Triamcinolone Acetonide (Intralesional — Keloid/Scar)

How it works

Within the scar it suppresses fibroblast proliferation and collagen synthesis, increases collagen breakdown and dampens local inflammation, reducing the excessive extracellular matrix that characterises keloid.

Prescribing in practice

• Inject precisely into the scar substance and avoid the surrounding normal dermis and subcutis, as misplaced or excessive injection commonly causes skin atrophy, telangiectasia and hypopigmentation.
• It is frequently combined with other modalities such as pressure, silicone or cryotherapy, and repeated courses are usually needed at intervals.
• Do not inject into infected skin, and use caution over very large lesions where cumulative steroid load and local adverse effects increase.

Monitoring

Monitor the treated scar for thinning, depigmentation or telangiectasia and assess response over successive treatment sessions.

Counselling the patient

• The injection is given into the scar itself to flatten and soften it, and several sessions are often required.
• The skin over and around the scar may thin, lighten or develop fine vessels.
• Report any signs of infection or unexpected skin changes at the site.

Evidence & guidelines

Intralesional corticosteroid is a long-established first-line treatment for keloid and hypertrophic scars in plastic surgery practice.