Clinical pitfalls of intralesional corticosteroid injection in alopecia areata by general practitioners: A retrospective study

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Background: Intralesional corticosteroid injection is a treatment of choice in alopecia areata. To our knowledge, no study explored and described pitfalls of this technique. Objective: To clarify common pitfalls of intralesional corticosteroid injection technique in alopecia areata among Thai general practitioners. Materials and Methods: The present study was conducted by reviewing score sheets and questionnaires of 127 participants who attended the annual short courses in practical dermatology for general practitioners organized by the Dermatological Society of Thailand in 2013 and 2014. Before the workshop, preliminary practical examination was conducted. Participants were instructed to perform intralesional corticosteroid injection in alopecia areata lesion using artificial skin model and were scored by two experienced dermatologists. Intralesional corticosteroid injection technique was categorized into four components (preparation technique, medication selection, equipment selection, and injection technique). Results: Common pitfalls among participants were inappropriate medication concentration (34.7%) and incorrect injection technique (33.9%). Physicians with more experience in intralesional corticosteroid injection demonstrated more confidence (p-value <0.05). Conclusion: Possible reasons for incorrect injection technique are limited dermatologic curriculum hour and insufficient experience. To achieve functional competency in intralesional corticosteroid injection technique, adequate training time and practical experiences in medical school are required.