- What are Kenalog injections used for?
- How do Kenalog injections work?
- How is a Kenalog injection given?
- What should I know about Kenalog injections?
- Who shouldn’t have Kenalog injections?
- Who might need a lower dose or extra monitoring?
- Can I have Kenalog injections while pregnant or breastfeeding?
- What are the possible side effects of Kenalog injections?
- Can I use other medicines with Kenalog injections?
- The Healing Process: Cast & Swelling
- I am exactly eight weeks after my rhinoplasty and it still looks like I have a lot of swelling; is that normal?
- Why did my nose change after the splint came off one week after rhinoplasty?
- How long should a cast stay on after a rhinoplasty?
- A dorsal on-lay graft was placed in my nose and I was wondering if it could be removed?
- How long does it take for Kenalog injections to work inside the nose?
- What Is Kenalog Scar Treatment?
- How long does Kenalog stay in your system?
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What are Kenalog injections used for?
Kenalog injection can be given by injection directly into a joint, or the soft tissue around a joint, to reduce inflammation and pain caused by:
- Rheumatoid arthritis or osteoarthritis.
- Tennis elbow, tenosynovitis, or bursitis.
Kenalog injection can also be given into a muscle to have a long-lasting effect on various inflammatory conditions that affect different areas of the body. The injection suppresses part of your immune system and reduces inflammation in conditions such as:
- Allergies such as severe asthma or hayfever.
- Inflammatory or allergic skin disorders, eg pemphigus, severe dermatitis, or Stevens Johnson Syndrome.
- Rheumatoid arthritis.
- Inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis.
- Inflammatory autoimmune disease called systemic lupus erythematosus.
- Kidney disease such as acute interstitial nephritis, minimal change nephrotic syndrome or lupus nephritis.
- Anaemia caused by the immune system attacking red blood cells (autoimmune haemolytic anaemia).
- Cancer of the lymph nodes (lymphoma).
How do Kenalog injections work?
Kenalog injection contains the active ingredient triamcinolone, which is a type of medicine called a corticosteroid.
Corticosteroids are hormones that are produced naturally by the adrenal glands. They have many important functions in the body, including control of inflammatory responses. Triamcinolone reduces inflammation by stopping cells from releasing chemicals that normally help produce immune and allergic responses. This can help control a wide number of disease states involving excessive inflammation, including severe allergic reactions, inflammation of the lungs in asthma and inflammation of the joints in arthritis.
Triamcinolone also decreases the numbers of white blood cells circulating in the blood and both actions make it useful for treating autoimmune diseases caused by the immune system attacking the body’s own tissues, as well as for treating certain types of blood cancer.
Corticosteroids have many important functions on every organ system. If the body’s natural level of steroid hormones is too low because the adrenal glands are not producing enough hormones, this must be treated with replacement therapy to allow the body to function normally. Triamcinolone can also be used for this purpose, although other corticosteroids are usually preferred.
How is a Kenalog injection given?
- Kenalog injection is given directly into inflamed soft tissue, for example in tennis elbow, or directly into a joint, for example in arthritis, to decrease inflammation and pain in that particular localised area, and increase mobility of the affected joint. It’s important not to overuse joints that feel better after joint injection, as the inflammatory process may remain active.
- Kenalog injection is given by injection into the muscle of the buttock in situations where a lasting corticosteroid effect is needed. The triamcinolone is slowly absorbed into the bloodstream from this area, so one injection produces an effect for about three weeks. If necessary the injection may be repeated, in which case it should be given into alternate buttocks. For people suffering from severe hay fever, that is not controlled by the usual treatments, one injection can relieve symptoms over the entire hay fever season.
What should I know about Kenalog injections?
- If you’ve been given more than one Kenalog injection during a three week period, or are having long-term treatment with Kenalog injections it’s important that the treatment is not stopped suddenly. Long-term use of steroids can stop your adrenal glands producing natural corticosteroids (this is called adrenal suppression), which means that your body becomes temporarily reliant on the medicine. This can also happen after repeated joint injections. When it’s time to stop treatment your dose should be reduced gradually, to allow your adrenal glands to start producing enough natural steroids again. Always follow the instructions given by your doctor or pharmacist.
- Long courses of steroids may increase your susceptibility to infections and can also mask the symptoms of infections, making you think they are less serious than they are. So it’s important to see your doctor if you get any signs of infection while you’re having Kenalog injections.
- If you’ve never had chickenpox you should avoid contact with people who have chickenpox or shingles while you’re having Kenalog injections. You should also avoid contact with people who have measles. If you’re exposed to these diseases either during treatment, or in the three months after stopping treatment, you should consult your doctor urgently. This is very important as these diseases can be life-threatening in people having long-term treatment with corticosteroids.
- Corticosteroid treatment, especially with high doses, can sometimes cause changes in your mood and behaviour when you first start treatment and some people may experience confusion, irritability, nightmares, difficulty sleeping, mood changes or depression, or suffer from delusions and suicidal thoughts. In a few cases these problems have happened when stopping treatment. It’s important to let your doctor know if you notice any change in your mood or behaviour, particularly if you begin to feel depressed, or have any disturbing thoughts or feelings. Most of these problems go away if the dose is lowered or the medicine is stopped. However if problems do happen they might need treatment.
- If you have more than one Kenalog injection you will be given a blue steroid card that contains details about your Kenalog treatment. This needs to be carried with you at all times because the effects that corticosteroids can have on the body may affect other medical treatment you may be given. You should show this card to any healthcare professionals treating you.
Who shouldn’t have Kenalog injections?
- People with widespread infection, unless this is being treated medicines such as antibiotics.
- Kenalog injection must not be injected into unstable or infected joints, or directly into tendons (only into the tendon sheath) or into the achilles tendon (which doesn’t have a true tendon sheath).
- Kenalog injection is not recommended for children under six years of age.
Who might need a lower dose or extra monitoring?
- Elderly people, children and adolescents. Steroid side effects are more likely in the very young and very old. Long-term use of steroids has the potential to slow growth in children, so if your child needs treatment with Kenalog for a long time your doctor will want to keep an eye on their height and weight.
- People with diabetes, or a family history of diabetes. Steroids can raise blood sugar levels and long-term use can sometimes cause diabetes or make diabetes more difficult to control.
- People with a stomach ulcer. Steroids can sometimes cause or worsen peptic ulcers so you may need to take an extra medicine to help protect your gut.
- People with a personal or family history of psychiatric illness, including depression, bipolar disorder or schizophrenia.
- People with or at risk of osteoporosis, including women who have passed the menopause. Steroids can sometimes cause weakening or thinning of the bones.
- People with kidney or liver problems.
- People with heart failure or who have recently had a heart attack.
- People with high blood pressure (hypertension). Your doctor will want to monitor your blood pressure.
- People with cataracts, glaucoma, or a family history of glaucoma. Steroids can cause or worsen these eye conditions.
- People with an infection, particularly people with herpes simplex virus infection of the eye or who have had tuberculosis (TB) in the past.
- People with inflammatory bowel disease such as ulcerative colitis or diverticulitis.
- People who have recently had a surgical procedure called intestinal anastomosis, which involves the joining together of ends of the intestine after a section has been removed.
- People with an underactive thyroid gland (hypothyroidism).
- People who suffer from epilepsy.
- People who have previously experienced muscle disorders (myopathy) caused by steroids, or who have myasthenia gravis.
- People with inflammation of veins in the legs associated with blood clot formation (thrombophlebitis).
Can I have Kenalog injections while pregnant or breastfeeding?
- Kenalog injection should only be used if the expected benefit to the mother is greater than any possible risk to the developing baby. When administered for long periods or repeatedly during pregnancy, corticosteroids may slow growth in the developing baby. They may also cause the baby to make less of its own steroid hormones after birth, though this usually resolves on its own and rarely causes any problems. Your doctor can give you more information.
- Triamcinolone may pass into breast milk. Kenalog injection should be used with caution in mothers who are breastfeeding and only if the benefits to the mother outweigh any risks to the nursing infant. Ask your doctor for more information and advice.
What are the possible side effects of Kenalog injections?
It’s hard to predict how likely you are to get side effects from Kenalog injection. It depends how many injections you have and any conditions you have that might make you more susceptible to problems. Side effects become more likely with higher doses and longer treatment.
Side effects are much less likely with joint injections, because the triamcinolone stays in the joint and is very slowly absorbed into rest of the body. The principal side effects following joint injection are flushing or dizziness and a temporary increase in pain and swelling for the first 24 to 48 hours and possibly some slight wasting of tissue or thinning of skin at the injection site. There is also a small risk of introducing infection into the joint, so it’s important to tell your doctor if you have a distinct increase in pain accompanied by swelling, further restriction of joint movement, fever and feeling generally unwell after your injection.
The following are some of the possible side effects associated with Kenalog injections:
- Raised blood sugar level. Talk to your doctor about monitoring your blood sugar if you have diabetes.
- Increased appetite and weight gain.
- Effects on the gut, such as indigestion or abdominal bloating, nausea, ulceration in the stomach or intestine, inflammation of the pancreas (pancreatitis).
- Muscle weakness or wasting.
- Thinning of the bones (osteoporosis) and increased risk of breaking a bone.
- Effects on the skin, such as skin thinning, impaired healing, acne, bruising, stretch marks, increased sweating, change in pigmentation, increased hair growth (hirsutism).
- Mental health problems, such as depression, suicidal thoughts, anxiety, confusion, memory loss, delusions or hallucinations. Make sure you see your doctor immediately if you experience anything like this.
- Increased susceptibility to infections (particularly thrush infections and chickenpox, shingles and measles) and increased severity of infections. It’s important to avoid contact with people who have chickenpox, shingles and measles and to see your doctor straight away if you develop any infections during your treatment.
- Cushing’s syndrome, characterised by a moon-shaped face.
- Changes in your menstrual period.
- Fluid retention.
- Increase in blood pressure (hypertension).
- Decrease in the level of potassium in the blood.
- Decrease in the production of natural steroids by the adrenal glands (adrenal suppression – see warning above).
- Effects on the eyes, such as raised pressure inside the eye (glaucoma), cataracts.
- Slowed growth in children and adolescents.
- Blood clots in the blood vessels (thromboembolism).
You should read the patient information leaflet that is supplied with your medication for more information about side effects associated with Kenalog injections. You can find a copy of this here.
If you think you have experienced side effects and you can report them using the yellow card scheme.
Can I use other medicines with Kenalog injections?
It’s important to tell your doctor what medicines you are already taking, including those bought without a prescription and herbal medicines, before you are given Kenalog an injection.
Check with your doctor or pharmacist before using steroid creams for eczema or allergic skin reactions or steroid nasal sprays for hayfever while you’re having Kenalog injections.
Don’t take anti-inflammatory painkillers (NSAIDs) like aspirin, ibuprofen or naproxen while you’re having Kenalog injections, unless they’ve been prescribed by your doctor. This type of painkiller may increase the risk of side effects on the gut, such as stomach ulceration and bleeding.
Remember that many cold and flu remedies and over-the-counter painkillers contain ibuprofen or aspirin and so should be avoided while you’re having Kenalog injections. Be sure to check the ingredients of other medicines, or ask your pharmacist for advice.
Triamcinolone can cause fluid and salt retention and so may oppose the effects of the following medicines:
- antihypertensive medicines used to treat high blood pressure
- diuretics such as furosemide
Triamcinolone may increase blood sugar levels and so may oppose the blood sugar lowering effects of antidiabetic medicines. People with diabetes may need an increase in their dose of insulin or antidiabetic tablets.
Triamcinolone may enhance the anti-blood-clotting effect of anticoagulant medicines such as warfarin. If you’re taking warfarin your blood clotting time (INR) should be monitored, particularly after starting or stopping treatment with Kenalog.
The following medicines may increase the removal of triamcinolone from the body, which could make it less effective:
- barbituates, eg amobarbital, phenobarbital
The following medicines may reduce the removal of triamcinolone from the body and so may increase the risk of its side effects:
- ciclosporin (triamcinolone may also increase the blood level and risk of side effects of ciclosporin)
- antifungal medicines such as itraconazole, ketoconazole
- antibiotics, such as clarithromycin, erythromycin, telithromycin
Triamcinolone may weaken your immune system, which means that vaccines may be less effective if given during treatment, because your body won’t produce sufficient antibodies in response to the vaccine. Live vaccines shouldn’t be given to people having Kenalog injections because they may cause serious infections. Live vaccines include: measles, mumps, rubella (MMR), BCG, chickenpox, oral typhoid, yellow fever and the nasal spray flu vaccine for children. You shouldn’t be given a live vaccine until at least three months after finishing a course of Kenalog.
Last updated 25.04.2019
Rita Ghelani (BPharm, MRPharmS) Pharmacist A UK registered practising pharmacist with over 20 years’ experience, Rita is a member of the medical journalists’ association (MJA) and has a wealth of experience in community pharmacy.
The Healing Process: Cast & Swelling
I am exactly eight weeks after my rhinoplasty and it still looks like I have a lot of swelling; is that normal?
Yes, it is very common, especially if the skin is thicker, to have swelling just two months after a rhinoplasty. In general, it does take six months to one year for all the swelling to fully come down, so the best thing is just to be patient and let the swelling come down.
Why did my nose change after the splint came off one week after rhinoplasty?
The cast pushes away swelling and helps it heal more quickly. Once you take the cast off the nose, then it allows the swelling to come back, but then it eventually goes away again.
How long should a cast stay on after a rhinoplasty?
The answer to this question depends mostly on the surgeon. The casts usually stay on anywhere from five to seven days, and if it needs to stay on a little longer, that is okay as well. In fact, I have most patients keep their casts and wear at night when they sleep so they don’t accidentally sleep on their face and cause the nose to change shape while it is still in the sensitive healing phase.
A dorsal on-lay graft was placed in my nose and I was wondering if it could be removed?
It is very common to ask questions in the healing period after a rhinoplasty. It is important to keep in mind that there is a lot of swelling that occurs after a rhinoplasty and patience is needed for all the swelling to go down in order to see what will be permanent and what will not. Dorsal on-lay grafts are pieces of cartilage that are placed on the bridge of the nose in order to smooth over any irregularities or to build up the bridge for a better look. Sometimes these can swell up a little bit more than the surrounding tissue and can look like a bump until all the swelling comes down. The best advice is to wait a minimum of six months, and then decide whether or not the graft will work out.
How long does it take for Kenalog injections to work inside the nose?
Kenalog is a steroid that is commonly used after rhinoplasty to reduce postoperative swelling. It is commonly used in people who have thick skin or a big rhinoplasty is performed where we go from a big nose to a small nose. Kenalog is a steroid that takes approximately 2-4 weeks to start working and we do not typically see the results until after a month. With that said, it is safe to get injections every 4-6 weeks, but that is a decision that is best left up to you and your surgeon.
To schedule your rhinoplasty appointment today, contact our Beverly Hills office at (310) 772-2866.
What Is Kenalog Scar Treatment?
Do you have raised scars? Did you know they can be treated? Kenalog Scar Treatment is a specially formulated anti-inflammatory injection that can be used to significantly improve raised scars, including injury scars, surgical scars, hypertrophic scars, and keloids.
Raised scars—or hypertrophic scars and keloids—are caused from injury and irritation of the lower layers of your skin. These injuries can range from seemingly harmless sources, such as insect bites, vaccinations, skin piercings, and tattoos, to more severe injuries, including burns, cuts, and surgery. Raised scarring may appear several months after an injury.
Hypertrophic scars are raised scars that are about the same shape as the original injury, and keloids are scars that grow and spread into the surrounding normal skin.
Kenalog Scar Treatment (active ingredient: triamcinolone) is an injection that reduces inflammation of your raised scars. The medication causes the scar to flatten and allows dark scars to lighten in some cases. Kenalog is a common non-surgical option for the treatment of these types of scars.
The treatments are normally given every few weeks, depending on the scar. Improvement of the scar is usually seen a few weeks after the first injection, although some softening of the scar tissue might be noticed within a few days.
The total number of injections needed will be determined on a case-by-case basis by your treatment provider.
If you think you have a hypertrophic or keloid scar, we are here to help. Schedule a consultation with one of our treatment providers to discuss possible treatment options.
How long does Kenalog stay in your system?
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