Derm Cases · Dermatology / Procedural Dermatology
OSCE — intralesional corticosteroid counselling and technique
An 8-minute OSCE on selecting IL triamcinolone for keloid and patchy AA, concentration by site, technique endpoints, intervals, and safety counselling.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE on selecting IL triamcinolone for keloid and patchy AA, concentration by site, technique endpoints, intervals, and safety counselling.
Brief (to candidate)
Clinic procedure room. A young adult has a shoulder keloid and two small AA patches. They want steroid injections today and ask if one session will “finish it.” You have 8 minutes to counsel and describe technique.
[11]Candidate instructions
- Confirm indications and exclude infection/diagnostic doubt.
- Explain TAC concentration differences by site.
- Describe blanching endpoint and AA grid spacing.
- Give interval and need for serial sessions.
- Counsel atrophy/pigment change and rare systemic steroid risk.
Mark scheme (examiner)
| Domain | Marks | Expected points |
|---|---|---|
| Selection | 2 | Keloid + limited AA appropriate; not infected |
| Concentration | 2 | Lower face/AA; higher thick keloid concept |
| Technique | 2 | Blanching aliquots; ~1 cm AA grid |
| Course | 2 | Every 3–6 weeks; multimodal keloid if needed |
| Safety | 2 | Atrophy/telangiectasia/hypopigmentation; rare systemic effects |
Examiner notes
Fail if candidate promises one-injection permanent keloid cure or injects through obvious cellulitis.[10]
References7ShowHide
- [1]Richards RN. Update on intralesional steroid: focus on dermatoses. Journal of Cutaneous Medicine and Surgery, 2010.PMID 20128986
- [2]Fredman R, Tenenhaus M. Cushing's syndrome after intralesional triamcinolone acetonide: a systematic review of the literature and multinational survey. Burns, 2013.PMID 23092701
- [3]Walsh LA, Wu E, Pontes D, et al. Keloid treatments: an evidence-based systematic review of recent advances. Systematic Reviews, 2023.PMID 36918908
- [7]Mateos-Haro M, Novoa-Candia M, Sánchez Vanegas G, et al. Treatments for alopecia areata: a network meta-analysis. Cochrane Database of Systematic Reviews, 2023.PMID 37870096
- [9]Dakkak M, Forde KM, Lanney H. Hair Loss: Diagnosis and Treatment. American Family Physician, 2024.PMID 39283847
- [10]Zhuang Z, Li Y, Wei X. The safety and efficacy of intralesional triamcinolone acetonide for keloids and hypertrophic scars: A systematic review and meta-analysis Burns, 2021.PMID 33814214
- [11]Yin Q, Wolkerstorfer A, Lapid O, et al. KECORT Study: an international e-Delphi study on the treatment of keloids using intralesional corticosteroids in clinical practice Am J Clin Dermatol, 2024.PMID 39298112