Steroid injections are often administered to reduce inflammation for various types of conditions such as low back pain, knee arthritis, shoulder bursitis, rotator cuff tendinitis, allergic reactions, autoimmune disorders, and more. These synthetic compounds mimic the action of our natural corticosteroid hormones, which are produced by the adrenal glands. They are often used to reduce inflammation and pain but not as a cure for diseases. They may be injected into blood vessels (intravenous), into the muscle (intramuscular), into a joint space (intra-articular), or into the epidural space of the spine (epidural).
Disadvantages of Steroid Injections
Although steroid injections can give rapid and long-lasting relief of pain and inflammation compared to oral steroids (taken by mouth), they have the disadvantage of being invasive and a bit painful when administered through the skin. Repeated injections may also cause more trauma and other complications. To reduce pain on injection, the doctor may incorporate a local anesthetic into the same syringe used for injecting the steroid.
Short-term complications of steroid injections include pain, local bleeding, infection, soreness, lightening of skin color (depigmentation) and shrinkage or dimpling at the site of injection. In some cases, when injections are administered into a joint, thinning of cartilages, weakening of ligaments and tendon rupture may occur. Post injection flare or increased inflammation at the area of injection are also possible side effects.
Skin dimpling, deformation, shrinkage or subcutaneous atrophy of soft tissues at the area of steroid injection is not a common complication or side effect. This sometimes happens when the medication collects at the muscle or fatty layer of the skin and changes the consistency or contour of the tissues, resulting in skin dimpling. This effect may happen depending on the amount and solubility of the steroid injected. Among the various steroid drugs used, triamcinolone hexacetonide and triamcinolone acetonide are the most likely offenders, since they are the least soluble steroids often used. Doctors may opt for more soluble agents, such as betamethasone or dexamethasone which is preferred for injecting into soft tissues.
Skin dimpling is also more likely to affect less padded areas where there is less tissue. It may appear within one to four months after injection and may last for more than six months. Although it may appear bad to the patient, it is not a serious complication and may resolve by itself within several months to a year.
The risk of skin dimpling or tissue deformation may be reduced by doing a gentle but deep massage after steroid injection to disperse the solution more evenly under the skin and tissues. This will help prevent accumulation of the injected solution into one area. Another way to prevent skin deformation and depigmentation is to apply pressure over the injection site using a gauze as the needle is withdrawn to avoid leakage of solution from the tissues.
Consult your doctor about any side effect or complication after steroid injections for more information.
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