Intralesional Kenalog for Localized Skin Inflammation
Concentration Selection and Administration
- The American Academy of Dermatology recommends 5-10 mg/mL concentration for most dermatologic conditions requiring intralesional therapy, with 0.05-0.1 mL per injection site producing localized therapeutic effect 1
- For nodular acne, 10 mg/mL concentration may be used, which may be diluted with sterile normal saline to 5 or 3.3 mg/mL 1
- For hypertrophic scars and keloids, 40 mg/mL concentration may be used 1
- For psoriasis, up to 20 mg/mL concentration may be used every 3-4 weeks 1
Injection Technique and Safety
- Inject just beneath the dermis in the upper subcutis to achieve optimal therapeutic effect 1
- The European Respiratory Society guidelines note that intralesional injections of triamcinolone acetonide may be more effective than topical preparations for limited skin lesions 2, 3
Maximum Safe Dosing and Contraindications
- Maximum 150 mg per injection site 1
- Active infection at injection site is an absolute contraindication 1
- Previous hypersensitivity to triamcinolone is an absolute contraindication 1
- Active tuberculosis or systemic fungal infections are absolute contraindications for large injections 1
- Facial and intertriginous areas are at higher risk for adverse effects, including atrophy, telangiectasias, and pigmentary changes 1, 4
- Uncontrolled diabetes, heart failure, or severe hypertension warrant careful consideration 1