Hypertrophic Scar After Nose Piercing Treated with Intralesional Kenalog
Patient Presentation
A 31-year-old female presented to our dermatology clinic in Katy, Texas, with a raised scar on her left nasal sidewall following a recent nose piercing. The patient reported that the piercing was done approximately three months ago, and she had been instructed by her piercer not to remove the jewelry for six months. She was concerned about the thickened appearance around the site and sought treatment for the developing scar.
Clinical Examination
A detailed facial examination revealed a firm, raised, pink scar consistent with a hypertrophic scar located at the piercing site on the left nasal sidewall. The lesion was mildly thickened but not tender or pruritic.
The patient appeared well-developed, well-nourished, and in no acute distress. A dermatoscope was used to assess the lesion, confirming no signs of infection, ulceration, or keloidal overgrowth.
Additional Findings
Milia (L72.0): Small yellow-white cystic papules on the right malar cheek, benign and superficial.
Benign Nevi (D22.4): Multiple evenly pigmented moles scattered throughout the body.
Diagnosis
Hypertrophic Scar (L91.0) – Left nasal sidewall (post-piercing)
Milia (L72.0) – Right malar cheek
Benign Nevi (D22.4) – Diffuse
Treatment Plan
1. Hypertrophic Scar Management
The patient was counseled regarding the nature of hypertrophic scars and treatment options, including:
Intralesional corticosteroid injections (Kenalog)
Silicone gel or silicone sheets
Pulse dye laser for vascular improvement
After informed consent, Intralesional Kenalog (ILK) was administered:
Concentration: 5 mg/cc (diluted from 10 mg/mL)
Volume: 0.1 cc
Injection Sites: 1 (left nasal sidewall)
Administered by: AB
The risks of skin atrophy and pigment alteration were discussed, and the patient tolerated the procedure well.
To prevent infection, mupirocin 2% ointment was prescribed:
Sig: Apply to affected area once to twice daily until healed
Quantity: 15 grams, 1 refill
2. Milia
Counseling included reassurance that milia are benign keratin-filled cysts, often resolving spontaneously or with gentle exfoliation. Treatment options reviewed:
In-office extraction if persistent or bothersome
3. Benign Nevi
Patient education included monthly self-skin checks to monitor for any changes in size, color, or shape.
Recommendations included:
Regular dermatologic full-body exams every 6–12 months
Discussion
Hypertrophic scars commonly occur at sites of trauma, piercings, or surgical incisions and result from excessive collagen deposition during wound healing.
Intralesional corticosteroid therapy, particularly Kenalog (triamcinolone acetonide), is highly effective in flattening and softening hypertrophic scars. Combining ILK injections with silicone-based therapy often improves long-term outcomes.
At Village Dermatology in Katy and Houston, Texas, Dr. Reena Jogi and her team emphasize a personalized, evidence-based approach to treating scars, milia, and benign skin lesions. This ensures both cosmetic improvement and skin health maintenance.
Conclusion
The patient’s hypertrophic scar from a recent nose piercing was successfully treated with intralesional Kenalog and topical mupirocin. She was counseled on scar care and follow-up options, including silicone therapy and laser treatments for refinement. The patient will return in 6–8 weeks for reevaluation.
