Intralesional Triamcinolone Dosing for Hypertrophic Lesions
For hypertrophic scars and keloids, use triamcinolone acetonide at 40 mg/mL concentration, injecting just beneath the dermis in the upper subcutis, with 0.05-0.1 mL per injection site. 1, 2
Concentration Selection Based on Lesion Type
Hypertrophic scars and keloids require the highest concentration available:
- Use 40 mg/mL triamcinolone acetonide for hypertrophic scars and keloids, which is notably higher than concentrations used for other dermatologic conditions 1, 2
- For facial keloids or areas at higher risk for atrophy, consider lower concentrations of 5-10 mg/mL to minimize skin atrophy risk 2
- Small lipomas (1-3 cm) respond to 40 mg total dose, while larger lipomas (4-6 cm) may require 80 mg total dose 3
Injection Technique and Volume
Proper injection depth is critical to avoid complications:
- Inject just beneath the dermis in the upper subcutis, not into the keloid substance itself 1, 2
- Use 0.05-0.1 mL per injection site, which produces therapeutic effect in approximately 0.5 cm diameter area 1, 2
- Maximum safe dose is 150 mg per injection session 1
Treatment Protocol and Frequency
Repeat injections are necessary for optimal outcomes:
- Administer injections every 3-4 weeks until the lesion flattens or symptoms resolve 2
- Research demonstrates that 96.7% of patients achieve complete resolution of itching symptoms and 75% achieve complete pain resolution after 24 weeks of treatment 4
- One study using 10 mg/mL concentration weekly for 8 weeks showed only 20% good-to-excellent improvement, while combination therapy achieved better results 5
Evidence-Based Outcomes
The concentration matters significantly for efficacy:
- A 2006 randomized trial showed that 10 mg/mL triamcinolone alone produced good-to-excellent improvement in only 20% of patients with keloids and hypertrophic scars 5
- When combined with 5-fluorouracil, the same 10 mg/mL concentration improved outcomes to 55% 5
- A 2023 study using intralesional triamcinolone demonstrated mean Vancouver Scar Scale improvement from 6.55 to 2.55 after 24 weeks 4
- Dose-dependent suppression of scar formation has been mechanistically demonstrated, with higher concentrations producing better outcomes 6
Critical Safety Considerations
Avoid these common pitfalls:
- Never inject into tendon substance or deep subcutaneous fat—always target the upper subcutis just beneath the dermis 2
- Facial and intertriginous areas carry higher risk for atrophy, telangiectasias, and pigmentary changes 1
- Atrophy and telangiectasia occurred in 37% of patients receiving triamcinolone alone in one study 5
- Use lower concentrations (10-20 mg/mL instead of 40 mg/mL) when treating facial keloids to minimize atrophy risk 2
Absolute Contraindications
Do not inject triamcinolone in the following situations:
- Active infection at injection site 1, 2
- Previous hypersensitivity to triamcinolone 1, 2
- Active tuberculosis or systemic fungal infections (for large injections) 1, 2
Special Precautions
Exercise caution in these clinical scenarios:
- Uncontrolled diabetes, heart failure, or severe hypertension 1, 2
- Large or diffuse lesions where even distribution is difficult and systemic absorption risk increases 7, 2
- Relatively flat or superficial lesions carry increased risk of local complications 7
Monitoring for Adverse Effects
Watch for these dose-dependent complications:
- Local adverse effects include skin atrophy, pigmentary changes, telangiectasias, and hypertrichosis, which occur with repeated injections 1
- Repeated injections can suppress the hypothalamic-pituitary-adrenal axis 1
- Minor hypopigmentation occurred in 25% of patients at 4-month follow-up in one lipoma study 3
- At 24 weeks, one study reported 3.75% skin shrinkage, 3.75% depigmentation, and 13.75% vasodilation 4