What is the typical dose of Kenalog (triamcinolone) injection?

Kenalog (Triamcinolone Acetonide) Injection Dosing

The typical dose of Kenalog injection varies by route and indication: for intra-articular use, 5-40 mg per joint depending on joint size; for intralesional use in dermatologic conditions, 2.5-10 mg/mL at volumes of 0.05-0.1 mL per injection site; and for intramuscular use in systemic conditions, 40-80 mg as a single dose. 1

Intra-Articular Dosing

• Large joints (knee, hip, shoulder): 20-40 mg per injection 1
• Medium joints (elbow, wrist, ankle): 10-20 mg per injection 1
• Small joints (fingers, toes): 5-10 mg per injection 1
• For trigger finger specifically, 20 mg demonstrates superior efficacy compared to 5 mg or 10 mg doses, with 79% effectiveness at 6 months versus 52% and 62% respectively 2

Important Precautions for Intra-Articular Use

• Do not exceed 40 mg per single injection site to minimize risk of postinjection flare 1, 3
• Severe postinjection flares can occur within 2 hours, mimicking septic arthritis with intense pain and joint effusion requiring aspiration 3
• The synovial fluid in flare reactions appears "butterscotch"-colored and contains triamcinolone crystals visible on polarized microscopy 3

Intralesional Dermatologic Dosing

For acne nodules and inflammatory lesions:

• Concentration: 2.5 mg/mL is most commonly used (reported by 52.5% of dermatologists) 4
• Volume: 0.05 mL per injection site (used by 42.3% of practitioners) 4
• Inject into the center of the lesion at intradermal depth 4
• Most acne nodules flatten within 48-72 hours 5

For keloids and hypertrophic scars:

• Concentration: 10-20 mg/mL 6
• Inject just beneath the dermis in the upper subcutis 6

For alopecia areata:

• Concentration: 5-10 mg/mL injected into affected scalp areas 6

For infantile hemangiomas:

• Intralesional triamcinolone shows 58% mean clearance rate, though oral propranolol has emerged as preferred first-line therapy 7

Critical Dosing Limits for Intralesional Use

• Do not exceed 150 mg total dose per treatment session across all injection sites 7
• Volume of 0.05-0.1 mL per site is sufficient for therapeutic effect 6
• Skin atrophy, when it occurs, typically lasts over 6 months but affects less than 1% of patients 4

Intramuscular Systemic Dosing

For systemic inflammatory conditions:

• Initial dose: 40-80 mg IM as a single injection 1
• Kenalog-40 contains 40 mg/mL; Kenalog-80 contains 80 mg/mL 1

For adrenal insufficiency (pediatric emergency):

• 2-3 mg/kg IV/IO (maximum 100 mg) over 3-5 minutes, followed by maintenance dosing 7

Intranasal Dosing

For allergic rhinitis:

• Age 2-5 years: 1 spray (55 mcg) per nostril daily 7
• Age 6-11 years: 2 sprays (110 mcg) per nostril daily 7
• Age ≥12 years: 2 sprays per nostril once or twice daily 7

Common Pitfalls to Avoid

• Never inject concentrated triamcinolone (>10 mg/mL) into facial skin due to high risk of permanent atrophy 6
• Avoid injecting at sites of active infection (impetigo, herpes) as this can worsen infection 5
• Do not use for extensive plaque psoriasis, pustular psoriasis, or erythrodermic psoriasis where systemic absorption risk is high 5
• Counsel patients about hypopigmentation and atrophy risk before every injection—only 50.5% of dermatologists do this consistently 4
• Monitor for postinjection flare within first 2-6 hours after intra-articular injection, particularly with doses ≥40 mg 3

Monitoring Requirements

• Assess injection sites at follow-up for atrophy, telangiectasia, and pigmentary changes 6
• Use minimum effective dose and consider maintenance regimens (twice weekly) once control achieved 6
• For repeated injections, consider steroid-sparing alternatives like topical calcineurin inhibitors for facial applications 6