What potential complications are associated with cortisone shots to the scalp? Is there is any link to glaucoma?—MARY DE SANDOLO, FNP, Waccabuc, N.Y.

Corticosteroid therapy can be administered topically, intralesionally, IM, IV, or orally. Potential side effects are common and delivery-specific. Intralesional corticosteroids (e.g., cortisone shots to the scalp) can be delivered via a syringe and needle or using a high-pressure needleless injection device (Dermo-jet). The skin condition being treated, treatment site, amount of corticosteroid used, and concentration of the preparation all influence local adverse effects of intralesional corticosteroids (J Am Acad Dermatol. 1981;4:149-151). Potential complications resulting from corticosteroids administered intralesionally include connective tissue damage, granuloma formation (due to foreign-body reaction), hypopigmentation, local atrophy, and rarely anaphylactic reactions (Plast Reconstr Surg. 2006;117:336 and Indian J Dermatol Venereol Leprol. 2003;69:345-346).—Philip R. Cohen, MD (134-10)