Can Kenalog cream (triamcinolone acetonide) be used to treat an active skin infection?

Kenalog Cream Should NOT Be Used for Active Skin Infections

Do not apply Kenalog cream (triamcinolone acetonide) to actively infected skin without concurrent antimicrobial therapy, as topical corticosteroids can mask infection symptoms, suppress local immune responses, and potentially worsen the infection. 1

Why Topical Steroids Are Contraindicated in Active Infection

Topical corticosteroids like triamcinolone acetonide suppress the local inflammatory response that is essential for fighting infection. The evidence clearly demonstrates several critical concerns:

• Risk of infection progression: When skin infections are present (bacterial, viral, or fungal), topical steroids may facilitate worsening by suppressing the immune response needed to clear pathogens. 2

• Masking of infection symptoms: Steroids reduce erythema, warmth, and other inflammatory signs, making it difficult to recognize worsening infection or treatment failure. 1

• Specific infection risks: Topical steroids may exacerbate conditions like tinea infections, folliculitis, impetigo, herpes simplex, and other cutaneous infections. 1

When Infection Is Suspected or Confirmed

If you suspect an active skin infection, the appropriate management algorithm is:

1. Obtain bacterial/viral/fungal cultures to identify the causative organism 2

2. Initiate appropriate antimicrobial therapy based on the suspected or confirmed pathogen:

   • For bacterial infections (especially Staphylococcus aureus): Start oral antibiotics such as flucloxacillin, or topical antibiotics for localized infection 2, 3
   • For fungal infections: Use appropriate antifungal agents
   • For viral infections: Consider antiviral therapy if indicated

3. Only after infection is controlled or concurrently with antimicrobial therapy should topical corticosteroids be considered, if there is an underlying inflammatory component requiring treatment 1

Special Considerations for Secondarily Infected Inflammatory Conditions

In cases where an inflammatory dermatosis (like eczema) becomes secondarily infected:

• Bacterial swabs should be taken and calculated anti-infective treatment started immediately 2

• Combination therapy with both antimicrobials and topical steroids may be appropriate, but the antimicrobial component must be adequate to treat the infection 3

• For superadded infection in eczema, add topical or oral antibiotics (such as flucloxacillin for S. aureus) while continuing appropriate anti-inflammatory treatment 3

Critical Safety Warning

The guidelines explicitly state that topical steroids should be used "only under the supervision of a dermatologist, as unwanted side-effects may occur if used inadequately." 2 This is particularly important when infection is a concern, as inappropriate steroid use can lead to:

• Perioral dermatitis 2
• Skin atrophy 2
• Worsening of existing infections 1
• Development of steroid-resistant organisms

The bottom line: Treat the infection first with appropriate antimicrobials, then consider adding topical corticosteroids only if there is a concurrent inflammatory component that requires treatment, and only under appropriate medical supervision.