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:
- Cystic acne (deep, painful, fluid-filled lesions)
- Nodular acne (firm, painful lesions beneath the skin surface)
- Inflammatory papules and large pustules unresponsive to topical therapy
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:
- Reduce inflammation and swelling rapidly
- Decrease pain and tenderness in the treated lesion
- Promote faster resolution of the lesion
- Reduce the risk of permanent acne scarring from prolonged inflammation
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:
- Rapid reduction in inflammation and swelling, often within 24–72 hours
- Decreased pain and tenderness in the treated lesion
- Faster healing compared to untreated lesions
- Reduced risk of permanent acne scarring from prolonged inflammation
- Improved cosmetic appearance during important events (when treated 24–72 hours in advance)
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:
- Observation — no treatment, allowing natural resolution
- Topical acne medications — benzoyl peroxide, salicylic acid, retinoids (tretinoin, adapalene, tazarotene), clindamycin, azelaic acid, dapsone
- Oral acne medications — antibiotics (doxycycline, minocycline, sarecycline), spironolactone (for hormonal acne), combined oral contraceptives, isotretinoin (Accutane) for severe cystic acne
- Procedural treatments — chemical peels, hydrafacial, light or laser therapy, photodynamic therapy
- Referral to dermatology for comprehensive acne evaluation and management
- Hormonal evaluation if hormonal acne is suspected (PCOS workup, hormone optimization)
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:
- HPA Axis Suppression — Theoretical risk with repeated or high-dose corticosteroid exposure. Adrenal function may be transiently affected with cumulative dosing. Generally not clinically meaningful at intralesional acne doses but is a consideration with frequent treatments.
- Cushingoid Features — Theoretical risk only with significant cumulative steroid exposure (weight gain, central adiposity, moon face). Not expected at standard intralesional acne dosing.
- Hyperglycemia in Diabetics — Even small corticosteroid doses may transiently affect glycemic control. Patients with diabetes should monitor blood glucose closely for 1–3 days after injection.
- Immune Modulation — Local and modest systemic immune effects. Patients who are immunocompromised, on immunosuppressive medications, or undergoing active infection management should disclose this to the provider.
- Vaccine Timing — Live vaccines (MMR, varicella, yellow fever, intranasal flu, oral typhoid) may have reduced efficacy near steroid administration. I will inform my provider if I have received or plan to receive a live vaccine within 2–4 weeks of treatment.
- Menstrual / Hormonal Effects — Rare; transient menstrual irregularity has been reported with corticosteroid exposure but is uncommon at intralesional doses.
- Mood Changes — Uncommon at low doses; insomnia, mood changes, or anxiety have been reported with systemic corticosteroids.
- Bone Health — Cumulative high-dose corticosteroid exposure may affect bone density; not a concern at standard intralesional acne dosing.
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:
- Triamcinolone is classified as FDA Pregnancy Category C — there are limited human data, and animal studies have shown adverse effects at much higher doses than used intralesionally
- Intralesional triamcinolone is generally not used during pregnancy unless the benefit clearly outweighs the risk; Navara Health typically defers intralesional acne treatment during pregnancy and refers to obstetric or dermatologic care
- Patients who are breastfeeding should discuss the risk-benefit with their provider; small amounts of corticosteroid may pass into breast milk, though intralesional acne doses are very small
- I will notify Navara Health immediately if I become pregnant or if I am or may be breastfeeding
- Pregnancy testing may be requested in clinically appropriate circumstances
Contraindications & Cautions
Intralesional triamcinolone may be contraindicated, deferred, or require modification if I have or disclose:
- Known hypersensitivity to triamcinolone or any excipient
- Active infection at or near the proposed injection site (including herpes simplex, impetigo, cellulitis)
- Pregnancy, planned pregnancy, or breastfeeding (case-by-case clinical judgment)
- Active uncontrolled diabetes (relative caution; glucose monitoring required)
- Immunocompromised status or active immunosuppressive therapy
- Recent live vaccine administration or planned live vaccine within 2–4 weeks
- Active systemic corticosteroid use (cumulative exposure consideration)
- Severe atrophic scarring from prior intralesional steroid use
- Active oral isotretinoin (Accutane) use — typically wait for skin healing if recent
- Bleeding disorders or anticoagulant use (clinical judgment)
- Unrealistic patient expectations
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:
- This treatment targets only the injected acne lesion and does not prevent future acne breakouts
- New lesions may develop and may require separate treatment
- Injection volumes are very small and discomfort is typically minimal, though pain perception varies
- I have been advised of the risks and benefits at today's visit, even if I have received this treatment previously; risks and dose considerations are re-assessed each visit
- I have disclosed all relevant medical conditions, allergies, medications, supplements, vaccines, and reproductive status to my provider
- The provider has the right to decline or modify treatment based on clinical judgment, including reducing dose, limiting number of lesions treated, or deferring treatment entirely
Communication & HIPAA Authorization
I authorize Navara Health to communicate with me regarding scheduling, post-procedure follow-up, and adverse event reporting through:
- The secure HIPAA-compliant patient portal
- Email to the address I have provided
- SMS / text message to the mobile number I have provided
- Telephone calls to the number I have provided
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:
- Local cosmetic effects including atrophy, hypopigmentation, telangiectasias, and contour changes
- Incomplete response or lack of improvement of the treated lesion
- Development of new acne lesions unrelated to the injection
- Adverse reactions, including rare allergic or systemic effects
- Outcomes related to undisclosed medical history, medications, supplements, or reproductive status
- Effects related to failure to follow post-procedure care
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.
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.
I understand the systemic considerations in Section 6, including effects on glucose control, immune function, vaccine timing, and HPA axis with repeated dosing.
I understand pregnancy and breastfeeding considerations in Section 7 and have disclosed my reproductive status to my provider.
I agree to follow the post-procedure care instructions in Section 9, including sun protection and avoiding manipulation of the treated lesion.
I confirm I am at least 18 years of age (Navara Health does not perform intralesional steroid acne injections on minors).
I agree to binding arbitration as described in Section 13 and understand that I am waiving the right to a jury trial.
Acknowledgment & Electronic Consent
By signing below (or by typing my full legal name as an electronic signature), I confirm and agree:
- I am at least 18 years of age.
- I have read and understand this Intralesional Triamcinolone (Kenalog®) Acne Injection Consent in its entirety.
- Jessica Boggs, APRN has explained the procedure to me, including the dilution, technique, and small injection volumes used to minimize atrophy risk.
- I understand the purpose, benefits, local and systemic risks, side effects, alternatives, and post-procedure care.
- I have disclosed my complete medical history, medications, supplements, allergies, vaccine history, reproductive status, and any prior intralesional steroid use.
- I have had the opportunity to ask questions, and all questions have been answered to my satisfaction.
- I voluntarily consent to receive intralesional triamcinolone (Kenalog®) injection for the targeted acne lesion(s) discussed today.
- I authorize communication through the channels described in Section 11.
- I voluntarily assume all risks and agree to the release of liability described in Section 12.
- I agree to binding arbitration as described in Section 13.
- I have completed the Patient Initials block above.
- My typed name serves as my legal electronic signature, equivalent to a handwritten signature, and this consent becomes part of my permanent medical record.
Lesion Location(s) Treated Today
Number of Lesions Treated
Concentration Used (mg/mL)
Total Volume Administered (mL)
Patient Signature (or Typed Electronic Signature)
Provider Signature — Jessica Boggs, APRN, FNP-C, ENP-C