When is steroid injection into the skin recommended for acne keloidalis nuchae?

Intralesional steroid injections place medicine directly into selected bumps or scars at the back of the neck and scalp. A dermatologist may recommend them when lesions are raised, firm, inflamed, tender, or itchy, particularly when reducing local inflammation is a treatment goal.

The injection is given into individual lesions rather than spread over the whole scalp. It may flatten or soften active bumps over time, but the response varies and more than one treatment visit may be considered. Temporary tenderness, a small indentation, or lighter skin at the injection site can occur, so the dose and placement need careful planning.

Avoid picking, scratching, tight collars, and close shaving if these worsen friction at the nape. Follow the clinic’s aftercare instructions and tell the dermatologist about previous reactions, skin infections, diabetes, medicines, and areas of thinning or colour change. Do not inject a lesion that has not been assessed.

Arrange prompt review for rapidly enlarging lesions, spreading redness, pus, fever, severe pain, or drainage. Seek assessment if hair loss extends beyond the affected bumps, scarring changes quickly, or a treated area develops a persistent depression or marked colour change.

Ask which lesions need injection, what improvement is realistic, how friction and shaving affect the plan, what skin changes to watch for, and when the area should be reassessed.