What is the recommended dose of triamcinolone acetonide (steroid) for an injection in a primary care physician (PCP) office?

Recommended Triamcinolone Acetonide Dosing for Primary Care Office Injections

For most primary care office steroid injections, use triamcinolone acetonide 40 mg for large joints (shoulder, knee), 20-40 mg for medium joints, and 5-10 mg/mL for dermatologic/soft tissue injections, with specific dosing determined by the anatomic site and clinical indication. 1, 2

Joint Injections

Large Joints (Knee, Shoulder)

• Administer 40 mg triamcinolone acetonide for large joint injections 1, 2
• For knee osteoarthritis specifically, 10 mg is non-inferior to 40 mg for pain relief, but 40 mg remains the standard guideline-recommended dose 3
• For shoulder capsulitis/adhesive capsulitis, 40 mg provides significantly greater symptom relief than 10 mg 4
• For severe adhesive capsulitis with intense pain (NRS ≥8), 20 mg is sufficient and may be preferred to minimize side effects 5

Medium Joints

• Use 20-40 mg total dose depending on joint size 1, 2
• For acute gout involving 1-2 joints, intra-articular corticosteroids are recommended with dose depending on joint size 6

Acute Gout (NPO Patient Alternative)

• Intramuscular methylprednisolone 0.5-2.0 mg/kg is recommended when intra-articular injection is not feasible 6
• Intramuscular triamcinolone acetonide monotherapy did not achieve consensus recommendation for NPO patients with acute gout 6

Soft Tissue and Bursa Injections

Pes Anserine Bursa

• Inject 20-40 mg total dose using 0.05-0.1 mL per injection site 1, 2
• Administer just beneath the dermis in the upper subcutis 1

Dermatologic/Intralesional Injections

Acne and Inflammatory Lesions

• Use triamcinolone acetonide 10 mg/mL for nodular acne, which may be diluted to 5 or 3.3 mg/mL 1
• For inflammatory nodulocystic acne, intralesional treatment flattens most nodules within 48-72 hours 2
• For acne keloidalis, use 10 mg/mL for inflammatory follicular lesions 1

Keloids and Hypertrophic Scars

• Administer triamcinolone acetonide 40 mg/mL 1
• Inject just beneath the dermis in the upper subcutis 1

Psoriasis Plaques

• Use triamcinolone acetonide up to 20 mg/mL every 3-4 weeks 1
• Injection volume varies based on lesion size 1

Alopecia Areata

• Inject triamcinolone acetonide 5-10 mg/mL into affected areas 2, 7

Palm/Hand Lesions

• Use triamcinolone acetonide 5-10 mg/mL with 0.05-0.1 mL per injection site 1
• This translates to 0.25-1 mg per injection site 1

Nail Psoriasis

• Administer intralesional triamcinolone acetonide 5-10 mg/mL affecting the nail matrix 2, 7

Critical Safety Considerations and Contraindications

Absolute Contraindications

• Do not inject at sites with active infection (impetigo, herpes) 1, 2
• Avoid in patients with previous hypersensitivity to triamcinolone 1, 2
• Do not use large injections in patients with active tuberculosis or systemic fungal infections 1, 2

Relative Contraindications and Cautions

• Exercise caution in patients with uncontrolled diabetes, heart failure, or severe hypertension 1, 2
• Facial and intertriginous areas carry higher risk for adverse effects and require more conservative dosing 1, 7

Local Adverse Effects to Monitor

• Watch for skin atrophy, pigmentary changes, telangiectasias, and hypertrichosis 1, 7
• Skin atrophy is a consistent side effect of intralesional corticosteroid therapy, particularly with triamcinolone 1, 7
• Be aware that repeated injections can suppress the hypothalamic-pituitary-adrenal axis 1

Administration Frequency

• For most dermatologic conditions, administer every 3-4 weeks as needed 1
• For acute gout, a single intra-articular injection is often sufficient 1
• Maximum dose per injection site should not exceed 150 mg 1

Clinical Pearls

• For knee arthritis, while 10 mg is non-inferior to 40 mg for pain relief at 12 weeks, the 40 mg dose remains the guideline standard 3
• When treating shoulder conditions, 40 mg provides superior pain and sleep disturbance relief compared to 10 mg, though range of motion improvement is similar 4
• Facial applications require particular caution due to thinner skin and higher atrophy risk 1, 7
• Apply sparingly to skin folds and intertriginous areas to minimize atrophy risk 7