The Infection Rate of Intralesional Triamcinolone and The Safety of Compounding in Dermatology for Intradermal and Subcutaneous Injection: A Retrospective Chart Review.

Abstract Background Intralesional injection of sterile medications remains a mainstay in dermatology, enabling a tailored, low-cost, in-office therapy. Following the 2012 United States outbreak of fungal meningitis from contaminated intrathecally administered corticosteroids, there has been increased regulation of in-office compounding, regardless of administration route. Studies demonstrating the safety data of in-office corticosteroid compounding for intradermal or subcutaneous use are lacking. Objective To assess the incidence of infection caused by compounded in-office intralesional triamcinolone. Methods A retrospective chart review identified subjects that received in-office intralesional corticosteroid injections in 2016. Medical documentation within 30 days of injection was reviewed for suspected infection. Results Charts of 4370 intralesional triamcinolone injections were assessed, 2780/4370 (64%) being compounded triamcinolone with bacteriostatic saline. Eleven suspected localized infections (0.25%) were identified, with 4/11 in the compounding cohort. Of these, 7/11 occurred after injection of an “inflamed cyst.” No hospitalizations or deaths occurred. No temporal/locational relationships were identified. Limitations This study was limited to two academic institutions. A 30-day post injection time frame of was used. Conclusion In-office compounding for intralesional dermal and subcutaneous administration is safe when sterile products are used by medical practitioners. There is no increased risk of compounded triamcinolone relative to non-compounded triamcinolone.