treatment of cortisone induced skin atrophy

[anniee]

Dear Dr.  I am suffering from a large atrophy indentation in the middle of my forehead due to a mistaken injection of undiluted cortisone for a cystic acne lesion. (approx. 20 cc of kenalog to be exact) This occured seven months ago and continues to worsen. There is complete atrophy of the subcutaneous fat/tissue down to the gala, not much change in pigmentation. Furthermore, the PS I consulted feels there was some intravenous uptake as it has tracked inferiorly. An anestetican recommended I wait a year before using fillers, and a PS recommended Restalyne or Sculputura but would not advise me one way or the other. I would greatly appreciate your advice as to (1) should I continue to wait and see if it fills in and if so how long? or (2) Do you feel Restylane, Sculptura, or fat injections would be most beneficial? (3) Will fillers impede or enhance the natural healing of the indentation? (4) Is the risk for lumping with Restylane increased in my case? (5) Also, do you know of any alternative treatment and what would you do in the case? I am in good health with no surgical history or health issues to speak of; this is all very new to me, as I have no experience with plastic surgery or it's procedures. I sincerely appreciate your help and advice! Annie 11/30/05

[Alan Rockoff, MD]

It takes a year or more for steroid-induced atrophy to fill in.  I don't know enough about fillers to advise you on which one to use and when, but Restylane sounds reasonable to at least consider, because its anticipated duration of effect--6 to 9 months--would coincide with the time it should take to fill in by itself as much as it's going to.  I can't think of any medical reason not to inject it now, though again, I am not an expert in this area.

Do you really mean 20 cc of Kenalog?  Even 20 milligrams would be a very large does and volume.

Best.

Dr. Rockoff

[anniee]

Dear Dr. - Yes, it was almost 20 cc or 20 mg of Kenalog.  The nurse filled the syringe with the wrong dose vial of Kenalog, and she injected too much.  At this strength and magnitude I am doubtful as to if it will ever fill in.  What do you think?

[Alan Rockoff, MD]

Not sure.  Time will tell.

Dr. Rockoff

[kring_george]

anniee, hi, I know exactly what you must be going through right now. I have one on my forhead also, and a couple all over my face; but I'm not sure how much was injected into my skin. I some area that I was injected I didn't have any pimples at all. I was told it was collagen. It's been about 1 month for me and I notice the area flattened. I read a post somewhere to massage it. I wonder if this is considered medical mal practice.

Regards.

[Tribeca]

I rarely get large cystic type acne but did recently.  Unfortunately, I was in Bombay when this happened.  I went to the country's leading dermatologist who prescribed an antibiotic to take for 3 days and injected the bump (right next to my left nostril, under my eye) with cortisone.  In a few days the bump flattened and unfortunately continued to flatten to the point of a discolored indentation.  I am obviously very upset about this and want to know if I should consult a dermatologist near where I live or just wait it out for 6 months for the indentation to hopefully “fill in.”  It sounds like 6 months is the magic number in these message boards.  My skin is pretty much clear other than this unsightly indentation.  

Basically, my questions are:

1. Should I wait it out for 6 months or go see a dermatologist immediately?
2. Will gels like Mederma be useful right now or will they make things worse?  

Thanks very much for your assistance.

[fmiller]

hello. similar problem to those above. i had .2 cc of Kenalog 40 injected into my forehead and chin. About 8 weeks later, i am noticing indentations. I suppose this is the cutaneous atrophy i am hearing about. Is it possible that it could have been injected into a facial muscle as i am very thin? How long will it take to resolve..or is it possible it may not.

fm

[fmiller]

and if i may mention, it was not diluted at all. I keep hearing things get worse over many months...i read online one person did not notice effects until 4 months later...are things going to get worse? i am so upset.