Why does the efficacy of intralesional injections of corticosteroids seem to vary from Dermatologist to Dermatologist?
In a certain way injecting corticosteroids into the scalp is more of an art than a science. There is a lot of “feel” employed by the physician when injecting these drugs. The procedure entails introducing the needle almost parallel to the skin and gauging the force needed to compress the plunger and distend the skin. If the plunger is easily compressed, the needle may be too deep and the injection won’t produce any beneficial effects. On the other hand, if the plunger is only compressed with difficulty, the needle may too superficial. This may promote the formation of skin atrophy and ulcerations. The use of air guns, similar to those used for mass vaccination, has also been used with corticosteroids. Most Dermatologists shy away from their use because they are erratic in terms of injection depth and an increased risk of postinjection infection.
