Bilateral avascular necrosis of the head of the femur after intradermal triamcinolone acetonide injection for alopecia areata: A first-of-its-kind case report

Intradermal injections of corticosteroids are extremely popular and the first line of therapy for a multitude of dermatological conditions, ranging from alopecia areata to lichen planus. It is widely believed that such injections lack potential for systemic side effects, including avascular necrosis (AVN). The occurrence of AVN following intradermal injection has never been reported. Here, we report a 35-year-old man who developed AVN following intradermal injections of corticosteroids given for alopecia areata. All other systemic causes of AVN were ruled out, and causality was established by the Naranjo algorithm. To the best of our knowledge, this is the first case report documenting the occurrence of AVN with intradermal injections.