Keloid Treatment with Kenalog Injection: Dosing and Frequency
For a 5x6x3 mm earlobe keloid, inject triamcinolone acetonide 40 mg/mL concentration at a dose of approximately 0.6-0.9 mg total (0.015-0.023 mL volume), repeated every 3-4 weeks until the keloid flattens. 1
Concentration Selection
- Use 40 mg/mL concentration specifically for keloids and hypertrophic scars, as this is the standard recommended concentration that differs from other dermatologic conditions 2, 1
- Lower concentrations (10-20 mg/mL) may be considered for facial keloids or areas at higher risk for atrophy, though the earlobe tolerates higher concentrations well 1
Dose Calculation for Your Specific Keloid
- The volume of your keloid is approximately 90 mm³ (5×6×3 mm)
- Target 1.2-2.0 mg of triamcinolone per mm³ of keloid tissue based on effective treatment protocols 3
- This translates to approximately 0.6-0.9 mg total dose for your 90 mm³ keloid
- Using 40 mg/mL concentration, inject 0.015-0.023 mL total volume 3
Injection Technique
- Inject just beneath the dermis in the upper subcutis, not into the keloid substance itself 1
- Distribute the volume across 2-3 injection sites within the keloid (approximately 0.05-0.1 mL per site produces therapeutic effect in a 0.5 cm diameter area) 2, 1
- The goal is to blanch the keloid tissue without causing excessive distension 1
Treatment Frequency and Duration
- Repeat injections every 3-4 weeks until the keloid flattens or symptoms resolve 2, 1
- Most earlobe keloids require 3-5 injections for adequate response 4, 3
- Research shows that 2-13 injections may be needed depending on clinical progress, with a mean of 5.2 injections 4
Pain Management
- Apply EMLA cream (lidocaine/prilocaine) 30-60 minutes before injection to minimize discomfort 1
- The small size of your keloid makes topical anesthesia sufficient without need for sedation 1
Expected Outcomes and Monitoring
- Response rates range from 50-100% regression with intralesional corticosteroid alone 5
- Monitor for local adverse effects including skin atrophy, pigmentary changes, and telangiectasias, which are dose-dependent and more likely with repeated injections 2, 1
- Recurrence rates are 33% at 1 year and 50% at 5 years with corticosteroid injection alone 5
Critical Pitfalls to Avoid
- Do not inject into subcutaneous fat or too superficially into the dermis itself—target the upper subcutis just beneath the dermis 1
- Do not exceed 150 mg total dose per treatment session (not a concern with your small keloid) 2
- Avoid injecting if there is active infection at the site 2, 1
- Do not use concentrations lower than 20 mg/mL for earlobe keloids, as 10 mg/mL has shown poor involution rates 3