Hydrocortisone Injection Dosing for Severe Allergic Pruritic Skin Lesions
For severe allergic skin lesions with extreme pruritus requiring injectable corticosteroid therapy, use intralesional hydrocortisone acetate 25 mg/mL injected just beneath the dermis in the upper subcutis, with 0.05-0.1 mL per injection site producing approximately 0.5 cm diameter treatment area. 1
Intralesional Injection Technique
- Inject hydrocortisone acetate 25 mg/mL just beneath the dermis in the upper subcutis at each affected site 1
- Each 0.05-0.1 mL injection will produce a localized treatment effect covering approximately 0.5 cm in diameter 1
- Multiple injections may be administered across the affected area, with the main limitation being patient discomfort 1
- This approach is most suitable for treating localized severe pruritic lesions of limited extent 1
Alternative Intralesional Corticosteroid Options
- Triamcinolone acetonide 5-10 mg/mL is an alternative intralesional option that may be more commonly available than hydrocortisone acetate 1
- For inflammatory nodular lesions, triamcinolone acetonide 10 mg/mL (which may be diluted to 5 or 3.3 mg/mL) can be injected directly into lesions 1
- Triamcinolone acetonide up to 20 mg/mL can be used for psoriatic lesions every 3-4 weeks, with injection volume varying based on lesional size 1
When Systemic IV Hydrocortisone is Indicated Instead
If the severe allergic reaction involves systemic manifestations (urticaria with hypotension, respiratory symptoms, or multi-organ involvement), use IV hydrocortisone 100-500 mg for moderate hypersensitivity reactions 1
- For isolated urticaria with severe pruritus but no systemic symptoms, IV hydrocortisone 200 mg is the recommended dose 1
- This systemic approach is reserved for acute hypersensitivity reactions, not for localized dermatologic conditions 1
Critical Pitfalls to Avoid
- Do not use systemic corticosteroids for localized severe pruritic dermatoses as they lack evidence of benefit and may cause rebound worsening upon discontinuation 2
- Avoid injecting at sites of active infection such as impetigo or herpes 1
- Local overdose of intralesional corticosteroids can result in skin atrophy, pigmentary changes, telangiectasias, and hypertrichosis 1
- Repeated intralesional injections can suppress the hypothalamic-pituitary-adrenal axis if used excessively 1
Adjunctive Topical Therapy
For extensive severe pruritic allergic skin lesions not amenable to intralesional injection:
- Apply high-potency topical corticosteroid such as clobetasol propionate 0.05% to affected areas for up to 2-4 weeks 3, 4
- Combine with oral antihistamines: fexofenadine 180 mg daily or loratadine 10 mg daily for daytime pruritus 3
- For nocturnal pruritus, add hydroxyzine 25-50 mg or diphenhydramine 25-50 mg at bedtime 3
- Apply emollients liberally to restore skin barrier function 3