QHow often can patients get intramuscular Kenalog injections?

Although there are no specific recommendations on the frequency of intramuscular steroid administration, there is some literature to guide our practice. Thomas et al. report use of intramuscular Kenalog administration is most desirable when administered every 4-6 weeks, as an alternative to a 3–4-week prednisone taper, and when patients are intolerant to oral steroids or poorly compliant. The intramuscular steroid side effect profile appears to be safer in most instances over oral prednisone with the exception of increased dysmenorrhea in females.

Calcium, vitamin D supplements, and bisphosphonates should be discussed for patients with chronic steroid use of greater than 4 weeks or with more than a single administration of IM steroid. Although Kenalog levels disappear after 21 days¹, remission often lasts longer with each successive dose.² If I cannot gradually clear my patients and/or extend intramuscular Kenalog administration to once every 3 months, I will discuss alternative therapy with the patient.

1. Thomas et al. JDD 2018
2. Cartson. Practical Dermatology 2008