What is the first‑line treatment for subcutaneous atrophy after intralesional or intramuscular corticosteroid injection?

Treatment of Subcutaneous Atrophy After Corticosteroid Injection

The first-line treatment for subcutaneous atrophy following intralesional or intramuscular corticosteroid injection is normal saline infiltration, which achieves complete resolution in 4-8 weeks with weekly injections. 1

Primary Treatment Approach

Normal saline infiltration is the preferred initial intervention based on demonstrated efficacy, safety profile, and rapid results. 1

Treatment Protocol for Saline Infiltration

• Inject bacteriostatic normal saline directly into the atrophic site using volumes of 5-20 mL per treatment session 1
• Administer weekly injections for a total of 3-6 treatment sessions 1
• Expect complete resolution of skin atrophy and restoration of surface contour within 4-8 weeks of initial presentation 1
• This approach is safe, tolerable, relatively rapid, and effective for local, persistent corticosteroid-induced atrophy 1

Alternative Treatment Options

If saline infiltration fails or for severe cases, consider the following alternatives:

Autologous Blood Injection (ABI)

• Collect autologous blood from peripheral veins and inject immediately into the affected tissue in small volumes targeting superficial, middle, and deep parts of the atrophic area 2
• Use approximately 4 cc of autologous blood per session 2
• Expect marked improvement after 2 sessions with resolution of both atrophy depth and associated depigmentation 2
• This represents a simple, effective, and safe procedure when saline therapy is unsuccessful 2

Fat Grafting

• Reserve autologous fat grafting for persistent atrophy that does not improve spontaneously within 1 year or when saline injection fails 3, 4, 5
• Fat grafting is particularly useful for severe contour deformities, such as those affecting the hip region 5
• Serial fat grafting may be necessary for severe cases of steroid-induced soft tissue atrophy 5
• This method is less invasive from a cosmetic standpoint and provides satisfying esthetic and functional results 3, 4

Natural History and Timing Considerations

• Subcutaneous atrophy after local corticosteroid injection is generally considered reversible and may improve spontaneously within approximately 1 year 3, 4
• If no spontaneous improvement occurs after 6 months to 1 year, active intervention is warranted 2, 3
• Some cases may resolve within 1-2 years without intervention 4

Common Pitfalls to Avoid

• Do not wait indefinitely for spontaneous resolution if the atrophy persists beyond 6-12 months without improvement 2, 3
• Do not proceed directly to fat grafting without first attempting the simpler, less invasive saline infiltration approach 1
• Avoid inadequate injection volumes during saline therapy—use sufficient volumes (5-20 mL) to adequately fill the atrophic defect 1
• Do not discontinue treatment prematurely—complete the full course of 3-6 weekly sessions even if early improvement is seen 1