Cortisone Injections- What are they? Why are they used?

What are "cortisone injections"?

Cortisone is an anti-inflammatory medication which helps reduce inflammation. Cortisone injections are an important part of the treatment for many types of hair loss.

What is the name of the medication being injected?

The name of the medication used for injections is called triamcinolone acetonide although some physicians may (rarely) use other types of medications to inject as well.  Triamcinolone acetonide is marketed under the name Kenalog® (so many individuals simply remember that they received Kenalog injections). The concentration of medication varies as well but generally ranges from 2-10 mg per mL.

How many injections are performed?

2 to 50 injections may be performed depending on the size of the area that is being addressed.  For example, a small quarter-sized area of alopecia areata may be treated with 4 injections and a full eyebrow may be treated with 5-6 injections.

Are cortisone injections safe? Are there any side-effects from injections?

When it comes to cortisiones, it's important to remember that there are three main ways that cortisones can be used by doctors - 1) cortisone creams and lotions that are applied to the surface of the skin, 2) cortisone injections and 3) cortisone pills that are taken by mouth.  Cortisone pills, by far, have the most potential side effects. Cortisone creams/lotions and injections have much fewer side effects - especially when used for short periods of time and under the care and direction of a physician. This last point can't be stated enough.

The most common side effect from injections is some discomfort at the time the medication is injected. Most  patients rate this discomfort about 3 out of 10 and it lasts about 3-4 seconds.  Many  individuals with report that injections in the eyebrows are slightly more uncomfortable than injections in the scalp.

Other side effects are possible too so it's important to meet with your doctor to discuss the range of side effects with injections.  For example, a small indentation or depression in the scalp can rarely occur in the area where the medicine is injected. This is a temporary indentation and goes away over time. However, it may take a few months to completely resolve.  It's not possible to predict who will have this side effect and who will not, but it's not common and most individuals are not bothered by the side effect should it occur.

What types of hair loss conditions can cortisone injections be used for?

I frequently use cortisone injections to stop or reduce inflammation under the scalp in many hair loss conditions, including:

• alopecia areata
• lichen planopilaris and frontal fibrosing alopecia
• central centrifigal cicatricial alopecia
• pseudopelade
• folliculitis decalvans
• some types of traction alopecia

What types of hair loss conditions are cortisone injections NOT used for?

Injections are not used for hair diseases that don't have much inflammation under the scalp. Therefore, I do not use cortisone injections as part of the treatment plan for the following conditions:

• androgenetic alopecia (male and female genetic balding)
• telogen effluvium (hair shedding problems)
• tinea capitis (fungal infections)
• trichotillomania (hair pulling)

Can children receive cortisone injections too ?

Although it is safe for young children can receive cortisone injections, I rarely perform injections in children with hair loss under the age of 8-10 years.  This is simply to make sure the child is comfortable with the treatment. But it all depends on the child.  There are some young children age 8 or 9 who feel comfortable with a few injections in the scalp, especially when I used  a variety of distraction techniques. However, there are other children and adolescents who are not comfortable at all -  and we choose not to inject but rather focus on other types of treatments.

What is the most important message to give about cortisone injections?

For many types of hair loss conditions, injections are a very important part of the treatment. When performed properly with the right concentration and amount these treatments are very safe.