Depigmentation due to Triamcinolone Acetonide

T. Nakada, Rei Sagara, M. Iijima
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Abstract

Department of Dermatology, Showa University School of Medicine, Tokyo , Japan pigmentation, teleangiectasia and mild atrophy on the extensor aspect of her right forearm and the dorsal aspect of the right hand ( fi g. 1 ). Whitish streaks were seen on the proximal side of the lesion. We diagnosed depigmentation due to triamcinolone acetonide on the basis of history and morphology. Many cases of depigmentation and atrophy due to corticosteroid injection have been reported [1–6] . The lesions appeared after a single injection to after approximately 40 injections, and perilesional linear streaks were seen in most cases [1–6] . Although their mechanism remains unclear, the suggested cause of whitish streaks is the lymphatic spread of the corticosteroid suspension resulting in dermal and epidermal atrophy [6] . Triamcinolone is a minimally soluble corticosteroid, and the formation of acetonide leads to enhanced percutaneous absorption and subsequently a strong anti-infl ammatory effect [7, 8] . Although the incidence of depigmentation and atrophy seems to be low, we must consider the cosmetic risk of those reactions [9] . Also, the anatomical sites to which such a medicament is administered should be considered [8] . Since most of the atrophic complications were described with the dose of 40 mg of triamcinolone [1–6] , a lower dosage may be more adequate for exposed sites, e.g. the face, wrists or hands.
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曲安奈德引起的色素沉着
日本东京昭和大学医学院皮肤科色素沉着,右前臂伸肌和右手背侧毛细血管扩张和轻度萎缩(图1)。病变近侧可见白色条纹。我们根据病史和形态学诊断曲安奈德引起的色素沉着。许多因皮质类固醇注射引起的色素沉着和萎缩的病例已被报道[1-6]。单次注射后至约40次注射后病变出现,多数病例病灶周围呈线状条纹[1-6]。虽然其机制尚不清楚,但白色条纹的可能原因是皮质类固醇悬浮液的淋巴扩散导致真皮和表皮萎缩[6]。曲安奈德是一种可微溶的皮质类固醇,其形成后可增强经皮吸收,并具有很强的抗炎作用[7,8]。虽然色素沉着和萎缩的发生率似乎很低,但我们必须考虑这些反应的美容风险[9]。此外,应考虑给药的解剖部位[8]。由于大多数萎缩性并发症的剂量为40mg曲安奈德[1-6],较低的剂量可能更适合暴露部位,如面部、手腕或手。
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Acknowledgement to Referees for Exogenous Dermatology 2004 Contents Vol. 3, 2004 Author Index Vol. 3, 2004 Is There Evidence that Geraniol Causes Allergic Contact Dermatitis? Subject Index Vol. 3, 2004
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