What is Kenalog (triamcinolone) used for?

What is Kenalog (Triamcinolone) Used For?

Kenalog (triamcinolone) is a corticosteroid used to treat inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, as well as for intra-articular injections in joint diseases and intralesional treatment of specific inflammatory skin conditions. 1

Primary Dermatologic Uses

Topical Applications

• Triamcinolone acetonide cream (0.1%) is FDA-indicated for relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, including conditions like eczema and psoriasis. 1
• The topical formulation addresses redness, itching, and various inflammatory skin conditions. 2

Intralesional Injections for Acne and Scarring

• The American Academy of Dermatology recommends intralesional triamcinolone acetonide (10 mg/mL, may be diluted to 5 or 3.3 mg/mL) for inflammatory nodulocystic acne, injected directly into nodular lesions. 3
• This treatment flattens most acne nodules within 48 to 72 hours. 3
• For acne keloidalis, triamcinolone acetonide is injected into inflammatory follicular lesions. 3
• For hypertrophic scars and keloids, triamcinolone acetonide -40 is recommended. 3
• Note that intralesional triamcinolone is effective for occasional or stubborn cystic lesions but not practical for patients with multiple lesions. 3

Psoriasis Treatment

• Intralesional triamcinolone acetonide at 2.5 mg/mL is virtually 100% effective in small plaques of psoriasis on the trunk and limbs. 4
• For more extensive psoriasis, topical corticosteroids (class 1-5) are recommended for up to 4 weeks for plaque psoriasis not involving intertriginous areas. 5
• Intralesional corticosteroids can be used for localized nonresponding or very thick lesions, with triamcinolone acetonide doses up to 20 mg/mL every 3 to 4 weeks. 5

Other Dermatologic Conditions

• Intralesional triamcinolone is highly effective in localized dermatitis including lichen simplex chronicus, prurigo nodularis, and nonspecific eczema. 4

Rheumatologic Uses

Juvenile Idiopathic Arthritis (JIA)

• The American College of Rheumatology strongly recommends intra-articular glucocorticoids as part of initial therapy for active oligoarthritis, with triamcinolone hexacetonide being the strongly preferred agent over triamcinolone acetonide. 5, 3
• Triamcinolone hexacetonide results in more durable clinical responses than triamcinolone acetonide based on randomized trials and large observational studies. 5
• For polyarticular JIA, intra-articular glucocorticoids are suggested as adjunct therapy when arthritis prevents ambulation or interferes with important daily activities. 3
• For recurrent lesions in children, triamcinolone hexacetonide (5-10 mg/mL) is preferred over triamcinolone acetonide due to more complete and longer duration of clinical response. 3

Acute Gout

• For acute gout involving 1-2 large joints, the American College of Rheumatology recommends intra-articular corticosteroids as an appropriate option, with dosing based on the size of the involved joint(s). 3
• Intramuscular triamcinolone (60 mg) has been compared to corticotropin in clinical trials for acute gout management. 5

Rheumatoid Arthritis

• Among intra-articular corticosteroids, triamcinolone hexacetonide is the most effective for relieving local symptoms of inflammation in early rheumatoid arthritis. 3

Allergic Rhinitis

• Triamcinolone acetonide nasal spray (Nasacort Allergy 24HR, 55 µg per spray) is FDA-approved for seasonal and perennial allergic rhinitis in patients ≥2 years old. 5
• Dosing varies by age: 2-5 years receive 1 spray per nostril daily; 6-11 years receive 2 sprays per nostril daily; ≥12 years receive 2 sprays per nostril once or twice daily. 5
• Available over-the-counter for convenient access. 5

Critical Safety Considerations

Absolute Contraindications

• Do not inject at sites of active infections (impetigo, herpes). 3
• Avoid in patients with hypersensitivity to triamcinolone, active tuberculosis, systemic fungal infection, extensive plaque psoriasis, pustular psoriasis, erythrodermic psoriasis, active peptic ulcer disease, uncontrolled diabetes, heart failure, severe hypertension, or severe depression/psychosis. 3

Important Adverse Effects

• Local overdose of intralesional triamcinolone can cause atrophy, pigmentary changes, telangiectasias, and hypertrichosis. 3
• Repeated injections can suppress the hypothalamic-pituitary-adrenal axis, requiring monitoring for infections, impaired wound healing, sterile abscess, and steroid acne. 3
• Long-term continuous use in children risks skin atrophy, growth suppression, and HPA axis suppression; use the minimum effective amount and consider periodic treatment breaks. 3
• Granulomatous foreign body reactions to intralesional triamcinolone have been reported, though rarely. 6
• Blindness from central artery occlusion has been reported with periorbital injections; never use high-pressure injections around the eyes. 4

Dosing Limits

• Clinical studies indicate safe dosing up to 6 cc (15 mg) or even 8 cc (20 mg) for patients over 50 kg every 3 to 4 weeks. 4
• Serum cortisol monitoring should be performed if concerns exist about adrenal suppression, particularly with periorbital or intranasal use. 4