Intralesional Steroid Injections (Triamcinolone)

How it works

Triamcinolone is a potent long-acting corticosteroid that does three things simultaneously when deposited inside a keloid. First, it suppresses the hyperactive fibroblasts that drive collagen overproduction, the core mechanism of keloid growth. Second, it down-regulates TGF-β1 signalling and up-regulates collagenase, which means less new scar tissue is laid down and some of the existing excess collagen is actively broken down. Third, it calms the local inflammatory environment — reducing the itching, tenderness, and burning sensation that many keloid patients find just as disabling as the visible scar. The effect is cumulative across multiple sessions, which is why protocols run 3-6 injections rather than one. It does not remove the scar — it shrinks and softens it — and combining with cryotherapy (to soften dense tissue first) or 5-FU (to add anti-proliferative action) generally outperforms triamcinolone alone.

MechanismSchematic cross-section

1. 1Direct delivery. A fine needle places triamcinolone inside the dense scar core where oral or topical drugs can’t reach.
2. 2Fibroblast suppression. The steroid inhibits fibroblast proliferation and collagen synthesis while calming local inflammation.
3. 3Gradual flattening. Repeated sessions every 4–8 weeks reduce scar height, itch, and tenderness over 3–6 months.

Typical protocol

Every 4-8 weeks for 3-6 sessions. Concentrations commonly range from 10 to 40 mg/mL, adjusted by scar thickness and location.

Time to results

Softening often within 4-6 weeks; visible flattening over 3-6 months.

Accessibility

widely available

Recurrence

20-50% when used alone; lower when combined with surgery or 5-FU

Insurance

often

Best for

• • Small to medium keloids
• • Ear keloids (lobe and cartilage)
• • Symptomatic keloids (itching, tenderness)
• • First-line treatment before considering surgery

Limitations to know

Combining with other treatments

Triamcinolone is the workhorse of keloid care and pairs well with almost every other modality. Post-excision steroid protocols (starting 2-4 weeks after surgery, continuing every 4-6 weeks for 6-12 months) are one of the most reliable ways to reduce surgical recurrence. Cryo-assisted steroid injection uses a brief contact freeze just before the needle goes in, which softens dense tissue and lets the drug disperse more evenly — this often allows a lower steroid dose with less atrophy risk. Combination with 5-fluorouracil (the 9:1 5-FU/triamcinolone mix) outperforms plain steroid on flattening and itch in randomized trials, and reduces steroid-related side effects because less steroid is needed overall. Silicone sheeting and red-light therapy are commonly layered on as daily background care between injection visits.