Common Sizes of Triamcinolone for Clinical Use
The common sizes of triamcinolone acetonide for intralesional injection are 5-10 mg/mL for nodular acne and inflammatory follicular lesions, and 40 mg/mL for hypertrophic scars and keloids. 1
Intralesional Triamcinolone Concentrations by Indication
- For nodular acne: triamcinolone acetonide is commonly used at 10 mg/mL concentration, which may be diluted with sterile normal saline to 5 mg/mL or 3.3 mg/mL depending on the treatment area 1
- For acne keloidalis: triamcinolone acetonide 10 mg/mL is used for inflammatory follicular lesions 1
- For hypertrophic scars and keloids: triamcinolone acetonide 40 mg/mL is the standard concentration 1
- For alopecia areata: hydrocortisone acetate (25 mg/mL) and triamcinolone acetonide (5-10 mg/mL) are commonly used 1
Injection Volumes and Techniques
- For intralesional treatment of acne, the most frequently used volume is 0.05 mL per injection site 2
- For alopecia areata, an injection of 0.05-0.1 mL will produce a tuft of hair growth about 0.5 cm in diameter 1
- The injection should be placed just beneath the dermis in the upper subcutis for optimal effect 1
- Multiple injections may be given, with the main limitation being patient discomfort 1
Clinical Efficacy
- In alopecia areata, intralesional triamcinolone has shown efficacy with 62% of patients achieving full regrowth with monthly injections 1
- For nodular acne, intralesional triamcinolone can flatten most acne nodules within 48 to 72 hours 1
- In a comparative study for alopecia areata, intralesional triamcinolone acetonide showed the best results with 60% of patients achieving >75% hair regrowth 3
Potential Adverse Effects
- Local overdose can result in skin atrophy, pigmentary changes, telangiectasias, and hypertrichosis 1
- Skin atrophy is a consistent side-effect, particularly with triamcinolone 1
- When atrophy occurs, it may last over six months in 48.4% of cases, although the overall incidence of adverse events is reported to be less than 1% 2
- Other potential adverse effects include impaired wound healing, sterile abscess formation, and steroid acne 1
Common Formulations for Other Routes of Administration
- For systemic therapy, triamcinolone acetonide is available in intramuscular formulations of 40 mg/mL (Kenalog-40) and 80 mg/mL (Kenalog-80) 4
- For intranasal use in allergic rhinitis, triamcinolone acetonide is formulated as both an aerosol and an aqueous metered-dose pump spray at concentrations of 110-220 micrograms per dose 5
- For intravitreal injections used in uveitic macular edema, a concentration of 4 mg/0.1 mL is commonly used 6
Clinical Considerations
- The concentration and volume of triamcinolone should be selected based on the specific condition being treated and the size/location of the lesion 1, 4
- For dermatological use, a survey of dermatologists found that 2.5 mg/mL was the most commonly reported concentration (52.5% of respondents) for intralesional treatment of acne 2
- When treating joints, the usual intra-articular injection technique should be followed, with doses ranging from 2.5-5 mg for smaller joints and 5-15 mg for larger joints 4
Remember that strict aseptic technique is mandatory when administering triamcinolone injections, and the suspension should be inspected for clumping or agglomeration before use 4.