Lesion with unclear etiology? Focus on the history
Because the cutaneous changes that steroids can induce are varied and nonspecific, it is important to carefully elicit any history of steroid injections when working up a patient for a cutaneous lesion of unclear etiology. Additional workup of neoplastic, infiltrative, vascular, and less commonly, infectious causes should be conducted if the etiology of such a lesion cannot be explained.
Although lesions from steroid injections are not usually evaluated with CT or MRI imaging, one study involving 2 volunteers suggested that pulsed ultrasound may be helpful in determining the long-term changes in skin thickness from steroid injection.16 Thus, it appears that radiological studies have little role in the diagnosis of steroid-induced skin changes, but may be used to raise or lower suspicion for other etiologies of cutaneous change when the diagnosis is unclear.
Healing comes in time, and sometimes, with saline Cutaneous atrophy caused by steroid injections may resolve spontaneously within one to 2 years, or may persist.7,10,13,16,17 Treatment of persistent atrophy with normal saline infiltration has been used, and appears to be safe, tolerable, and relatively effective.17
