Attention to risk may reduce the likelihood and severity of cutaneous damage. Insoluble preparations should be used only for deep injections into joints, bursae, or muscles, and care should be taken not to track the steroid into the more superficial tissues.
More soluble preparations should be used for superficial structures.10,12 In addition, the lowest effective concentration of steroid preparation should be used, and it should not be mixed with vasoconstrictors like epinephrine.10 The anatomical location of the injection also plays a role in the extent and duration of change.10 For instance, injections into more superficial structures (eg, skin, tendons) could produce cutaneous changes that are more obvious than injections into deeper structures (eg, joints, bursae).10
Our patient As noted earlier, our patient had the lesion excised. At follow-up one week later, she continued to progress well clinically.
CORRESPONDENCE Tia Kostas, MD, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115; tkostas@partners.org
