Recommended Depth for Intralesional Triamcinolone Injections
For intralesional triamcinolone injections, the recommended depth is 1.0 mm for most dermatological conditions, with adjustments based on the specific condition being treated. 1
Depth Recommendations by Condition
Acne Vulgaris
- Nodular acne: Inject triamcinolone acetonide (10 mg/mL) directly into the inflammatory nodule
- May be diluted with sterile normal saline to 5 or 3.3 mg/mL depending on lesion size 2
- Target the mid-dermis where the inflammatory process is most active
Alopecia Areata
- Standard technique: 1.0 mm depth is effective for delivering triamcinolone acetonide 1
- First-line treatment for limited patchy alopecia areata with approximately 62% success rate 3
- Concentration typically ranges from 2.5-10 mg/mL depending on the area being treated
Keloids and Hypertrophic Scars
- Higher concentration: Triamcinolone acetonide 40 mg/mL for hypertrophic scars and keloids 2
- Inject directly into the body of the scar tissue
- Multiple passes at different depths may be required for thicker lesions
Lipomas
- Deeper injection: For subcutaneous lipomas, inject directly into the center of the lesion
- Small lipomas (1-3 cm): 40 mg triamcinolone acetonide
- Large lipomas (4-6 cm): 80 mg triamcinolone acetonide 4
Chalazia
- Shallow injection: 0.1 to 0.2 mL of triamcinolone acetonide (40 mg/mL)
- Inject directly into the lesion with care to avoid globe penetration 5
Hidradenitis Suppurativa
- Variable depth: Inject directly into inflammatory nodules
- Concentrations of 10-40 mg/mL have shown efficacy 6, 7
- Higher concentrations (20-40 mg/mL) may be more effective for acute flares 7
Technical Considerations
- Needle selection: 27-30 gauge needles are typically used for facial lesions
- Injection technique: Slow, steady pressure with minimal trauma
- Volume: Use minimal volume necessary to achieve blanching of the lesion
Potential Complications Based on Depth
- Too shallow: Inadequate delivery of medication, poor response
- Too deep: Risk of fat atrophy, pigmentary changes, and telangiectasias 2
- Proper depth monitoring: Observe for slight blanching of the lesion during injection
Contraindications and Precautions
- Do not inject at sites of active infections (impetigo, herpes)
- Avoid in patients with hypersensitivity to triamcinolone
- Use caution in patients with active tuberculosis or systemic fungal infections 2
- Consider lower concentrations in facial areas and in patients with darker skin types to minimize risk of atrophy and pigmentary changes
Novel Delivery Methods
- Microneedling with drug delivery (MMP®) has been used successfully at 1.0 mm depth for alopecia areata
- This technique promotes more uniform absorption of corticosteroids than traditional methods 1
Remember that the efficacy of intralesional triamcinolone depends not only on proper depth but also on appropriate concentration, volume, and technique for each specific condition.