Depigmentation due to Triamcinolone Acetonide

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.