Can I treat hidradenitis suppurativa with Kenalog (triamcinolone) injections?

Can Kenalog (Triamcinolone) Injections Treat Hidradenitis Suppurativa?

Yes, intralesional triamcinolone (Kenalog) injections are recommended for short-term control of individual inflamed lesions in hidradenitis suppurativa, but only as an adjunctive therapy for acute flares—not as a primary or standalone treatment. 1

Role of Intralesional Corticosteroids in HS Management

Intralesional triamcinolone is specifically indicated for:

• Acute inflamed nodules and abscesses requiring rapid symptom relief 2, 3
• Dosing: Triamcinolone 10 mg/mL, injected at 0.2-2.0 mL per lesion 2, 3
• Expected outcomes: Significant reduction in erythema, edema, suppuration, and pain within days 2, 3
• Evidence level: Level III (expert consensus and limited case series), making this a weak recommendation based primarily on clinical experience rather than robust trials 1

Critical Limitations You Must Understand

Intralesional steroids do NOT address the underlying disease process and should never be used as monotherapy:

• They provide only temporary symptomatic relief for individual lesions 1
• They have no effect on disease progression, sinus tract formation, or scarring 1
• They cannot prevent new lesion formation 1
• Repeated injections are not a sustainable long-term strategy and may cause local tissue atrophy 1

When to Use Intralesional Triamcinolone

Use Kenalog injections in these specific scenarios:

• Acute flares while initiating or bridging to systemic therapy 1
• Individual painful nodules requiring immediate relief in patients already on appropriate systemic treatment 2, 3
• Adjunctive therapy in combination with antibiotics or biologics for particularly symptomatic lesions 1

What You Should Actually Be Prescribing

The evidence-based treatment algorithm for HS depends on Hurley stage:

Mild Disease (Hurley Stage I)

• First-line: Topical clindamycin 1% twice daily for 12 weeks 1, 2
• Adjunct: Intralesional triamcinolone for inflamed lesions 2, 3

Moderate Disease (Hurley Stage II)

• First-line: Tetracycline 500 mg twice daily for up to 4 months OR doxycycline 100 mg once or twice daily 1, 2
• Second-line (preferred): Clindamycin 300 mg twice daily PLUS rifampicin 300-600 mg daily for 10-12 weeks (response rates 71-93%) 1, 2, 3
• Adjunct: Intralesional triamcinolone for acute flares 1

Severe Disease (Hurley Stage III)

• First-line: Adalimumab 160 mg at week 0,80 mg at week 2, then 40 mg weekly starting week 4 1, 2, 4
• Surgical consultation for definitive management 1, 2
• Bridge therapy: Short-term systemic corticosteroids or intralesional injections while awaiting biologic effect 1

Common Pitfalls to Avoid

• Do not use intralesional steroids as primary treatment for HS—this delays appropriate systemic therapy and allows disease progression 1
• Do not inject into sinus tracts or fibrotic lesions—steroids only work on acute inflammatory nodules, not established scarring 1
• Do not continue injections beyond acute management—if a patient requires repeated injections, they need systemic therapy escalation 1
• Assess treatment response at 12 weeks using HiSCR (Hidradenitis Suppurativa Clinical Response) criteria 2, 4

Additional Essential Management

Beyond medications, address these factors that impact morbidity and quality of life:

• Smoking cessation (tobacco worsens outcomes) 2, 3, 4
• Weight loss in patients with obesity 2, 3, 4
• Screen for depression/anxiety (highly prevalent in HS) 2, 3
• Cardiovascular risk factor screening (BP, lipids, HbA1c) 2
• Appropriate wound care for draining lesions 3, 4