Q: In March I received a Kenalog steroid injection in my right hip to help treat an allergic reaction that I’d gotten from weeding a certain plant. In May I noticed a small dent at the site in which the shot was administered. Soon after, I began to feel discomfort and soreness in the same area. I contacted the dermatologist’s office who gave me the shot and spoke to a nurse who assured me that this was a common side effect and my skin would return to normal after six to nine months. I was very upset I wasn’t told of this “common” side effect before being given the shot. The “dent” seems to be increasing in size and the discomfort hasn’t receded. I am worried this may never go away!
Do you know anything about this issue? Any information you can give me would be greatly appreciated. Thank you.
A: I have no way of knowing if you received a Kenalog 10 (mg), a Kenalog 40 (mg), or another Kenalog product. As a general rule, if you had an allergic reaction, you would likely have received a shot into the buttocks/gluteal muscle and not into a joint.
The Kenalog 10 is a triamcinolone acetonide steroid injected into a joint space for the treatment of arthritis, tennis elbow (epicondylitis), bursitis, skin disorders, and other conditions such as psoriasis, lupus, and lichen planus. Side effects may include pain, headache, insomnia, bruising, swelling, irregular menstrual cycles for women, and more. The product, like all steroids, may interact with a number of other medications that include anti-coagulants, birth control pills, oral diabetic drugs, seizure medications, NSAIDs (non-steroidal anti-inflammatory drugs), aspirin, and numerous others.
The Kenalog 40 Injection is a synthetic corticosteroid with anti-inflammatory action suitable for intramuscular and intra-articular use only. It is not for intradermal injection. Symptoms are similar those of a Kenalog 10 injection and may also include high blood pressure, vision difficulties, shortness of breath, and cardiac arrhythmias. Less serious side effects may include acne, scaling or other skin changes.
Kenalog is as medication with a long history of relatively problem-free administration, yet this may not be the case with Kenalog injections. According to internet blogs written by patients regarding Kenalog injections and covered by Risk Review, a publication of Princeton Insurance, one such side effect is atrophy that can result in an indentation the size of a baseball or orange. In some instances, physicians may not even be aware of the possibility of tissue atrophy and are therefore unable to warn their patients of the potential for such situations to arise. Drugs.com does make specific reference to the need for a deep, intramuscular injection in order to avoid the atrophy, yet the packaging insert provided by the manufacturer doesn’t mention it for the 10 mg dose. The 40 mg dose states the product “should be injected deeply into the gluteal muscle. Period. Packaging inserts were updated in 2007 but if physicians fail to keep up with such changes, he or she, as well as the patient, may remain in the dark.
I recommend you remain in touch with your physician’s office and be assured your concerns are recorded in your medical history. I wish I could tell you how long to expect your “dent” to last but unfortunately, I can’t. With luck, the nurse you spoke with will be correct and things will return to normal soon yet if she didn’t call you in for a follow-up visit so the dermatologist could get a visual and record that information in your chart, that doesn’t speak well for the office as a whole. Patients should be well-informed of such possibilities prior to experiencing them personally, not after the fact. Let me know how things turn out.
