Effectiveness of Kenalog (Triamcinolone) for Poison Ivy
Intralesional injection of triamcinolone acetonide (Kenalog) is effective for treating severe poison ivy dermatitis, particularly for larger, nodular lesions where rapid improvement and decreased pain are needed. 1
Mechanism and Effectiveness
Poison ivy dermatitis is a type IV hypersensitivity reaction caused by exposure to urushiol, presenting as a pruritic erythematous rash with vesicles and bullae in areas that contacted the plant 2. Symptoms typically appear 24-48 hours after exposure and can last 2-3 weeks without treatment 3.
Triamcinolone acetonide (Kenalog) works through its potent anti-inflammatory properties to rapidly reduce inflammation and alleviate symptoms of poison ivy dermatitis.
Treatment Algorithm Based on Severity
Mild to Moderate Cases
- First-line: Topical treatments and supportive care
- Washing area immediately with a lipid-solvent to remove urushiol 4
- Topical corticosteroids
- Antihistamines for itching
- Cool compresses
Severe or Widespread Cases
Intralesional triamcinolone (Kenalog) injection for:
- Larger, nodular lesions
- Areas with significant inflammation
- Cases where rapid improvement is needed
- Dosage: Use lowest effective concentration to minimize side effects 1
Systemic corticosteroids for:
- Extensive involvement (>20% body surface area)
- Facial or genital involvement
- Severe symptoms not responding to other treatments 3
Important Considerations and Precautions
Local Side Effects: Local atrophy can occur at injection sites. Minimize this risk by:
- Using lower concentrations of triamcinolone
- Limiting the volume injected
- Avoiding repeated injections in the same area 1
Systemic Absorption: There is potential for systemic absorption and possible adrenal suppression, especially with multiple or large-volume injections 1
Duration of Treatment: Poison ivy dermatitis is self-limiting, typically resolving in 2-3 weeks. Treatment aims to provide symptom relief during this period 3
Special Populations: For facial, genital, or widespread eruptions, systemic corticosteroids may be preferable to multiple intralesional injections 5
When to Refer
- Systemic involvement (fever, extensive blistering)
- Facial or genital involvement with severe symptoms
- Symptoms not improving with standard treatments
- History of severe reactions to poison ivy
Prevention Strategies
Prevention remains the most effective approach:
- Plant identification and avoidance
- Protective clothing when in high-risk areas
- Immediate washing with soap and water after potential exposure
- Barrier creams before potential exposure 4
Kenalog (triamcinolone) injections should be considered for severe, localized poison ivy dermatitis, particularly when rapid symptom relief is needed, but should be used judiciously to minimize potential side effects.