Intradermal triamcinolone acetonide (specifically formulations like Kenalog-10) is preferred over other Kenalog formulations for skin lesions mainly because it is formulated for safe, localized intralesional (intradermal) injection. This allows direct delivery of the corticosteroid into the lesion for maximum anti-inflammatory effect with minimal systemic absorption and side effects.

Key reasons for preference include:

Formulation suitability 

  • Kenalog-10 (10 mg/mL) is designed as an aqueous suspension safe for intralesional use in skin lesions such as keloids, hypertrophic scars, and inflammatory dermatoses. Higher-concentration Kenalog-40 or Kenalog-80 contain preservatives and excipients inappropriate for intradermal injection and can cause adverse effects like skin atrophy or tissue damage if injected into the dermis.

Targeted anti-inflammatory effect

  • Intralesional injection delivers the corticosteroid directly to the site of inflammation within or just below the skin, providing a concentrated local effect, reducing inflammation, collagen formation, and fibroblast activity. This leads to more effective lesion flattening and symptom relief than topical or systemic steroids.

Reduced systemic side effects

  • By concentrating the drug locally, intradermal triamcinolone minimizes systemic absorption and thus the risks associated with systemic corticosteroids, such as Cushing's syndrome or osteoporosis.

Lower risk of adverse effects with correct dosing

  • Using appropriate concentrations and volumes reduces the incidence of hypopigmentation, skin atrophy, or localized tissue loss. Dermatologists often use low volumes (e.g., 0.05 mL) of diluted triamcinolone and shallow intradermal techniques to minimize side effects.

Rapid and effective response

  • Intralesional triamcinolone injections can flatten lesions and reduce inflammation within days, providing quicker relief for conditions like cystic acne, keloids, or hypertrophic scars compared to topical treatments.

In contrast, Kenalog formulations intended for intramuscular or intra-articular injection (Kenalog-40/80) are not recommended for intradermal use because they may cause skin damage due to their excipients and concentration.

Therefore, when treating skin lesions, dermatologists prefer an intradermal formulation of triamcinolone acetonide (such as Kenalog-10) because it balances efficacy and safety by being formulated and administered specifically for that purpose.