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Introduction <p>Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that presents with painful nodules, abscesses, and sinus tracts, significantly impacting patients' quality of life. Injectable triamcinolone acetonide is widely used to manage acute HS flares; however, there is no consensus on optimal dosing or administration techniques. This systematic review aims to review the literature, evaluate the effectiveness of triamcinolone injections for HS, and propose treatment guidelines based on existing evidence.</p> Methods <p>We conducted a systematic review of studies that evaluated triamcinolone therapy for HS using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including PubMed, Embase, Cochrane Library, and Web of Science were searched for relevant studies. A total of 13 studies with 549 participants were included. Data were extracted on dosing, administration techniques (with and without ultrasound guidance), efficacy outcomes, and adverse events.</p> Results <p>The review included 4 retrospective cohort studies, 4 prospective cohort studies, 2 case series, 1 case report, 1 randomized controlled trial, and 1 case–control study. Intralesional triamcinolone (ILTAC) was found to be effective in reducing HS lesion size, inflammation, and patient-reported pain across multiple studies. Ultrasound-assisted injections improved precision in needle placement and lesion targeting, leading to better clinical outcomes, particularly for fistulas and abscesses. Common adverse events included localized skin atrophy and pigmentary changes, which were dose-dependent. Glycemic decompensation was noted in some patients with diabetes.</p> Discussion <p>While ILTAC is an effective option for treating acute HS flares, significant variability exists in dosing and administration techniques. Ultrasound guidance enhances the accuracy of injections and improves outcomes, particularly in more severe or complex cases. However, limitations such as inconsistent study methodologies, small sample sizes, and lack of standardization in treatment protocols hinder definitive conclusions about optimal dosing strategies.</p> Conclusion <p>Triamcinolone injections are an effective and well-tolerated treatment option for managing HS flares. Based on the evidence, we provide treatment guidelines to standardize dosing and administration techniques, including the use of ultrasound guidance where applicable. Further research is necessary to establish more precise recommendations for dosage based on lesion size and HS severity.</p>

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Injectable Triamcinolone Therapy for Hidradenitis Suppurativa: a Systematic Review and Treatment Recommendations

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月23日

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  • Zahidul Islam,
  • Sarah Romanelli,
  • Katie Roster,
  • Hansen Tai,
  • Tian Ran Zhu,
  • Mohammed Riaz,
  • Mei Hong Liu,
  • Daniel S. Alicea,
  • Peter Ch’en,
  • Caroline Delbourgo Patton,
  • Kristina Campton,
  • Steven R. Cohen

摘要

Introduction

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that presents with painful nodules, abscesses, and sinus tracts, significantly impacting patients' quality of life. Injectable triamcinolone acetonide is widely used to manage acute HS flares; however, there is no consensus on optimal dosing or administration techniques. This systematic review aims to review the literature, evaluate the effectiveness of triamcinolone injections for HS, and propose treatment guidelines based on existing evidence.

Methods

We conducted a systematic review of studies that evaluated triamcinolone therapy for HS using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including PubMed, Embase, Cochrane Library, and Web of Science were searched for relevant studies. A total of 13 studies with 549 participants were included. Data were extracted on dosing, administration techniques (with and without ultrasound guidance), efficacy outcomes, and adverse events.

Results

The review included 4 retrospective cohort studies, 4 prospective cohort studies, 2 case series, 1 case report, 1 randomized controlled trial, and 1 case–control study. Intralesional triamcinolone (ILTAC) was found to be effective in reducing HS lesion size, inflammation, and patient-reported pain across multiple studies. Ultrasound-assisted injections improved precision in needle placement and lesion targeting, leading to better clinical outcomes, particularly for fistulas and abscesses. Common adverse events included localized skin atrophy and pigmentary changes, which were dose-dependent. Glycemic decompensation was noted in some patients with diabetes.

Discussion

While ILTAC is an effective option for treating acute HS flares, significant variability exists in dosing and administration techniques. Ultrasound guidance enhances the accuracy of injections and improves outcomes, particularly in more severe or complex cases. However, limitations such as inconsistent study methodologies, small sample sizes, and lack of standardization in treatment protocols hinder definitive conclusions about optimal dosing strategies.

Conclusion

Triamcinolone injections are an effective and well-tolerated treatment option for managing HS flares. Based on the evidence, we provide treatment guidelines to standardize dosing and administration techniques, including the use of ultrasound guidance where applicable. Further research is necessary to establish more precise recommendations for dosage based on lesion size and HS severity.