Cole BJ & Schumacher RH: Injectable corticosteroids in modern practice. J Am Acad Orthop Surg 13: 37, 2005.
Hochberg MC , Roy DA & April KT: American College of Rheumatology recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip and knee. Arthritis Care Res (Hoboken) 64: 465, 2012.
Zulian F , Martini G & Gobber D et al.: Triamcinolone acetonide and hexacetonide intra-articular treatment of symmetrical joints in juvenile idiopathic arthritis: a double-blind trial. Rheumatology (Oxford) 43: 1288, 2004.
Conaghan PG , Hunter DJ & Cohen SB: Effects of a single intra-articular injection of a microsphere formulation of triamcinolone acetonide on knee osteoarthritis pain: a double-blinded, randomized, placebo-controlled, multinational study. J Bone Joint Surg Am 100: 666, 2018.
Markovic M , Crichton K & Read JW et al.: Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton's neuroma. Foot Ankle Int 29: 483, 2008.
Park D , Yu KJ & Cho JY et al.: The effectiveness of 2 consecutive intra-articular polydeoxyribonucleotide injections compared with intra-articular triamcinolone for hemiplegic shoulder pain. Medicine (Baltimore) 96: e8741, 2017.
Hochberg MC , Perlmutter DL & Hudson JI et al.: Preferences in the management of osteoarthritis of the hip and knee: results of a survey of community based rheumatologists in the United States. Arthritis Care Res 9: 170, 1996.
Cohen BE , Bashey S & Cole C et al.: Dermal titanium dioxide deposition associated with intralesional triamcinolone injection. Am J Dermatopathol 38: e163, 2016.
Okere K & Jones MC: A case of skin hypopigmentation secondary to a corticosteroid injection. South Med J 99: 1393, 2006.
George WM: Linear lymphatic hypopigmentation after intralesional corticosteroid injection: report of two cases. Cutis 64: 61, 1999.
Van Vendeloo SN & Ettema HB: Skin depigmentation along lymph vessels of the lower leg following local corticosteroid injection for interdigital neuroma. Foot Ankle Surg 22: 139, 2016.
Triamcinolone acetonide is a synthetic glucocorticoid used to treat numerous acute and chronic inflammatory conditions. The various side effects of this drug from parenteral administration are well documented in the literature. In this study, three patients present with a rare side effect of violaceous dermal pigmentation. To the best of the authors' knowledge, this finding is rarely presented in the current literature. The purpose of this study is to provide awareness of a less-documented, delayed side effect from triamcinolone acetonide administration. Although all patients presenting in this study had a known history of autoimmune disease (eg, lupus, psoriatic arthritis) further research is needed to suggest a possible association between dermal violaceous change and the use of triamcinolone.
Quantum Foot and Ankle Group, Woodcliff Lake, NJ.