have played a role in the low rates of surgery we observe.

Эффективность интравитреального введения стероидного препарата перед витрэктомией у больных регматогенной отслойкой сетчатки, осложненной отслойкой сосудистой оболочки

<p style="text-align: justify;"><span style="font-size: 13.0080003738403px; line-height: 1.538em; color: #800000;"><span style="color: #800000;">https://doi.org/10.31288/oftalmolzh201354150</span></span> <p style="text-align: justify;"><strong><span style="font-size: 13.0080003738403px; line-height: 1.538em; color: #800000;">The efficacy of intravitreal steroid preparation injection before vitrectomy in patients with rhegmatogenous retinal detachment complicated by choroidal detachment</span></strong>

Topical steroids for chronic wounds displaying abnormal inflammation

IntroductionChronic, non-healing wounds are often characterised by an excessive, and detrimental, inflammatory response. We review our experience of using a combined topical steroid, antibiotic and antifungal preparation in the treatment of chronic wounds displaying abnormal and excessive inflammation. MethodsA retrospective review was undertaken of all patients being treated with a topical preparation containing a steroid (clobetasone butyrate 0.05%), antibiotic and antifungal at a tertiary wound healing centre over a ten-year period. Patients were selected as the primary treating physician felt the wounds were displaying excessive inflammation. Healing rates were calculated for before and during this treatment period for each patient. Changes in symptom burden (pain, odour and exudate levels) following topical application were also calculated. ResultsOverall, 34 ulcers were identified from 25 individual patients (mean age: 65 years, range: 37–97 years) and 331 clinic visits were analysed, spanning a tot...

The short term fetal cardiovascular effects of corticosteroids used in obstetrics.

Background: Corticosteroids are widely used in obstetrics due to their striking effect on perinatal morbidity and mortality of premature neonates. Despite this, relatively few studies have explored short term fetal effects of corticosteroids as measured by ultrasound. Objectives: 1) To present a literature review of short term fetal cardiovascular effects of corticosteroids 2) To describe the protocol of a current observational study (SUPER‐A*STEROID) of cardiovascular effects of dexamethasone and betamethasone in the first week after their administration. This trial is nested within the A*STEROID blinded multicentre randomised controlled trial of the two steroid preparations. Findings: Existing data suggest corticosteroids have little effect on the major measured fetal blood vessels when the baseline ultrasound is normal. In the compromised fetus, where the umbilical artery end‐diastolic flow is abnormal prior to maternal corticosteroids, flow is temporarily restored in approximately 50% of cases. Whether such changes are beneficial is uncertain. Very little data exist that directly compare the short‐term effects of betamethasone and dexamethasone. The SUPER‐ A*STEROID study described will help provide this information.

Neuropsychological outcomes of a randomized trial of prednisone versus dexamethasone in acute lymphoblastic leukemia: Findings from Dana-Farber Cancer Institute All Consortium Protocol 00-01

Dexamethasone is more efficacious than prednisone in the treatment of acute lymphoblastic leukemia (ALL), but has also been associated with greater toxicity. We compared neuropsychological outcomes for patients treated on DFCI ALL Consortium Protocol 00-01, which included a randomized comparison of the two steroid preparations during post-induction therapy in children and adolescents with ALL. Between 2000 and 2005, 408 children with standard-risk or high-risk ALL treated on Dana-Farber Cancer Institute Consortium Protocol 00-01 were randomly assigned to prednisone or dexamethasone administered as 5-day pulses every 3 weeks for 2 years, beginning at week 7 of treatment. Blinded neuropsychological testing was completed for 170 randomized patients (prednisone, N = 76; dexamethasone, N = 94), all of whom were in continuous complete remission after completion of therapy. Outcomes were comparable for most variables, although patients on the dexamethasone arm performed more poorly on a measure of fluid reasoning (P = 0.02). They also tended to be more likely to be enrolled in special education (dexamethasone, 33% vs. prednisone, 20%, P = 0.09). Dexamethasone has well documented benefit in treatment of ALL. Although formal testing provided little indication of increased risk for neurotoxicity relative to prednisone, the somewhat greater utilization of special education services by patients treated with dexamethasone merits further investigation.

At Least Two More Compounding Pharmacies Recall Steroid Preparations With Suspected Fungal Contamination

At Least Two More Compounding Pharmacies Recall Steroid Preparations With Suspected Fungal Contamination

Intra-Articular Cortisone Injection Has Limited Clinical Benefit for Non-Operative Treatment of Femoral Acetabular Impingement with Labral Pathology (SS-29)

Intra-articular cortisone injection of the hip is commonly performed both as a confirmatory diagnostic test and also as a therapeutic treatment modality in patients with femoral acetabular impingement (FAI). However, to our knowledge, there is no published data documenting the clinical benefit of these injections in patients with FAI. Therefore, the purpose of our study is to assess the efficacy of intra-articular cortisone injection in patients with FAI and associated labral tear prior to hip arthroscopy. We hypothesize that intra-articular cortisone injection does not provide significant therapeutic benefit for the non-operative treatment of FAI with associated labral tear. The records of patients undergoing hip arthroscopy for FAI at our institution between January 2008 and October 2012 who agreed to participate in research were reviewed. A cohort of patients was identified that underwent a pre-operative ultrasound or fluoroscopic guided intra-articular cortisone injection. Inclusion criteria were a diagnosis of FAI with labral tear, Tonnis grade 0 or 1, and minimum 50% pain relief during the anesthetic phase of the intra-articular injection. Exclusion criteria were patients with concomitant osteoarthritis as defined as Tonnis grade 2 or 3. Numerical rating scale (NRS) pain scores were prospectively recorded pre-injection, immediately post-injection, and at 14 day follow-up. An absolute change of 2 points on the NRS score at 14 days was considered the minimal amount of clinically significant pain relief. The type of steroid used was documented. 35 patients met our inclusion criteria and included 29 females (83%) and 6 males (17%) with a mean age of 34.4 ± 12.9 years. 7 patients had Tonnis grade 0 (20%) and 28 had Tonnis grade 1 (80%). Patients received anesthetic combined with methylprednisolone (21 patients), triamcinolone (12 patients), or betamethasone (2 patients) during the intra-articular injection. Median pre-injection NRS score was 6 (range 2-10). Median immediate post-injection NRS score was 2 (range 0-6). Median 14 day post-injection NRS score was 4 (range 0-10). Median absolute change in NRS score at 14 days was 0 (range 0-8) with 23 patients reporting no change (66%) and 11 patients (31%) reporting a change of ≥ 2 points. There was no significant difference in pain reduction between the different steroid preparations. In patients with symptomatic FAI and associated labral pathology, our data indicates that intra-articular cortisone injection has limited clinical benefit in two-thirds of patients as a therapeutic non-operative treatment modality.

Topical steroids for chronic wounds displaying abnormal inflammation

Chronic, non-healing wounds are often characterised by an excessive, and detrimental, inflammatory response. We review our experience of using a combined topical steroid, antibiotic and antifungal preparation in the treatment of chronic wounds displaying abnormal and excessive inflammation. A retrospective review was undertaken of all patients being treated with a topical preparation containing a steroid (clobetasone butyrate 0.05%), antibiotic and antifungal at a tertiary wound healing centre over a ten-year period. Patients were selected as the primary treating physician felt the wounds were displaying excessive inflammation. Healing rates were calculated for before and during this treatment period for each patient. Changes in symptom burden (pain, odour and exudate levels) following topical application were also calculated. Overall, 34 ulcers were identified from 25 individual patients (mean age: 65 years, range: 37-97 years) and 331 clinic visits were analysed, spanning a total time of 14,670 days (7,721 days 'before treatment' time, 6,949 days 'during treatment' time). Following treatment, 24 ulcers demonstrated faster rates of healing, 3 ulcers showed no significant change in healing rates and 7 were healing more slowly (p=0.0006). Treatment generally reduced the burden of pain and exudate, without affecting odour. In normal wound healing, inflammation represents a transient but essential phase of tissue repair. In selected cases, direct application of a steroid containing agent has been shown to improve healing rates, presumably by curtailing this phase. Further evaluation is required to establish the role of preparations containing topical steroids without antimicrobials in the management of chronic wounds.

Combination of carbon isotope ratio with hydrogen isotope ratio determinations in sports drug testing

Carbon isotope ratio (CIR) analysis has been routinely and successfully applied to doping control analysis for many years to uncover the misuse of endogenous steroids such as testosterone. Over the years, several challenges and limitations of this approach became apparent, e.g., the influence of inadequate chromatographic separation on CIR values or the emergence of steroid preparations comprising identical CIRs as endogenous steroids. While the latter has been addressed recently by the implementation of hydrogen isotope ratios (HIR), an improved sample preparation for CIR avoiding co-eluting compounds is presented herein together with newly established reference values of those endogenous steroids being relevant for doping controls. From the fraction of glucuronidated steroids 5β-pregnane-3α,20α-diol, 5α-androst-16-en-3α-ol, 3α-Hydroxy-5β-androstane-11,17-dione, 3α-hydroxy-5α-androstan-17-one (ANDRO), 3α-hydroxy-5β-androstan-17-one (ETIO), 3β-hydroxy-androst-5-en-17-one (DHEA), 5α- and 5β-androstane-3α,17β-diol (5aDIOL and 5bDIOL), 17β-hydroxy-androst-4-en-3-one and 17α-hydroxy-androst-4-en-3-one were included. In addition, sulfate conjugates of ANDRO, ETIO, DHEA, 3β-hydroxy-5α-androstan-17-one plus 17α- and androst-5-ene-3β,17β-diol were considered and analyzed after acidic solvolysis. The results obtained for the reference population encompassing n = 67 males and females confirmed earlier findings regarding factors influencing endogenous CIR. Variations in sample preparation influenced CIR measurements especially for 5aDIOL and 5bDIOL, the most valuable steroidal analytes for the detection of testosterone misuse. Earlier investigations on the HIR of the same reference population enabled the evaluation of combined measurements of CIR and HIR and its usefulness regarding both steroid metabolism studies and doping control analysis. The combination of both stable isotopes would allow for lower reference limits providing the same statistical power and certainty to distinguish between the endo- or exogenous origin of a urinary steroid.

Efficacy of Long-Acting Formulations of Estradiol or Progesterone Plus Estradiol on Estrous Synchronization in Broodmares

A preliminary trial was performed to evaluate the ability of sustained release preparations of estradiol-17β or progesterone plus estradiol-17β to synchronize estrus in cyclic mares. Group 1 mares were treated with a 50 mg intramuscular (IM) injection of sustained release estradiol-17β, while group 2 mares were treated with estradiol plus 1.5 g of sustained release progesterone. All mares received an IM injection of 10 mg of prostaglandin-F2α (PGF2α) 10 days after steroid treatment. Mares were examined by transrectal ultrasonography on Days 1 and 10 of treatment and then at ≤2 day intervals to monitor follicle size. Once a follicle ≥30 mm diameter and uterine edema were detected, 0.5 mg of the GnRH analog histrelin was administered IM. Mares were examined daily thereafter to detect ovulation. Group 1 mares did not exhibit ovulation synchrony (ovulations occurred 12-22 days after steroid treatment), whereas ovulation synchrony was satisfactory in group 2 mares (interval to ovulation being 20.4 ± 1.5 days, range 17-22 days). Using sustained release preparations of progesterone plus estradiol-17β, with PGF2α administered on Day 10, could eliminate the need for daily injections of steroid preparations in oil when synchronizing estrus and ovulation.

Exserohilum Rostratum Fungal Meningitis Associated With Methylprednisolone Injections

<i>Exserohilum Rostratum</i> Fungal Meningitis Associated With Methylprednisolone Injections

Treatment preferences in juvenile idiopathic arthritis – a comparative analysis in two health care systems

BackgroundVariations in the treatment of juvenile idiopathic arthritis (JIA) may impact on quality of care. The objective of this study was to identify and compare treatment approaches for JIA in two health care systems.MethodsPaediatric rheumatologists in Canada (n=58) and Germany/Austria (n=172) were surveyed by email, using case-based vignettes for oligoarticular and seronegative polyarticular JIA. Data were analysed using descriptive statistics; responses were compared using univariate analysis.ResultsTotal response rate was 63%. Physicians were comparable by age, level of training and duration of practice, with more Canadians based in academic centres. For initial treatment of oligoarthritis, only approximately half of physicians in both groups used intra-articular steroids. German physicians were more likely to institute DMARD treatment in oligoarthritis refractory to NSAID (p<0.001). Canadian physicians were more likely to switch to a different DMARD rather than a biologic agent in polyarthritis refractory to initial DMARD therapy. For oligoarthritis and polyarthritis, respectively, 86% and 90% of German physicians preferred regular physiotherapy over home exercise, compared to 14% and 15% in Canada. Except for a Canadian preference for naproxen in oligoarthritis, no significant differences were found for NSAID, intra-articular steroid preparations, initial DMARD and initial biologic treatment.ConclusionsTreatment of oligo- and polyarticular JIA with DMARD is mostly uniform, with availability and funding obviously influencing physician choice. Usage of intra-articular steroids is variable within physician groups. Physiotherapy has a fundamentally different role in the two health care systems.

Expounding newer vistas in VEGF

Expounding newer vistas in VEGF

Cutaneous Atrophy and Alopecia After Greater Occipital Nerve Injection Using Triamcinolone

Greater occipital nerve (GON) infiltration is widely used for the treatment of primary and secondary headache disorders mainly on the basis of open-label evidence, although recent double-blinded placebo-controlled trials have demonstrated its efficacy in cluster headache. The procedure is generally well tolerated although corticosteroid-related side effects, including Cushing's syndrome and local cutaneous changes, can occur. We report the occurrence of cutaneous atrophy and alopecia in 4 patients who underwent GON blockade with triamcinolone and lidocaine. Triamcinolone injection is associated with cutaneous atrophy, especially in superficial injection sites; therefore, alternative steroid preparations like methylprednisolone and betamethasone might be more appropriate for GON blockade.