Which keloid scars are most suitable for injection with triamcinolone (Kenalog)?

From the Guidelines

The best keloid scars to inject with triamcinolone are those that are hypertrophic, as they can be effectively treated with triamcinolone acetonide at a concentration of 40 mg/mL, as indicated in the guidelines of care for the management of acne vulgaris 1. When considering the treatment of keloid scars with triamcinolone, it is essential to evaluate the characteristics of the scar, including its size, age, and symptoms.

• Smaller, newer keloids (less than 2 years old) typically respond better to injection therapy than older, larger ones.
• The concentration of triamcinolone acetonide used can vary, but for hypertrophic scars and keloids, a concentration of 40 mg/mL is recommended, as stated in the guidelines 1.
• Injections are usually given directly into the keloid at 4-6 week intervals until maximum response is achieved.
• Potential side effects include skin atrophy, telangiectasia, and hypopigmentation, which are more common with higher concentrations and in patients with darker skin tones, as noted in the guidelines 1.
• It is crucial to avoid injecting triamcinolone at the site of active infections, such as impetigo or herpes, and to use caution in patients with certain medical conditions, such as uncontrolled diabetes, heart failure, or severe hypertension, as contraindicated in the guidelines 1.
• The medication should be injected into the body of the keloid until blanching occurs, using a 27-30 gauge needle.
• Triamcinolone works by suppressing inflammation, reducing fibroblast proliferation, and decreasing collagen synthesis, which helps flatten and soften the keloid.
• For very large or resistant keloids, combination therapy with other treatments like surgical excision, silicone sheeting, or pressure therapy may be more effective than triamcinolone alone.

From the Research

Keloid Scars Treatment with Triamcinolone

The treatment of keloid scars with triamcinolone injections is a common approach, with various studies examining its effectiveness.

• The use of triamcinolone acetonide (TAC) intralesional injections for keloid scars has been reviewed, highlighting its variable response rate of 50-100% regression and a recurrence rate of 33% and 50% after 1 and 5 years, respectively 2.
• A study comparing TAC with verapamil found that TAC showed a faster and more effective response, although with a higher complication rate 2.
• The combination of TAC with 5-fluorouracil (5-FU) has been found to be effective, with statistically significant overall improvements of scars over time and long-term stable results 2, 3.
• Another study found that the combination of TAC, 5-FU, and pulsed-dye laser was more effective and acceptable to patients, producing better results and a promising effect on lightening the lesion 3.

Factors to Consider for Keloid Scars Treatment

When considering the treatment of keloid scars with triamcinolone, several factors should be taken into account, including:

• The size and location of the keloid scar
• The patient's medical history and potential allergies
• The potential side effects of triamcinolone injections, such as atrophy and telangiectasia
• The combination of triamcinolone with other treatments, such as 5-FU or laser therapy, to enhance effectiveness and minimize side effects 2, 3, 4, 5, 6.

Current Research and Recommendations

Current research recommends the use of silicone gel or sheeting with corticosteroid injections as first-line therapy for keloids, with adjuvant intralesional 5-FU, bleomycin, or verapamil considered for recalcitrant lesions 6.

• Excision of keloids with immediate post-excision radiation therapy is also an effective option for recalcitrant lesions 5, 6.
• Larger and more robust controlled studies are necessary to further understand the variety of existing and emerging keloid treatments, including corticosteroids, cryotherapy, intralesional injections, lasers, photodynamic therapy, excision and radiation, pressure dressings, and others 6.