Keloid Injection Treatment
For keloid treatment, intralesional triamcinolone acetonide 40 mg/mL is the recommended first-line therapy, administered every 3-4 weeks until the lesion resolves or up to 24 weeks. 1
Recommended Dosing Protocol
The American Academy of Dermatology specifically recommends triamcinolone acetonide 40 mg/mL concentration for hypertrophic scars and keloids. 1 This is notably higher than concentrations used for other dermatologic conditions (such as 10 mg/mL for acne keloidalis or 5-10 mg/mL for alopecia areata). 1
Administration Details
- Inject just beneath the dermis in the upper subcutis for optimal keloid penetration 1
- Repeat injections every 3-4 weeks as needed until resolution or up to 24 weeks 1, 2
- Treatment response typically shows 50-100% regression with monotherapy, though recurrence occurs in 33% at 1 year and 50% at 5 years 3
Expected Clinical Response
The efficacy of triamcinolone alone is well-established but variable:
- Response rates range from 50-100% regression with intralesional corticosteroid monotherapy 3
- Improvement in height, vascularity, and pliability occurs progressively with successive treatments 2
- Vascularity decreases significantly with triamcinolone treatment, as demonstrated by spectral imaging 4
- Fibroblast proliferation decreases, contributing to scar flattening 4
Combination Therapy Considerations
When triamcinolone monotherapy proves insufficient, combination approaches offer superior outcomes:
Triamcinolone + 5-Fluorouracil (5-FU)
The combination of triamcinolone and 5-FU is more effective than either agent alone and produces fewer adverse effects compared to monotherapy. 3, 2 This combination offers:
- Faster response rates with balanced efficacy across multiple scar parameters 2
- Reduced adverse effects compared to triamcinolone alone 2
- Comparable or superior clinical outcomes to monotherapy 3, 2
Triamcinolone + Bleomycin
For refractory keloids that have failed standard triamcinolone therapy:
- A mixture of bleomycin (1 u/cc) with triamcinolone acetonide (13.3 mg/cc) administered every 4-6 weeks for up to 6 cycles showed 78.8% excellent response (75-100% flattening) in resistant keloids 5
- This combination is specifically indicated for keloids that have not responded to traditional triamcinolone therapy 5
Critical Adverse Effects to Monitor
Local adverse effects are dose-dependent and occur more frequently with triamcinolone than alternative agents:
- Skin atrophy occurs in 44% of patients treated with triamcinolone versus 8% with 5-FU 4
- Telangiectasias develop in 50% of patients with triamcinolone versus 21% with 5-FU 4
- Pigmentary changes (both hyper- and hypopigmentation) occur commonly 2, 5, 6
- Pain at injection site is expected but typically resolves 6
Absolute Contraindications
Do not inject triamcinolone in the following situations:
- Active infection at the injection site (impetigo, herpes) 1
- Previous hypersensitivity to triamcinolone 1
- Active tuberculosis or systemic fungal infections (for large injection volumes) 1
Special Precautions
Exercise caution in patients with:
- Uncontrolled diabetes, heart failure, or severe hypertension 1
- Facial or intertriginous keloids, which carry higher risk for adverse effects 1
- Large or diffuse keloids, where even distribution is difficult and systemic absorption risk increases 7
When to Consider Alternative or Combination Therapy
Switch from monotherapy to combination treatment if:
- No response after several treatment cycles (typically 3-4 injections over 12 weeks) 2
- Keloid proves refractory to standard triamcinolone dosing 5
- Patient develops significant adverse effects limiting continued monotherapy 4
- Cosmetically sensitive areas require minimizing atrophy and telangiectasia risk 4