NAVARA HEALTH
Functional · Hormonal · Aesthetic · Integrative
Intralesional Steroid Injection · Aesthetic Consent

Intralesional Triamcinolone (Kenalog®)
Acne Injection Informed Consent

Targeted Treatment · Adults 18+
FDA-Approved Injectable Corticosteroid · Intralesional Use Per Standard Dermatologic Practice
Practice
Navara Health, PLLC
5301 Alpha Road, Suite 34, Room 21
Dallas, Texas 75240
Contact
469-653-3124
contact@navarahealthtx.com
Treating Provider
Jessica Boggs, MSN, APRN, FNP-C, ENP-C
Medical Director
Simal Patel, MD
Procedure Class
Intralesional corticosteroid injection
Medication
Triamcinolone acetonide (Kenalog®)
18+
Adult-Only Procedure. Navara Health provides intralesional triamcinolone injections to patients age 18 and older only. Pediatric and adolescent acne treatment is not offered at Navara; minors will be referred to dermatology for age-appropriate evaluation and treatment.

Purpose of This Consent

This document is the procedure-specific informed consent for intralesional triamcinolone acetonide (Kenalog®) injection at Navara Health, PLLC. It addresses the nature, expected benefits, risks (local and systemic), alternatives, post-procedure care, and patient responsibilities specific to this targeted treatment. It operates alongside the Navara General Informed Consent & Practice Policies and any applicable Photography & Marketing Consent.

Treatment Description

I understand that I am receiving intralesional corticosteroid injections for the treatment of inflamed acne lesions, which may include:

The procedure involves injecting a small, diluted amount of triamcinolone acetonide (Kenalog®), an FDA-approved injectable corticosteroid, directly into the affected acne lesion. The goal of this treatment is to:

I understand that this is a localized, targeted treatment for individual lesions and is not intended to treat generalized acne, prevent future breakouts, or replace a comprehensive acne treatment regimen.

Treatment Protocol & Technique

Standard Intralesional Triamcinolone Protocol

Medication Triamcinolone acetonide (Kenalog®)
Stock Concentration Kenalog-10 (10 mg/mL) or Kenalog-40 (40 mg/mL)
Diluted Concentration 2.5–10 mg/mL (diluted in sterile saline or lidocaine)
Volume Per Lesion 0.05–0.1 mL (typically a "trace" amount)
Needle & Syringe 30-gauge needle, tuberculin (1 mL) syringe
Injection Depth Intradermal / intralesional (into the lesion itself)
Maximum Lesions Per Visit Provider discretion; typically < 10 lesions per visit
Treatment Interval Minimum 4–6 weeks between treatments of the same lesion

The dilution and small injection volume are essential to minimize the risk of skin atrophy. Lower concentrations and smaller volumes are associated with substantially lower atrophy risk, while higher concentrations carry meaningfully higher risk of skin depression. Final dose and concentration are determined by the provider based on lesion size, location, depth, prior response, and individual risk factors.

Expected Benefits

Potential benefits of intralesional triamcinolone for inflamed acne lesions may include:

I understand that results are not guaranteed, individual response varies, and some lesions respond better than others. The lesion may also be approaching natural resolution; not all improvement can be attributed to the injection.

Alternatives to Treatment

I understand that alternative treatment options for inflamed acne lesions may include, but are not limited to:

I have discussed alternatives with my provider and am voluntarily choosing intralesional triamcinolone for the targeted lesion(s).

Local Risks & Potential Side Effects

Common
Local Reactions at the Injection Site
Mild stinging or pinching sensation during injection. Brief erythema (redness) immediately after injection. Mild bruising. Small bump or wheal at injection site (resolves within hours).
Possible — Cosmetic / Dose-Related
Skin Atrophy & Pigment Changes
Localized skin thinning or atrophy — depression or "pit" at the injection site, particularly with higher concentrations or repeated injections of the same lesion. Hypopigmentation (lightening of the skin) at the injection site, more commonly noticed in darker skin tones. Temporary skin depressions or contour irregularities. Telangiectasias (small visible blood vessels) at the injection site. These cosmetic changes are often temporary, lasting weeks to several months, but in some cases may persist for many months or, rarely, be permanent.
Possible — Treatment-Related
Incomplete or Variable Response
Incomplete reduction of the lesion. No measurable improvement (rare). Need for repeat injection or alternative treatment. Worsening of the lesion or development of new lesions nearby (unrelated to injection).
Rare
Infection, Allergic Reaction, & Other Serious Events
Infection at the injection site (cellulitis, abscess) — rare with proper aseptic technique. Allergic reaction to triamcinolone or excipients, including rare anaphylaxis. Significant bruising or hematoma. Bleeding in patients on anticoagulants. Persistent atrophy or scarring that does not resolve. Steroid acne flare (paradoxical worsening, very uncommon at low intralesional doses).

I understand that when side effects occur, they are most often temporary, but may persist for several months and, in rare cases, may be permanent. Larger atrophic depressions may benefit from observation, time, or — in select cases — saline injection or other corrective measures.

Systemic Corticosteroid Risk Disclosure

Systemic Considerations — Important

Systemic Effects of Intralesional Steroid Injection

Although intralesional triamcinolone uses very small doses delivered to a localized area, some systemic absorption occurs. With single small-volume injections of inflamed acne lesions, systemic effects are generally negligible. However, repeated injections, larger doses, multiple lesions per visit, or frequent visits may increase systemic exposure.

I understand and acknowledge the following potential systemic considerations:

I have disclosed to my provider any conditions or medications that could increase my systemic risk, including diabetes, immunosuppression, recent or planned vaccines, active infection, pregnancy, or breastfeeding.

Pregnancy & Breastfeeding

I understand and acknowledge:

Contraindications & Cautions

Intralesional triamcinolone may be contraindicated, deferred, or require modification if I have or disclose:

Post-Procedure Care

Care Instructions After Intralesional Triamcinolone Injection

To support optimal healing and reduce risk of side effects, I will follow these post-procedure care instructions:

Immediately After Apply gentle pressure with clean gauze if minor bleeding occurs. Cold compress or ice (10–15 minutes on, 10 minutes off) may reduce immediate swelling.
Cleansing Gently cleanse the treated area with a mild cleanser. Avoid scrubbing, exfoliating, or harsh treatments for at least 24 hours.
Makeup & Skincare Avoid makeup directly over the injection site for at least 4–6 hours after the procedure. Avoid retinoids, AHAs/BHAs, vitamin C, and exfoliants for 24–48 hours on the treated area.
Sun Protection Apply broad-spectrum SPF 30+ daily. Sun exposure may worsen hypopigmentation or pigment changes.
Avoid Picking Do not pick, squeeze, or manipulate the treated lesion. Allow the medication to work.
Expected Timeline Improvement is typically visible within 24–72 hours, with continued reduction over 5–7 days. Some lesions may take longer to fully resolve.
Watch For Increased redness, warmth, pain, or pus (signs of infection); spreading redness; significant swelling; allergic symptoms. Contact Navara Health if any of these occur.
Follow-Up Atrophy assessment recommended at 4–6 weeks if the lesion was treated for the first time, or sooner if any concerning changes develop. Repeat treatment of the same lesion should generally be deferred at least 4–6 weeks.

Important Acknowledgments

I acknowledge and understand that:

Communication & HIPAA Authorization

I authorize Navara Health to communicate with me regarding scheduling, post-procedure follow-up, and adverse event reporting through:

I understand that email and SMS are not fully secure channels. I may revoke authorization for any specific channel in writing to contact@navarahealthtx.com.

Assumption of Risk & Release of Liability

I voluntarily assume all known, unknown, and unforeseen risks associated with intralesional triamcinolone injection. To the fullest extent permitted by law, I agree to release, indemnify, and hold harmless Navara Health, PLLC, Jessica Boggs APRN, the medical director, and all affiliated providers, nurses, staff, contractors, and agents from liability related to:

This release does not apply to cases of gross negligence or willful misconduct, and does not waive any right that cannot lawfully be waived under the laws of the State of Texas.

Dispute Resolution & Governing Law

Any dispute, controversy, or claim arising out of or relating to this Consent or the intralesional triamcinolone procedure shall first be addressed by good-faith negotiation. If not resolved within thirty (30) days, the parties agree to submit the dispute to binding arbitration in Dallas County, Texas, under the rules of a recognized arbitration body. The parties waive the right to a jury trial.

This Consent shall be governed by the laws of the State of Texas. If any provision is found unenforceable, the remaining provisions shall remain in full force and effect.

Patient Initials — Required for Each Critical Clause

Each of the following requires my separate written initials.
I understand this is a targeted, localized treatment for individual inflamed acne lesions and does not treat generalized acne or prevent future breakouts.
Initials
I understand the most significant cosmetic risks are skin atrophy (depression/pit) and hypopigmentation, which are dose-dependent and may persist for weeks to months, or rarely, be permanent.
Initials
I understand the systemic considerations in Section 6, including effects on glucose control, immune function, vaccine timing, and HPA axis with repeated dosing.
Initials
I understand pregnancy and breastfeeding considerations in Section 7 and have disclosed my reproductive status to my provider.
Initials
I agree to follow the post-procedure care instructions in Section 9, including sun protection and avoiding manipulation of the treated lesion.
Initials
I confirm I am at least 18 years of age (Navara Health does not perform intralesional steroid acne injections on minors).
Initials
I agree to binding arbitration as described in Section 13 and understand that I am waiving the right to a jury trial.
Initials

Acknowledgment & Electronic Consent

By signing below (or by typing my full legal name as an electronic signature), I confirm and agree:

Patient Printed Name
Date of Birth
Lesion Location(s) Treated Today
Number of Lesions Treated
Concentration Used (mg/mL)
Total Volume Administered (mL)
Patient Signature (or Typed Electronic Signature)
Date
Provider Signature — Jessica Boggs, APRN, FNP-C, ENP-C
Date