Peri-lymphatic hypopigmentation following intralesional corticosteroid injection

An 18-year-old male presented with multiple white lesions over the left leg for 1 month. He had received two intralesional triamcinolone injections (10 mg/mL) 1 month apart, for a hypertrophic scar. Examination revealed linear atrophic hypopigmented macules over the left leg and feet extending proximally along the lymphatics [Figure 1]. Local ultrasound and Doppler were done, and involvement of arteries and veins was ruled out. We recommended a biopsy to the patient, but the patient declined. Based on the history and clinical features, a diagnosis of post-steroid injection perilymphatic hypopigmentation was made. This occurs because lymphatic vessels are responsible for clearing macromolecules such as triamcinolone acetonide, leading to localized depigmentation. The disorder is usually diagnosed based on clinical features, but it can be confirmed by biopsy, which shows decreased melanin granules and sebaceous glands, and by Patent Blue dye injection, which stains the lymphatics. Once triamcinolone injections are discontinued, hypopigmentation usually improves and resolves within 1 year.

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Figure 1: Multiple linear, streaky, and hypopigmented macules noted in the lateral part of the left leg.

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