Intralesional Triamcinolone Acetonide for Dermatologic Conditions: Dosing and Availability
For dermatologic conditions, use triamcinolone acetonide at concentrations of 5-10 mg/mL for most inflammatory conditions and alopecia areata, or 40 mg/mL for keloids and hypertrophic scars, with injections administered every 3-4 weeks. 1, 2
Condition-Specific Dosing
Alopecia Areata
- Use 5-10 mg/mL concentration injected just beneath the dermis in the upper subcutis 3
- Inject 0.05-0.1 mL per site, producing hair regrowth in approximately 0.5 cm diameter area 3
- Multiple injections can be given at one session, with the main limitation being patient discomfort 3
- Expect response in 62% of patients with monthly injections, with better outcomes in those having fewer than five patches of <3 cm diameter 3
Keloids and Hypertrophic Scars
- Use 40 mg/mL concentration for optimal efficacy 1, 2
- For facial keloids or high-risk areas, reduce to 5-10 mg/mL to minimize atrophy risk 1
- Inject just beneath the dermis in the upper subcutis, not into the keloid substance itself 1
- Repeat every 3-4 weeks until the keloid flattens or symptoms resolve 1
- Important caveat: Higher concentrations (20-40 mg/mL) carry significantly increased risk of skin atrophy and telangiectasia compared to lower concentrations or alternative agents like 5-FU 4
Nodular Acne
- Use 10 mg/mL concentration, which may be diluted with sterile normal saline to 5 or 3.3 mg/mL 2
- Administer every 3-4 weeks as needed 2
Psoriasis (Localized Plaques)
- Use up to 20 mg/mL concentration every 3-4 weeks 2
- For small plaques on trunk and limbs, 2.5 mg/mL is safe and virtually 100% effective 5
- Injection volume varies based on lesion size 2
Localized Dermatitis (Lichen Simplex Chronicus, Prurigo Nodularis)
- Use 2.5 mg/mL concentration for highly effective results 5
Administration Technique
- Always inject just beneath the dermis in the upper subcutis, never into subcutaneous fat or deeper structures 3, 1
- Use 0.05-0.1 mL per injection site for localized effect 3, 2
- For multiple sites, total dose can safely reach 15-20 mg (6-8 cc at 2.5 mg/mL) every 3-4 weeks in patients over 50 kg 5
- Maximum dose per injection session should not exceed 150 mg 2
Critical Safety Considerations
Absolute Contraindications
- Active infection at injection site (impetigo, herpes) 2
- Previous hypersensitivity to triamcinolone 2, 6
- Active tuberculosis or systemic fungal infections 2
High-Risk Situations Requiring Caution
- Uncontrolled diabetes, heart failure, or severe hypertension 1, 2
- Facial or intertriginous areas (higher risk for adverse effects) 2
- Periorbital injections (historical reports of blindness with older products and high-pressure injections) 5
Common Adverse Effects
- Skin atrophy is the most consistent side effect, particularly with triamcinolone and higher concentrations 3, 4
- Pigmentary changes and telangiectasias are dose-dependent 2
- Repeated injections can suppress the hypothalamic-pituitary-adrenal axis 2
- Anaphylaxis is rare but documented, even after years of uneventful use 6
Availability in the Philippines
Triamcinolone acetonide (commonly branded as Kenacort) is widely available in the Philippines through:
- Hospital pharmacies
- Dermatology clinics
- Major pharmaceutical distributors
The medication typically comes in vials of 40 mg/mL, which can be diluted with sterile normal saline to achieve lower concentrations (10 mg/mL, 5 mg/mL, or 2.5 mg/mL) as needed for specific conditions 2, 5
Evidence Quality Considerations
The strongest evidence supports combination therapy over monotherapy for keloids: TAC combined with 5-FU shows superior long-term results compared to TAC alone, with better improvement in scar height, pliability, and pigmentation, though this combination approach requires careful consideration of the increased complexity 4. For alopecia areata, intralesional corticosteroids have Grade B recommendation strength despite Grade III evidence quality, reflecting widespread clinical experience despite limited controlled trials 3.