How long does it take hair to grow back after cortisone injection

What are intralesional steroid injections?

This article refers to intralesional steroid injections for hair loss. This is where the steroid medication is injected directly into skin where the hair loss is present. This is in order to keep the effects of steroids in the area where it is needed and to reduce the chance that side effects might be caused elsewhere in the body from absorption of steroids.

Steroid injections can also be given by injection in larger doses into the muscle or intravenously so that the effect of the medication can circulate all around the body. This article does not refer to large dose steroid injection into the muscle or into a vein

Which hair loss conditions can steroid injections help?

Steroid injections are used for the following forms of hair loss

• Alopecia areata of the scalp where less than 50% of the scalp area is involved
• Alopecia areata of the eyebrows
• Alopecia areata of the beard
• Lichen plano pilaris
• Frontal fibrosis alopecia
• Discoid lupus
• Folliculitis de calvans

Which hair loss conditions are steroid injections not used for?

Steroid injections do not work for male or female pattern hair loss, telogen effluvium, advanced traction alopecia and other hair loss conditions which are not listed above.

Which steroid injection is used?

The usual steroid used for hair loss injections is Triamcinolone acetonide. Brand names include Adcortyl, and Kenaolg-10.

What are the benefits of steroid injections in alopecia areata?

When steroid injections are used for alopecia areata, they can help bring about regrowth. Steroid injections have been used for alopecia areata since 1958.

• Studies from the 1970’s showed that hair regrowth was found in 71% of people with Alopecia Areata, when treated every 2 weeks for 3 times.
• In another study, 63% of those receiving monthly steroid injections found regrowth at 4 months. Regrowth was found to be more successful if there were fewer than 5 patches, if the patches were less than 3cm in diameter, and if the lesions were less than 1 month old.
• In a smaller study, 6 out of 10 patients with extensive alopecia areata that was covering more than 50% of their scalp found that steroid injections helped bring about hair growth.

It is very important to understand that steroid injections do not cure alopecia areata but they temporarily or permanently resolve a patch. The nature of alopecia is that it can come back in the same patch or in a new area at a later time, and having steroid injections does not appear to prevent that.

While steroid injections help a large proportion of patients, it does not help everyone and a result can not be guaranteed.

What are the benefit of steroid injections for other hair loss conditions?

Steroid injections are used for controlling inflammation in Lichen plano pilaris, Frontal fibrosis alopecia and Discoid lupus. In these conditions, steroid injection can slow down the progression of the condition and is usually given in connection with other medication – either creams or tablets.

What are the risks of steroid injections?

• Tiny pin point bleeding at some injection points can be seen. We ask you not to disturb the area until the next day when it is OK to shampoo, shave etc.
• Mild headaches and soreness is possible but this usually settles in an hour or two with Paracetamol if necessary.
• Skin thinning. Steroid injections can thin the skin and the fat under the skin, and is perhaps the most important concern. This can cause the skin to appear paler and more wrinkled, and the skin can start showing thread veins. If there is thinning of the fat, then dimples can appear.  Any indentations are usually on temporary and recover with time.
• Pigmentation disturbance. Very rarely, there can be loss of pigmentation at the site of steroid injection. Occasionally hyperpigmentation can be seen too.
• Acne. Acne and folliculitis type spots (pustules) can occur in an area treated with steroid injection.
• Absorption into the rest of the body. It is probable that a small amount of the steroid injected into the skin reaches the rest of the body. This can be a significant amount if a large area needs to be treated. In these instances it is possible that side effects such as diabetes, high blood pressure, bone thinning, disturbance in the menstrual cycle and a temporary reduction in the immune system could occur. This is very minimal at the usual doses required for hair loss.

Many of these side effect can be reduced by using a lower concentration of steroid solution and spreading it out evenly over the area with multiple injections of small volumes, using a very fine syringe. This technique of micro droplet steroid injection in my experience reduces the chance of this side effect to less than 5%.

How many treatments are required?

Treatment is given every 4 weeks, for up to 6 months.

Some people only need one or two treatments, while others need the full 6 treatments. The average number of treatments is 3 to 4. Treatment is not extended beyond 6 treatments if there have been no results.

When should steroid injections be performed?

It is believed that steroid injections are likely to be most beneficial within the first month of developing a patch of alopecia areata. It may also be that by controlling inflammation early on, the immune system is quietened down and may not cause patches of hair loss elsewhere in the scalp though this has not been conclusively proven. Steroid injection can however be given at any stage, as recommended by your doctor, even one or two years after a patch has been present.

How is treatment performed?

The skin is first cleaned with an antiseptic cleanser.

Treatment is performed using a micro droplet technique. In this technique and very fine needle is used to install a small drop at multiple sites with in an area so as to spread the dose of medication evenly and to reduce the chance of side effects. Treatments takes no more than 5 to 10 minutes. An eyebrow may require about 6 to 8 injections. A patch of hair loss that is 5 x 5cm may require about 10 to 15 small injections. There is very slight discomfort at the time of injection that is short lived. An anaesthetic is not required.

How much do steroid injections cost?

The prices for steroid injection can be found here.

References

Abell E, Munro DD. Intralesional treatment of alopecia areata with triamcinolone acetonide by jet injector. Br J Dermatol 1973: 88: 55–59.

Kubeyinje EP. Intralesional triamcinolone acetonide in alopecia areata amongst 62 Saudi Arabs. East Afr Med J 1994: 71: 674–675

Pelin Ustuner, Ali Balevi & Mustafa Özdemir (2017) Best dilution of the best corticosteroid for intralesional injection in the treatment of localized alopecia areata in adults, Journal of Dermatological Treatment, 28:8, 753-761, DOI: 10.1080/09546634.2017.1329497

Author information

Author: Dr Sajjad Rajpar

Date last reviewed: 1 Sept 2020

Conflict of interest and disclaimer

This information is based on the views of a UK Consultant Dermatologist (a doctor who is on the specialist register for Dermatology, the equivalent of which is ‘Board certified’ in the USA).  This information is intended for patients of this Clinic and under our care only as supplementary information to their consultations. Practices vary nationally and internationally and we do not wish to contravene advice you have been provided by your own Physician. This page, nor does any part of this website, constitute personal medical advice.

How long does hair loss last after steroid injection?

How long does it take for hair to grow after steroid injections?

Do cortisone injections cause hair loss?

Does cortisone shots help alopecia?