Triamcinolone acetonide is most often used. It can be diluted with normal saline or lignocaine and is delivered in volumes of 1-2 mL. The concentration used depends on the pathology and skin site. Generally, one commences with a concentration of 5 mg/mL working up to the full concentration of 40 mg/mL, if necessary, when there is no response. If required, the injection can be repeated every 4-6 weeks. The adverse effects include pain, secondary infection, telangiectasia, leucoderma and dermal atrophy. Systemic adverse effects are rare unless large quantities are used. Intralesional steroids are not used for epidermal conditions. Care is required to introduce the steroid deep into the dermis to avoid epidermal atrophy, as well as dermal atrophy in those conditions where there is not a grossly thickened dermis. In the case of keloid, atrophy of the dermis following the use of treatment is unlikely to be a problem.