Triamcinolone acetonide, skin

Topical preparations usually contain relatively insoluble steroids, such as clobetasol propionate, triamcinolone acetonide, or triamcinolone diacetate. Side effects of this mode of drug application are usually milder and more transient than those seen after systemically administered steroids. However, potent topical corticosteroids, such as clobetasol propionate (Temovate), can suppress adrenal function when used in large amounts for a long time, especially when the skin surface is denuded or when occlusive dressings are employed. Since the high potency topical preparations carry a higher risk of local side effects, their use should be held in reserve. 

A 42-year-old woman developed a nonpigmented fixed drug eruption after skin testing and an intra-articular injection of triamcinolone acetonide, which has not been previously reported (178). 

Intralesional triamcinolone acetonide has been used extensively for the treatment of hypertrophic and keloid scars. Complications are few, usually being local skin color changes, prominent vascular markings, or subcutaneous atrophy. Cushing s syndrome after intralesional administration of triamcinolone acetate has been described in two adults and two children (aged 10 years and 21 months) after treatment of hypertrophic burn scars with intralesional triamcinolone acetonide (SEDA-21, 419) (408). These two children may have had a form of hypersensitivity to triamcinolone acetonide, as Cushing s syndrome was not the result of overdosage. 

Nicolazzo et al. [52] considered the use of the lipophilic skin penetration enhancers, octisalate and padimate (both used in sunscreens), in comparison to Azone on the buccal absorption of various drugs in vitro. They were found to have limited effect in enhancing the permeation of triamcinolone acetonide (although some increase in tissue uptake was proposed in some cases) relative to Azone, while reducing the penetration of estradiol and caffeine. One interesting report is that of the effect of capsaicin from capsicum, a commonly used food ingredient, which has been reported to enhance the permeability of sulfathiazole in human volunteers [53] presumably by a direct irritation effect on the mucosa. This raised an interesting issue of the effect of diet on oral mucosal permeability. 

Urea has been shown to be an efficient accelerant for the penetration of different drugs.52-57 Increased levels of hydrocortisone, triamcinolone acetonide,53 dithranol,54 and retinoic acid52 were found in various layers of isolated human skin after 1000 min of exposure time to creams containing 10 to 12% urea. Also the penetration of ketoprofen through isolated rat skin was enhanced by the addition of urea.56 Furthermore, it has been shown that the time of onset of erythema, induced by hexyl nicotinate, was significantly reduced by simultaneous exposure to an oily cream containing urea.55... 

The penetration rates of four steroids through intact abdominal autopsy skin were, in the order of their physiological activity, betamethasone 17-valerate (I) > desonide > triamcinolone acetonide (II) > hydrocortisone (III). Triamcinolone itself is five times more active systemically than hydrocortisone, but has only one-tenth of its topical activity. The acetonide of triamcinolone has a topical activity 1000 times that of the parent steroid... 

Hypertrophic scars should be treated immediately. Prescribe silicone gel sheets for 6 months. Then treat with intralesional injections of triamcinolone acetonide 10-40 mg/mL at 4- to 6-week intervals. Diffuse or spotted hypopigmentation This is usually persistent. Skin needling sometimes induces repigmentation. Camouflaging maybe necessary. 

Dermatology is another important field where fatty acid esters of corticosteroids are applied. Examples are creams with hydrocortisone acetate and triamcinolone acetonide, respectively. These fat-soluble derivatives are used because they show better penetration into the lipophilic stratum comeum of the skin. 

A 21-year-old Japanese man with alopecia multiplex developed pruritic linear eruptions on the left thigh. He was given intramuscular triamcinolone acetonide 40 mg once a month, and after 10 such injections developed numerous eruptions on his left thigh consisting of multiple pigmented brownish macules and papules with a tendency to disseminate. Skin biopsy was consistent with lichen planus. He used topical 0.05% difluprednate ointment for more than 1 year, without improvement. 

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