From the FDA Drug Label
C FOR INTRALESIONAL ADMINISTRATION DEPO-MEDROL is indicated for intralesional use in alopecia areata, discoid lupus erythematosus, keloids, localized hypertrophic, infiltrated, inflammatory lesions of granuloma annulare, lichen planus, lichen simplex chronicus (neurodermatitis), and psoriatic plaques, necrobiosis lipoidica diabeticorum. In intralesional treatment, 0. 2 mL/cm2 of Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension is injected intradermally (not subcutaneously) using a tuberculin syringe with a 25-gauge, 1/2-inch needle.
Alternative Steroids for Intralesional Use:
- Methylprednisolone (DEPO-MEDROL): can be used for intralesional injection in various dermatologic conditions, including alopecia areata, discoid lupus erythematosus, and psoriatic plaques 1.
- Betamethasone (Betamethasone Sodium Phosphate and Betamethasone Acetate Injectable Suspension): can be used for intralesional treatment of dermatologic conditions, with a recommended dose of 0.2 mL/cm2 injected intradermally 2.
From the Research
Triamcinolone acetonide is the recommended alternative steroid for intralesional use in dermatology following the unavailability of Kenalog and Adcortyl. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of effective treatment for keloids and hypertrophic scars 3. The study highlights the need for a multimodal approach to keloid management, and intralesional steroid injection is a commonly used treatment option.
Key Considerations for Triamcinolone Acetonide Use
- Typically used at concentrations of 5-10 mg/ml for most dermatological conditions
- Can be administered at 2.5-5 mg/ml for facial lesions and up to 40 mg/ml for hypertrophic scars and keloids
- The usual injection volume ranges from 0.1-0.5 ml per site, with a maximum of 20 mg per session
- Injections can be repeated every 3-4 weeks as needed
Mechanism of Action and Efficacy
Triamcinolone works by suppressing inflammation, reducing cell proliferation, and inhibiting collagen synthesis, making it effective for conditions like keloids, hypertrophic scars, alopecia areata, and psoriatic plaques. The medication should be injected into the mid to deep dermis using a 27-30 gauge needle, with proper aseptic technique to minimize complications.
Potential Side Effects
Side effects may include skin atrophy, hypopigmentation, and telangiectasia, particularly with higher concentrations. It is essential to weigh the benefits and risks of treatment and to closely monitor patients for any adverse effects.
Clinical Decision Making
The choice of treatment for keloids and hypertrophic scars should be based on individual patient needs and circumstances. A comprehensive review of the literature, including recent studies such as the one published in 2021 3, can provide valuable guidance for clinicians in making informed treatment decisions.