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Q1: Definition and agents (2 min)
What is intralesional therapy? Name the main agents used in dermatology.
Expected answer: Direct injection of drug into a lesion for high local concentration. Mainstay is triamcinolone acetonide; others include 5-FU (keloid protocols), bleomycin and Candida antigen (selected warts), and less common specialised agents.
[1]Q2: Keloid practical (3 min)
How do you inject a keloid with TAC? Concentration, endpoint, interval, escalation.
Expected answer: Confirm diagnosis/exclude infection; choose concentration for thick scar; enter scar substance; small aliquots to blanching; serial sessions; photograph. If incomplete, consider TAC+5-FU, silicone/pressure, or surgery with postoperative IL steroid in a multimodal plan. Counsel that one injection rarely cures.[2]
Q3: Alopecia areata practical (2 min)
When is IL TAC appropriate for AA? Grid concept.
Expected answer: Limited patchy AA in cooperative patients. Inject dermal grid with lower concentrations than thick keloid; serial sessions; if extensive disease, do not rely on injections alone — consider broader AA therapies.[3]
Q4: Safety (3 min)
Local and systemic risks. Face-specific caution.
Expected answer: Atrophy, telangiectasia, hypopigmentation, pain; ulceration with some non-steroid agents. Rare cumulative systemic glucocorticoid effects including Cushingoid features; rare anaphylaxis. Thin facial skin needs lower concentration and restraint.[1][2]
Q5: Pitfall (2 min)
Colleague wants to inject high-strength TAC into a soft red warm expanding plaque thought to be “scar.” Your response?
Expected answer: Stop. Warm expanding plaque may be infection or inflammatory disease — do not inject through cellulitis. Re-examine, consider antibiotics/workup, biopsy if tumour mimic. Wrong-site IL steroid worsens infection and delays diagnosis.[1]
References3ShowHide
- [1]Laisuan W, Wongsa C, Dchapaphapeaktak N, et al. Anaphylaxis following intralesional triamcinolone acetonide (Kenacort) injection Asia Pac Allergy, 2017.PMID 28487843
- [2]Jiang ZY, et al. The Safety and Efficacy of Intralesional Verapamil Versus Intralesional Triamcinolone Acetonide for Keloids and Hypertrophic Scars: A Systematic Review and Meta-analysis. Adv Skin Wound Care, 2020.PMID 32195728
- [3]Meah N, et al. The Alopecia Areata Consensus of Experts (ACE) study: Results of an international expert opinion on treatments for alopecia areata. J Am Acad Dermatol, 2020.PMID 32165196