What kind of steroid injections do you prefer?

[andrea]

I'm fairly new to moonlighting, and have come across lots of patients wanting steroid shots. It seems to be very difficult to find literature on it, I guess because injections are not the preferred tx route for most of this stuff. But, I asked one attending what he usually does, and this is what he said:

For contact dermatitis, all over poison ivy, etc, use 40-60 mg IM Kenalog

Solumedrol IM for very short acting stuff like asthma exacerbation

Depomedrol (? what dose): long acting, like for hay fever / environmental allergies

Is this what the rest of you do? I want to make sure I'm doing this right.

Thanks!

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[deleted87716]

I don't give injections for any of that stuff. Oral steroids will do just as well, at a lower cost, and without the risk of injection-site fat atrophy.

 

[MOHS_01]

I don't give injections for any of that stuff. Oral steroids will do just as well, at a lower cost, and without the risk of injection-site fat atrophy.

Echo what Blue said. Oral pred is dirt cheap, works faster, can be stopped if any problems arise, does not involve a needle, does not run the risk of atrophy or abscess formation, etc.

 

[Shinken]

Echo what Blue said. Oral pred is dirt cheap, works faster, can be stopped if any problems arise, does not involve a needle, does not run the risk of atrophy or abscess formation, etc.

Also you don't run the risk of turning an African American's skin bone white at the site of injection.

I have to admit I have injected a patient with Kenalog that had severe dermatitis and worked beautifully, but I don't think I'll do it again. As Blue mentioned, oral works fine.

Pretty much all my steroid injections are joint injections nowadays.

 

[deleted87716]

The bottom line is "primum non nocere." If better/safer options exist (and they do), you should use them.

 

[andrea]

Yes, I understand you should use the safer options first - I was hoping that was implied. What I'm talking about are the people who have done a course of steroids and still can't get rid of the poison ivy. What do you do then?

 

[deleted87716]

What I'm talking about are the people who have done a course of steroids and still can't get rid of the poison ivy. What do you do then?

I've never had that happen.

Lots of people give inadequate does of oral prednisone for contact dermatitis, however. If you just throw a Medrol Dosepack at them, forget it...their symptoms will rebound immediately. I always write a slow taper over 10-14 days, starting at 60 mg/day (adults). If the rash doesn't go away at that point, I'll either reconsider the diagnosis or try to find out how they're getting re-exposed.

 

[paintballdoc]

I have found topical steroids work better than injections anyways for eczema/contact dermatitis. I use oral steroids as a supplement.

I would use Fluocinonide or Clobetasol for about a week bid--clears up all rashes. The only issue is to warn patients these creams are MUCH stonger than HC, so do not overuse them. Would also make sure that contact derm is actually being treated and not tinea, etc.

 

[deleted87716]

I have found topical steroids work better than injections anyways for eczema/contact dermatitis.

If it's localized, yes. However, if it's widespread, topicals aren't going to cut it. Plus, you can get pretty high systemic absorption if people are using high-potency topical steroids over a large body surface area. Instead, have them use Calamine lotion, oatmeal baths, or something until the oral steroids kick in.