Making a dent with corticosteroid injections for de Quervain's tenosynovitis.

To cite: Khoo A, Grattan CE. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015214225 DESCRIPTION A 71-year-old patient presented with an abnormal patch of skin on the radial aspect of her right wrist (figures 1 and 2). Eighteen months previously, she had undergone an intra-tendon sheath steroid injection (0.25 mL triamcinolone 40 mg/mL) at the site, for de Quervain’s tenosynovitis. In the weeks following the injection, she noticed marked indentation of the skin surrounding the injection point, followed by tenderness and a predisposition to bruising. Examination revealed an atrophic patch of skin with a central ecchymosis from mild accidental trauma. These findings would be consistent with a lipo-atrophy and dermal-atrophy. Skin atrophy is a well-known complication of topical and systemic steroid treatment. However, atrophy from intratendon sheath injections is much less common, and may arise from leakage of the steroid preparation into the subcutaneous tissues. A related phenomenon is linear atrophy and hypopigmentation resulting from the lymphogenous spread of the steroid. Treatment options are limited. We discussed simple observation or excision of the affected area and emplacement of a full-thickness skin graft. Intradermal fillers with saline or autologous fat transplants have also been tried. 3