Making Steroid Injections Less Painful for Hair Loss Patients: Should we be using Lidocaine ?

New Study Suggests Use of Lidocaine Makes Steroid Injections More Painful

I perform a lot of steroid injections in my practice for various types of hair loss. I’ve always wondered if I should add a bit of numbing medication (like lidocaine) to my syringes when I perform steroid injections. Would this make the procedure less painful for my patients? 

I’ve gone through periods of time in the past where I use a bit of lidocaine for a few weeks and then long stretches of time when I don’t.  For many years now, I haven’t used lidocaine in the syringes when I perform steroid injections. I suppose I was never really convinced using lidocaine makes my patient’s experience better. But every time a patient asks me “are you going to use freezing?” I start in again thinking about the role of lidocaine.

A new study suggests that lidocaine does not make steroid injection procedures less painful. In fact, it increases pain.

New Study Suggests to Leave Lidocaine Out.

A new study, presented at the American Academy of Dermatology virtual meeting puts an end to the wondering. The study informs us all that adding lidocaine to steroid injections only makes the pain worse. The authors performed a double blind randomized study of 31 patients. Some received steroid injections with saline (the typical way we do injections) and some received steroid injections with lidocaine at 1:100,000. In addition to alopecia patients, patients in the study had patients receiving injections for a range of dermatological issues like psoriasis and keloids. Patients who received injections with lidocaine reported more pain than those who received steroid injections with only saline.

I enjoyed reading this news. It puts to rest a question that has plagued me for a long time. I will keep my lidocaine back on the shelves and keep doing steroid injections with saline dilutions.

Reference 

Helio.com. Intralesional corticosteroid injections with lidocaine more painful. Accessed Sep 11, 2020.