What is the treatment plan for keloids using Kenalog (triamcinolone acetonide)?

Treatment Plan for Keloids Using Kenalog (Triamcinolone Acetonide)

For keloid treatment, intralesional triamcinolone acetonide (Kenalog) at 40 mg/mL concentration is the first-line therapy, administered every 3-4 weeks until the keloid flattens, with a maximum of 4-6 sessions. 1

Dosing and Administration Protocol

Initial Assessment

• Evaluate keloid size, location, symptoms (pain, itching), and previous treatments
• Document baseline appearance with photographs if possible

Treatment Protocol

1. Concentration and Preparation

   • Use triamcinolone acetonide (Kenalog) at 40 mg/mL for hypertrophic scars and keloids 1
   • For facial or thin-skinned areas, consider diluting to 10-20 mg/mL to reduce risk of atrophy

2. Injection Technique

   • Clean the area with antiseptic solution
   • Inject directly into the keloid, not beneath it
   • Use small amounts (0.05-0.1 mL) per injection site within the keloid
   • Multiple injection points may be needed for larger keloids
   • Total volume depends on keloid size but typically ranges from 0.5-2 mL per session

3. Treatment Schedule

   • Initial treatment every 3-4 weeks 2
   • Continue until satisfactory flattening is achieved
   • Typically requires 4-6 sessions for optimal results 2, 3

Expected Outcomes and Monitoring

Efficacy

• Complete flattening in 64% of lesions 3
• Symptomatic relief (reduction in pain and itching) in 72% of cases 3
• Visible improvement often begins after the second injection

Follow-up Schedule

• Evaluate response every 3-4 weeks during active treatment
• After completion of treatment, follow up at 3 months and 6 months
• Long-term monitoring recommended as recurrence rates increase over time (up to 50% at 5 years) 4

Potential Side Effects and Management

Common Side Effects

• Skin atrophy (thinning)
• Hypopigmentation
• Telangiectasia (small dilated blood vessels)
• Pain at injection site

Management of Side Effects

• For atrophy or hypopigmentation: reduce concentration or increase interval between treatments
• For pain: consider topical anesthetic 30 minutes before injection
• If significant atrophy occurs, discontinue treatment and reassess after 3-6 months

Special Considerations

For Resistant Keloids

• Consider combination therapy with:
  • Surgical excision followed by immediate triamcinolone injection 5
  • Intralesional cryotherapy plus triamcinolone 6
  • Combined PRP and triamcinolone (shown to reduce side effects like atrophy and hypopigmentation) 2

Contraindications

• Active infection at or near the treatment site
• Known hypersensitivity to triamcinolone
• Caution in patients with diabetes, hypertension, or immunosuppression

Pitfalls and Caveats

• Avoid injecting too superficially as this increases risk of atrophy and hypopigmentation
• Avoid excessive pressure during injection which can cause tissue damage
• Be aware that recurrence rates increase over time - 33% at one year and approximately 50% at 5 years 4
• Patient expectations should be managed - complete permanent resolution is not always achievable
• Multiple treatment modalities may be required for optimal outcomes in resistant cases

This treatment approach balances efficacy in reducing keloid size and symptoms with minimizing potential side effects, focusing on the outcomes of improved quality of life through reduced pain, itching, and cosmetic appearance.