Triamcinolone Concentration for Facial Keloids
For facial keloids, use triamcinolone acetonide at 40 mg/mL concentration, as this is the guideline-recommended dose specifically for hypertrophic scars and keloids. 1
Recommended Concentration and Dosing
The American Academy of Dermatology specifically recommends triamcinolone acetonide 40 mg/mL for hypertrophic scars and keloids, which represents the standard of care for these lesions 1
The maximum dose per injection session should not exceed 150 mg total 1
Injections should be administered every 3-4 weeks as needed 1
Facial-Specific Considerations
Facial skin requires heightened caution due to increased risk of adverse effects. The face is thinner and more prone to steroid-induced atrophy than other body sites, necessitating careful monitoring with repeated injections 2
Dilution Strategy for Facial Use
Consider diluting the 40 mg/mL preparation with sterile normal saline to 20 mg/mL or lower for initial facial treatments to balance efficacy with safety, particularly given the higher risk of atrophy and telangiectasia on facial skin 1, 2
The British Association of Dermatologists suggests diluting triamcinolone preparations or reducing application frequency while maintaining efficacy 2
Administration Technique
Inject just beneath the dermis in the upper subcutis 3
Use volumes of 0.05-0.1 mL per injection site to produce localized therapeutic effect 1
Blanching at the injection site serves as a useful endpoint indicator 4
Use a 23-26 gauge needle for intralesional delivery 4
Expected Outcomes and Monitoring
Monotherapy with triamcinolone achieves 50-100% regression of keloids, though recurrence rates are 33% at 1 year and 50% at 5 years 5
Monitor closely for skin atrophy, telangiectasia, and pigmentary changes, which are dose-dependent and occur more frequently with repeated injections at higher concentrations 1, 2
Atrophy and telangiectasia occur in approximately 37% of patients treated with triamcinolone alone 6
Combination Therapy Considerations
If monotherapy with triamcinolone proves inadequate or causes excessive side effects, consider combination approaches:
Triamcinolone 40 mg/mL combined with 5-fluorouracil (3:1 ratio of 5-FU to TAC) demonstrates superior efficacy with fewer adverse effects compared to either agent alone 7, 6
Adding platelet-rich plasma to triamcinolone (20 mg/mL) yields better cosmetic outcomes with lower incidence of atrophy and hypopigmentation compared to triamcinolone alone 8
Triple therapy with triamcinolone (10 mg/mL) + 5-FU + pulsed-dye laser produces 70% good-to-excellent responses versus 15% with triamcinolone alone 6
Common Pitfalls to Avoid
Avoid injection at sites of active infection (impetigo, herpes) 1
Do not use in patients with previous hypersensitivity to triamcinolone 1
Exercise caution in patients with uncontrolled diabetes, heart failure, or severe hypertension 1
Be aware that repeated injections can suppress the hypothalamic-pituitary-adrenal axis 1
Facial and intertriginous areas carry higher risk for developing adverse effects, requiring more conservative dosing strategies 1