What are the side effects of kenalog?

Question

What are the side effects of kenalog when injected to treat scar tissue? I'm most concerned with general health problems, not merely the aesthetic ramifications.

James Knoetgen, III, MD · Answer

Kenalog (triamcinolone acetonide) is a corticosteroid that can have systemic side effects, especially when injected repeatedly or in high doses. When used for scar treatment, most concerns involve localized effects, but systemic effects are possible depending on absorption and individual sensitivity.
General Health Side Effects of Kenalog Injections:
1.	Hormonal & Metabolic Effects
o	Adrenal Suppression: Long-term or frequent use can suppress the body's natural steroid production, leading to adrenal insufficiency.
o	Cushing’s Syndrome: Prolonged steroid use may cause weight gain, moon face, thinning skin, and high blood sugar.
o	Increased Blood Sugar: Can worsen diabetes or induce temporary hyperglycemia.
2.	Immune System Suppression
o	Increased Infection Risk: Corticosteroids can weaken the immune system, making you more susceptible to infections.
o	Delayed Wound Healing: Slows the body's ability to heal tissue.
3.	Neurological & Psychological Effects
o	Mood Changes: Anxiety, depression, irritability, or mood swings (commonly called "steroid rage").
o	Insomnia: Some people experience difficulty sleeping after steroid injections.
o	Headaches & Dizziness
4.	Gastrointestinal Issues
o	Ulcers & Stomach Irritation: Increased risk of gastritis or peptic ulcers, especially when combined with NSAIDs.
o	Nausea & Vomiting
5.	Cardiovascular Effects
o	High Blood Pressure: Can cause or worsen hypertension.
o	Fluid Retention: May lead to swelling in the hands and feet.
6.	Bone & Muscle Effects
o	Osteoporosis: Chronic use can weaken bones and increase fracture risk.
o	Muscle Weakness or Atrophy
Local Side Effects (at Injection Site)
•	Skin Atrophy (Thinning of Skin)
•	Hypopigmentation or Hyperpigmentation
•	Fat Atrophy (Dents or Depressions in the Skin)
•	Localized Pain or Swelling
If you are considering a Kenalog injection for scar tissue, it's crucial to weigh these risks with your doctor, especially if you have a history of diabetes, hypertension, or immune conditions.

Jose Leon, MD · Answer

Hello, thank you for your question. Kenalog, or its generic name triamcinolone, is a medium to strong corticosteroid, it would have the side effects of any corticosteroid when used chronically, but for scars usually one to three sessions is enough so you should not see any health side effects. 
Because of the aesthetic side effects with discoloration, and how it consumes deep tissue to the applied scar, I have recently switched to PB Serum

Mats Hagstrom, MD (license on probation) · Answer

Anti-inflammatory steroids can decrease inflammation, which is part of scar tissue formation during early healing.
Steroid injections can slow down the inflammatory process stopping the body from making excessive amounts of scar tissue in individuals who are prone to form excessive scar tissue. This is usually more of an issue for how the skin heals with hypertrophic or keloid scar formation, which is not related to excessive scar tissue formation internally. 
I think the first thing you should assess is if scar tissue is truly the problem or if that’s just some term that’s being used loosely to justify less than ideal outcomes.
For “skin scars” widening of the scar it’s probably the most common undesirable side effect Of steroid injections.
For deeper injections, the development of fat atrophy is probably the biggest risk.
Fat atrophy is fairly uncommon but when it happens, it can be devastating.
First and foremost, make sure that steroid injections are clearly indicated.
It doesn’t make sense to inject Kenalog if the problem is that you still have residual glandular tissue for example. 
Without pictures, we can’t begin to make an assessment.
The great majority of patients who get Kenalog injections do not have negative side effects.
Steroid injections can take time and continue working for months after the treatment.
I’m generally apprehensive about doing repeat injections in short time intervals.
If you’re unhappy with your outcome, then consider getting a second opinion.
Any time we contemplate a treatment the first thing we should ask ourselves is if we have a clear understanding of what the problem is.
When patients are unhappy with surgical outcomes, it is sometimes related to not understanding the primary problem.
Best,
Mats Hagstrom MD

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