From the Guidelines
Dexamethasone can be considered for intralesional injection in cystic acne, similar to triamcinolone, as an adjuvant therapy for larger acne papules or nodules, as recommended in the guidelines of care for the management of acne vulgaris 1. When managing cystic acne with intralesional corticosteroid injections, it is essential to use them judiciously, especially for patients at risk of acne scarring and/or for rapid improvement in inflammation and pain.
- The guidelines suggest using a lower concentration and volume of corticosteroid to minimize the risks of local corticosteroid adverse events 1.
- Typical concentrations of dexamethasone range from 0.4-4 mg/mL, with 1-2 mg/mL commonly used.
- For individual cystic lesions, 0.05-0.3 mL is typically injected using a 30-gauge needle, with the total dose not exceeding 2 mg per session.
- Dexamethasone offers certain advantages over triamcinolone, including less risk of skin atrophy and hypopigmentation, which are common concerns with triamcinolone injections.
- The procedure should be performed with proper sterile technique, and patients should be informed that improvement typically occurs within 24-72 hours.
- Multiple lesions can be treated in one session, but treatment should be limited to inflammatory nodules and cysts rather than pustules or comedones.
From the Research
Intralesional Corticosteroid Injections for Cystic Acne
- Intralesional corticosteroid injections have been used to treat various dermatological diseases, including acne, with the purpose of achieving a high concentration of the drug at the diseased site and minimal systemic absorption 2.
- Triamcinolone is a commonly used corticosteroid for intralesional injections in the treatment of acne, with studies evaluating its efficacy and safety in this context 3, 4.
- The use of dexamethasone as an alternative to triamcinolone for intralesional injections in cystic acne is not explicitly mentioned in the provided studies.
- However, the general principles of intralesional corticosteroid injections, including the importance of the method of injection and the potential for local and systemic side-effects, may still apply 2.
- Steroidal molecules, including intralesional corticosteroids, are an important part of the acne treatment armamentarium, targeting the systemic or local hormones and inflammation that contribute to acne pathogenesis 5.
Comparison of Corticosteroids for Intralesional Injections
- A study comparing the efficacy of triamcinolone acetonide at different concentrations found that a concentration of 0.63 mg/mL was as efficacious as a higher concentration of 2.5 mg/mL in the treatment of nodulocystic acne 4.
- Betamethasone phosphate was found to have little effect on nodulocystic acne lesions at concentrations of 3.0,1.5, and 0.75 mg/mL, compared to saline controls 4.
- The provided studies do not specifically address the use of dexamethasone for intralesional injections in cystic acne, and therefore, its efficacy and safety in this context are unclear.