Intralesional Therapy for Localized Plaque Psoriasis

Abstract

Localized plaque psoriasis is a chronic inflammatory skin disorder characterized by well-demarcated, erythematous plaques with silvery scales. When lesions are limited in number and resistant to topical therapy, intralesional therapy offers a targeted treatment option that delivers medication directly into the affected skin, maximizing local efficacy while minimizing systemic side effects. Intralesional corticosteroids, particularly triamcinolone acetonide, are the most commonly used agents in this approach. They exert anti-inflammatory, immunosuppressive, and antiproliferative effects, leading to reduction of erythema, scaling, and plaque thickness. The therapy is typically administered through multiple small injections into the dermis of psoriatic plaques at intervals of several weeks. Intralesional treatment is especially beneficial for persistent plaques on areas such as the scalp, elbows, knees, and nails. Clinical studies have demonstrated that intralesional therapy can significantly improve localized lesions, particularly those refractory to conventional topical treatments. However, potential adverse effects include skin atrophy, hypopigmentation, telangiectasia, and pain at the injection site, which necessitate careful dosing and technique. In conclusion, intralesional therapy represents an effective and localized treatment modality for patients with limited plaque psoriasis. With proper patient selection and administration, it can provide rapid improvement while reducing the need for systemic therapy. Further research is recommended to optimize dosing regimens and explore additional intralesional agents for enhanced therapeutic outcomes.