Safety of Intramuscular Triamcinolone Injections for Hidradenitis Suppurativa Flares: Findings from a Retrospective Cohort Study

Introduction Hidradenitis Suppurativa (HS) is an inflammatory skin condition that is typically controlled with systemic antibiotics, anti-androgen agents, and biologic therapies. HS flares can also be managed with short courses of oral prednisone (OP) or Intramuscular triamcinolone injection (ITI) therapy, however, the safety profile of multiple ITIs in HS is unknown. We assess the short-term (one-month) and long-term (one-year) risk of adverse effects after multiple ITIs in HS patients. Methods Using the TriNetX Research Network, we identified 892 HS patients who received one ITI and 892 matched HS patients who received three or more ITIs within one year. A second analysis of patients compared the risk profile of multiple ITIs to multiple courses of OP in HS patients. We matched 650 HS patients who received three or more ITIs to 650 HS patients who received three or more regimens of 20mg OP within one year. Results Compared to single ITI, in patients with multiple ITIs, no significantly increased one-month or one-year risk of metabolic conditions, infections, psychiatric syndromes, or peptic ulcers was observed. There was no observed increased one-year risk of metabolic conditions, adrenocortical insufficiency, osteoporosis, cataracts, or glaucoma. Compared to OP, patients with multiple ITIs did not have an observed significant difference in the one-year risk of metabolic conditions, osteoporosis, cataracts, glaucoma, psychiatric syndromes, peptic ulcers, or infections. Patients with OP had a significantly higher risk of hypertension. Discussion We demonstrate that multiple ITIs do not increase the short-or long-term risk of adverse corticosteroid effects compared to multiple regimens of OP or singular ITI.