What is the typical dilution of Kenalog (triamcinolone) for keloid injection?

Triamcinolone Dilution for Keloid Injection

For keloid intralesional injection, use triamcinolone acetonide at concentrations of 20-40 mg/mL without dilution, with 20 mg/mL being the most commonly recommended concentration.

Recommended Concentrations

The optimal concentration is 20 mg/mL triamcinolone acetonide, which provides effective keloid treatment with acceptable side effect profiles. 1, 2

• Concentrations of 20 mg/mL and 40 mg/mL are both effective for keloid treatment, with no significant difference in outcomes between these two strengths (p = 0.58). 2

• Concentrations below 20 mg/mL (specifically 10 mg/mL) are inadequate and result in poor keloid involution, leading to treatment discontinuation in clinical studies. 2

• The volume of triamcinolone infiltrate should be adjusted according to the size of the lesion, typically delivering 1.2-2.0 mg of triamcinolone per mm³ of keloid tissue. 2

Clinical Application Protocol

Inject the triamcinolone directly into the keloid tissue without further dilution from the commercial preparation:

• Use the commercially available formulation (Kenalog® or equivalent) at 20 mg/mL or 40 mg/mL concentration as supplied. 1, 2, 3

• Administer intralesional injections at 3-4 week intervals until adequate response is achieved. 1, 2

• Most keloid nodules flatten within 48-72 hours after intralesional triamcinolone injection. 4

Important Clinical Considerations

Common adverse effects include local pain at injection site, telangiectasias, and skin atrophy, which are generally minimal but should be discussed with patients. 1

• The American Academy of Dermatology recommends caution in patients with diabetes, heart failure, or severe hypertension when using triamcinolone. 4

• Contraindications include hypersensitivity to triamcinolone and active infections at the treatment site. 4

• Long-term recurrence rates are significant: approximately 33% at one year and 50% at five years, even with initially successful treatment. 3

Combination Therapy Considerations

For recurrent or large keloids, combining triamcinolone with 5-fluorouracil in a 1:1 ratio (40 mg/mL triamcinolone: 50 mg/mL 5-FU) may enhance outcomes. 5

• This combination can be administered in monthly courses with adjunctive therapies such as polarized light therapy. 5

• Surgical excision combined with perioperative triamcinolone infiltration and post-operative pressure therapy shows improved results for earlobe keloids. 2