For patients with hidradenitis suppurativa (HS), multiple intramuscular triamcinolone injections (ITIs) do not increase the short- or long-term risk for adverse corticosteroid effects compared with multiple courses of oral prednisone (OP) or a single ITI, according to a study published in the March issue of SKIN.
Madelyn Schmidt and Kathleen Kroger, M.D., from the University of Texas Medical Branch in Galveston, examined the short-term (one month) and long-term (one year) risk for adverse effects after multiple ITIs in patients with HS. A total of 892 patients with HS who received one ITI were identified and matched with 892 patients with HS who received three or more ITIs within one year. A second analysis compared the risk profile of 650 patients with HS who received three or more ITIs and 650 patients with HS who received three or more regimens of 20 mg OP within one year.
The researchers found that patients with multiple ITIs did not have a significantly increased one-month or one-year risk for metabolic conditions, infections, psychiatric syndromes, or peptic ulcers compared with a single ITI. Patients with multiple ITIs did not have a significant difference in the one-year risk for metabolic conditions, osteoporosis, cataracts, glaucoma, psychiatric syndromes, peptic ulcers, or infections compared with those receiving OP. A significantly higher risk for hypertension was seen among those with OP.
“Our findings are consistent with previous studies that have reported a comparable safety profile of ITIs in other dermatologic conditions,” the authors write.
Black Americans — particularly Black women — are disproportionately affected by HS and often experience greater disease severity before receiving a diagnosis. Because of this, they may require repeated interventions to manage painful flare-ups and lesions while long-term therapies take effect.
Safety data supporting repeated intramuscular triamcinolone injections may help providers feel more confident using this treatment when appropriate, especially in patients with recurrent inflammatory nodules.
While intramuscular triamcinolone injections may provide quick symptom relief for patients, they are not a replacement for comprehensive disease management. Black patients frequently face diagnostic delays that allow HS to progress to more advanced stages with chronic inflammation, sinus tract formation, and scarring. Prompt recognition, dermatology referral, and initiation of appropriate medical therapy may reduce flare frequency and improve long-term outcomes for patients.
For patients with moderate-to-severe HS, providers should pair flare management with maintenance therapies that address the underlying inflammatory process. In addition to biologics, newer targeted therapies — such as JAK1 inhibitors — are expanding the treatment landscape and may offer additional options for appropriate patients. However, clinicians should continue to make individual treatment decisions based on the patient’s disease severity, comorbidities, and patient preferences.
ITIs are commonly used to deliver rapid relief for acutely inflamed HS lesions and abscesses, particularly when patients present with localized, painful flares. Unlike systemic therapies, these injections target individual lesions, helping reduce inflammation, pain, and swelling within days of treatment.
For many patients, especially those with moderate-to-severe disease, intramuscular triamcinolone injections serve as an adjunct rather than a standalone treatment. They may be particularly beneficial while patients are initiating or adjusting to long-term therapies, which can take several weeks or months to achieve their full effect. The new safety findings may provide reassurance to providers who may have been hesitant to repeat injections over time in patients with recurring flares.
A concern some patients may have about repeated ITIs is whether cumulative steroid exposure could increase the risk of unwanted side effects. Findings like these can help inform conversations about the role of injections within a broader treatment plan.
When discussing treatment options, explain that intramuscular triamcinolone injections are meant to target individual lesions with relatively small doses, making them different from prolonged systemic corticosteroid use. Setting expectations about when injections are appropriate and when escalation to maintenance therapy is necessary can reassure patients and make them feel more confident about their care, which can greatly increase treatment adherence.
Although HS treatment options continue to expand and evolve, access to specialty care and advanced therapies remains a challenge for some patients. Black patients, who experience HS at disproportionately higher rates, may also face barriers such as delayed referrals, insurance limitations, and limited access to HS specialists.
As providers gain additional reassurance about the safety of repeated intramuscular triamcinolone injections, these therapies may remain a critical tool for managing flares. At the same time, patients await specialty care or initiate longer-term treatment. Ensuring equitable access to both procedural and disease-modifying therapies will be essential to reducing disparities in HS.
This study reinforces the role of intramuscular triamcinolone injections as a valuable tool for managing acute HS flare-ups. Instead of replacing systemic therapies, these procedures should be viewed as one part of a comprehensive treatment approach that combines rapid symptom relief with long-term disease control.
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