What is the recommended dose of triamcinolone (corticosteroid) for treating hypertrophic scars?

Triamcinolone Dosing for Hypertrophic Scars

For hypertrophic scars, intralesional triamcinolone acetonide should be injected at a concentration of 10-20 mg/mL, with 0.05-0.1 mL per injection site, repeated every 2-4 weeks until clinical improvement is achieved. 1, 2

Recommended Dosing Protocol

Concentration and Volume

• Use triamcinolone acetonide at 10-20 mg/mL concentration for intralesional injection into hypertrophic scars 1
• Inject 0.05-0.1 mL per injection site, which produces therapeutic effect in the target area 1
• The injection should be administered just beneath the dermis in the upper subcutis of the affected area 1

Treatment Schedule

• Repeat injections every 2-4 weeks based on clinical response 3
• Most lesions respond within 3 months of therapy, and treatment should be changed if substantial improvement has not occurred after a complete course 4
• Continue treatment until adequate flattening and softening of the scar is achieved 5, 3

Evidence-Based Dosing Ranges

Standard Monotherapy

• 10 mg/mL concentration has been validated in multiple clinical trials as effective for hypertrophic scars 6
• 20 mg/mL concentration showed superior efficacy in recent comparative studies 3
• The FDA label indicates that for local injections, doses up to 10 mg for smaller areas and up to 40 mg for larger areas have usually been sufficient 7

Combination Therapy (Superior Outcomes)

Recent high-quality evidence demonstrates that combination therapy produces significantly better results than triamcinolone alone:

• Triamcinolone (20 mg/mL) + 5-fluorouracil (25 mg/mL) showed ≥50% height reduction and faster response rates with fewer complications compared to triamcinolone alone 3
• A 2018 study using triamcinolone + verapamil demonstrated significant improvement in scar relief, pain, itchiness, and surface area with long-term stable results 5
• The triple combination of triamcinolone (10 mg/mL) + 5-FU + pulsed-dye laser achieved 70-75% good-to-excellent patient-reported outcomes versus only 20% with triamcinolone alone 6

Critical Safety Considerations

Adverse Effects to Monitor

• Skin atrophy at injection sites is the most consistent side effect of intralesional triamcinolone therapy 1, 2
• Local complications may include fat and/or dermal atrophy and pigmentary changes 4
• Adrenal suppression can occur when large doses (>4 mg/kg) are administered 4

Injection Technique Precautions

• Strict aseptic technique is mandatory to avoid introducing infection 7
• Inject into the dermis/upper subcutis, not into subcutaneous fat, as improper injection depth causes fat atrophy 7
• Avoid high injection pressures and volumes to prevent vascular complications 4
• Apply sparingly and monitor closely when treating sensitive areas 1

Practical Algorithm for Treatment Selection

Start with combination therapy for optimal outcomes:

1. First-line approach: Triamcinolone 20 mg/mL + 5-fluorouracil 25 mg/mL every 2 weeks for 8-10 weeks 3

   • This provides faster response, better efficacy, and fewer complications than monotherapy

2. Alternative combination: Triamcinolone 10 mg/mL + 5-FU + pulsed-dye laser at weeks 1,4, and 8 6

   • Best for erythematous scars requiring pigment lightening

3. Monotherapy option: Triamcinolone 10-20 mg/mL alone every 2-4 weeks 1, 3

   • Reserve for patients who cannot access combination therapy or have contraindications

Dose-Dependent Response

Research demonstrates that triamcinolone suppresses scar formation in a dose-dependent manner, with higher concentrations producing greater reduction in collagen expression (COL1, COL3) and α-SMA levels in hypertrophic scar tissue 8. This mechanistic evidence supports using adequate concentrations (10-20 mg/mL) rather than underdosing.