Management of Twak-vaivarnya (~skin discoloration) following intra-articular triamcinolone acetonide injection using Bakuchyadi oil: A case series

Twak - vaivarnya (~skin discoloration) is often reported after intralesional and extra-articular Glucocorticoid (GC) injections. This adverse effect is more common with the injection of triamcinolone acetonide, though it may rarely be seen after Intra-Articular (IA) GC injections. The discoloration is due to local hypopigmentation. No specific treatment is advised for this condition, as the lesions usually re-pigment over an indefinite period. Bakuchi [ Cullen corylifolium (L.) Medik] is frequently used in Kushtha (~various skin diseases), including Shvitra (~leucoderma). Four cases of whitish discoloration of skin following IA GC injection, in patients with Amavata (~inflammatory arthritis) who were on various antirheumatic medications, are being reported here. These patients were treated with the topical application of Bakuchyadi oil. Re-pigmentation was initially observed after 4–6 weeks, with 95–99% re-pigmentation within four months. This oil may also be useful for cases of discoloration of the skin following extra-articular and intralesional triamcinolone acetonide injections.