Intralesional Corticosteroid Injection for Keloid Treatment

Recommended Concentration and Injection Technique

• The British Journal of Dermatology recommends using lower concentrations (5-10 mg/mL) of triamcinolone acetonide for facial keloids or areas at higher risk for atrophy 1
• Inject triamcinolone acetonide just beneath the dermis in the upper subcutis, not into the keloid substance itself, as recommended by the British Journal of Dermatology 1

Volume and Dosing Protocol

• Inject 0.05-0.1 mL per injection site to produce a therapeutic effect in approximately 0.5 cm diameter area, according to the British Journal of Dermatology 1
• Repeat injections every 3-4 weeks until the keloid flattens or symptoms resolve, as suggested by the British Journal of Dermatology 1

Pain Management

• Apply EMLA cream (lidocaine/prilocaine) as topical anesthesia prior to injection to minimize discomfort, recommended by Clinical Infectious Diseases 2
• Consider premedication with topical anesthetic 30-60 minutes before the procedure, as suggested by Clinical Infectious Diseases 2
• In young children or patients with extensive keloids requiring multiple injection sites, general anesthesia or sedation may be necessary, according to Pediatrics 3

Special Precautions and High-Risk Situations

• Patients with a history of keloid formation should be counseled that outcomes remain uncertain despite treatment, as noted by Pediatrics 3

Common Adverse Effects and How to Minimize Them

• Use lower concentrations (10-20 mg/mL instead of 40 mg/mL) and smaller volumes when treating facial keloids or sensitive areas to minimize the risk of skin atrophy, recommended by the Journal of the American Academy of Dermatology 4

Critical Pitfall to Avoid

• Always target the upper subcutis just beneath the dermis, and avoid injecting into the tendon substance or subcutaneous fat, as emphasized by the British Journal of Dermatology 1

Keloid Injection Treatment

Recommended Dosing Protocol

• The American Academy of Dermatology recommends triamcinolone acetonide 40 mg/mL concentration for hypertrophic scars and keloids, which is notably higher than concentrations used for other dermatologic conditions 5
• The American Academy of Dermatology specifically recommends triamcinolone acetonide 40 mg/mL concentration for hypertrophic scars and keloids 5

Administration Details

• Inject just beneath the dermis in the upper subcutis for optimal keloid penetration 5

Absolute Contraindications

• Do not inject triamcinolone in cases of active infection at the injection site, previous hypersensitivity to triamcinolone, or active tuberculosis or systemic fungal infections 5

Special Precautions

• Exercise caution in patients with uncontrolled diabetes, heart failure, or severe hypertension 5
• Exercise caution in patients with facial or intertriginous keloids, which carry higher risk for adverse effects 5
• Exercise caution in patients with large or diffuse keloids, where even distribution is difficult and systemic absorption risk increases 6, 7