Generic Name: triamcinolone topical

Uses

Corticosteroid-responsive Dermatoses

Relief of inflammatory and pruritic manifestations of moderate to severe corticosteroid-responsive dermatoses.

Generally most effective in acute or chronic dermatoses (e.g., seborrheic or atopic dermatitis, localized neurodermatitis, anogenital pruritus, psoriasis, late phase of allergic contact dermatitis, inflammatory phase of xerosis).

Topical therapy generally preferred over systemic therapy; fewer associated adverse systemic effects.

Topical therapy generally only controls manifestations of dermatoses; eliminate cause if possible.

Topical efficacy may be increased by using a higher concentration or occlusive dressing therapy. (See Administration with Occlusive Dressing under Dosage and Administration.)

Response may vary from one topical corticosteroid preparation to another.

Anti-inflammatory activity may vary considerably depending on the vehicle, drug concentration, site of application, disease, and individual patient.

Triamcinolone acetonide 0.5% cream and 0.1% ointment are considered to have high-range potency.

Triamcinolone acetonide 0.1% cream and 0.1% lotion are considered to have medium-range potency.

Oral Lesions

Triamcinolone acetonide paste used as an adjunct for temporary symptomatic relief of oral inflammatory or ulcerative lesions resulting from trauma.

Dosage and Administration

General

• Consider location of the lesion and the condition being treated when choosing a dosage form.
• Creams are suitable for most dermatoses, but ointments may also provide some occlusion and are usually used for the treatment of dry, scaly lesions.
• Lotions are probably best for treatment of weeping eruptions, especially in areas subject to chafing (e.g., axilla, foot, groin). Lotions, gels, and aerosols may be used on hairy areas, particularly the scalp.
• Formulation affects percutaneous penetration and subsequent activity; extemporaneous preparation or dilution of commercially available products with another vehicle may decrease effectiveness.
• Patients applying a topical corticosteroid to a large surface area and/or to areas under occlusion should be evaluated periodically for evidence of hypothalamic-pituitary-adrenal (HPA)-axis suppression by appropriate endocrine testing (e.g., ACTH stimulation, plasma cortisol, urinary free cortisol). (See Hypothalamic-Pituitary-Adrenal Axis Suppresion and also Systemic Effects, under Cautions.)

Administration

Topical Administration

For dermatologic use only; avoid contact with eyes.

The area of skin to be treated may be thoroughly cleansed before topical application to reduce the risk of infection; however, some clinicians believe that, unless an occlusive dressing is used, cleansing of the treated area is unnecessary and may be irritating.

Apply cream, lotion, or ointment sparingly in a thin film and rub gently into the affected area.

Use the 0.5% cream and 0.5% ointment only in the treatment of dermatoses that are refractory to treatment with lower concentrations.

To apply triamcinolone acetonide aerosol, spray an area about the size of the patient’s hand for about 2 seconds from a distance of about 7.5–15 cm.

For use in the mouth, press a small amount (about 0.6 cm) of the 0.1% paste to the lesion without rubbing until a thin film develops; a larger amount may be required to cover some lesions.

After a favorable response is achieved, frequency of application or concentration (strength) may be decreased to the minimum necessary to maintain control and to avoid relapse; discontinue if possible.

Administration with Occlusive Dressing

Dermatologic preparations of triamcinolone acetonide usually should not be used with occlusive dressings unless directed by a clinician. However, when appropriate, occlusive dressings may be used as directed by a clinician to augment efficacy of triamcinolone preparations when treating severe or resistant dermatoses. (See Occlusive Dressings under Cautions.)

Soak or wash the affected area to remove scales; apply a thin film of cream, lotion, or ointment; rub gently into the lesion; and apply another thin film. Cover affected area with a thin, pliable plastic film and seal it to adjacent normal skin with adhesive tape or hold in place with a gauze or elastic bandage.

If affected area is moist, incompletely seal the edges of the plastic film or puncture the film to allow excess moisture to escape. For added moisture in dry lesions, apply cream, ointment, or lotion and cover with a dampened cloth before the plastic film is applied or briefly soak the affected area in water before application of the drug and plastic film.

Thin polyethylene gloves may be used on the hands and fingers, plastic garment bags may be used on the trunk or buttocks, a tight shower cap may be used for the scalp, or whole-body suits may be used instead of plastic film to provide occlusion.

Frequency of occlusive dressing changes depends on the condition being treated; cleansing of the skin and reapplication of the corticosteroid are essential at each dressing change.

Occlusive dressing is usually left in place for 12–24 hours and therapy is repeated as needed. Although occlusive dressing may be left in place for 3–4 days at a time in resistant conditions, most clinicians recommend intermittent use of occlusive dressings for 12 hours daily to reduce the risk of adverse effects (particularly infection) and systemic absorption and for greater convenience.

The drug and an occlusive dressing may be used at night, and the drug or a bland emollient may be used without an occlusive dressing during the day.

In patients with extensive lesions, sequential occlusion of only one portion of the body at a time may be preferable to whole-body occlusion. (See Occlusive Dressings under Cautions.)

Dosage

Available as triamcinolone acetonide; dosage expressed in terms of the salt.

Pediatric Patients

Administer the least amount of topical preparations that provides effective therapy. (See Pediatric Use under Cautions.)

Corticosteroid-responsive Dermatoses

Topical

Apply appropriate preparations of triamcinolone acetonide sparingly 2–4 times daily.

Apply 0.1 and 0.5% creams 2–3 times daily according to severity of the condition.

Apply aerosol 3–4 times daily.

Adults

Corticosteroid-responsive Dermatoses

Topical

Apply appropriate preparations of triamcinolone acetonide sparingly 2–4 times daily.

Apply 0.1 and 0.5% creams 2–3 times daily according to severity of the condition.

Apply aerosol 3–4 times daily.

Apply paste at bedtime and, if necessary, 2 or 3 times daily, preferably after meals. If substantial regeneration or repair of oral tissues does not occur after 7 days, further investigate the etiology of the lesions.

Cautions

Contraindications

• Known hypersensitivity to triamcinolone acetonide or any ingredient in the formulation.

Warnings/Precautions

Sensitivity Reactions

Allergic contact dermatitis may manifest as failure to heal rather than irritation as occurs with other topical preparations that do not contain corticosteroids; confirm with diagnostic patch testing.

General Precautions

Hypothalamic-Pituitary-Adrenal Axis Suppression

Topically applied corticosteroids can be absorbed in sufficient amounts to reversibly suppress the HPA axis.

Perform periodic HPA-axis evaluation by appropriate testing (e.g., ACTH stimulation, morning plasma cortisol, urinary free cortisol), especially in patients applying a topical corticosteroid to a large surface area or to areas under occlusion.

If HPA-axis suppression occurs, withdraw the drug, reduce the frequency of application, and/or substitute a less potent corticosteroid.

HPA-axis function recovery generally is prompt and complete following drug discontinuance.

Rarely, glucocorticosteroid insufficiency may require systemic corticosteroid therapy.

Systemic Effects

Systemic absorption following topical administration may result in manifestations of Cushing's syndrome, hyperglycemia, and glucosuria in some patients.

Risk of adverse systemic effects increases with use of a high-potency topical corticosteroid, especially if applied to large areas of the body, for prolonged periods of time, with an occlusive dressing, and/or concurrently with other corticosteroid-containing preparations.

Infants and children may be more susceptible to adverse systemic effects. (See Pediatric Use under Cautions.)

Local Effects

Possible adverse local reactions (e.g., burning, itching, irritation, dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, maceration of the skin, secondary infection, skin atrophy, striae, miliaria); may occur more frequently with the use of occlusive dressings, especially with prolonged therapy.

Prolonged use of topical corticosteroids may cause atrophy of the epidermis and subcutaneous tissue; these effects are most likely to occur (even with short-term use) in intertriginous (e.g., axilla, groin), flexor, and facial areas.

If irritation occurs, discontinue drug and institute appropriate therapy.

Skin Infection

If concurrent skin infection is present or develops, initiate appropriate anti-infective therapy. If infection does not respond promptly, discontinue topical corticosteroid therapy until the infection has been controlled.

When topical corticosteroids and topical anti-infectives are used concomitantly, consider that the corticosteroid may mask clinical signs of bacterial, fungal, or viral infections; prevent recognition of ineffectiveness of the anti-infective; or suppress hypersensitivity reactions to ingredients in the formulation. In addition, consider the cautions, precautions, and contraindications associated with the anti-infective.

Do not use occlusive dressings in patients with primary skin infection.

Some manufacturers state that topical corticosteroids are contraindicated in patients with tuberculosis of the skin, dermatologic fungal infections, and cutaneous or systemic viral infection (including vaccinia and varicella and herpes simplex of the eye or adjacent skin). However, most clinicians believe topical corticosteroids can be used with caution if the infection is treated.

Occlusive Dressings

Adverse systemic corticosteroid effects may occur with use of occlusive dressings on large areas of the body and for prolonged periods of time; monitor accordingly. (See Hypothalamic-Pituitary-Adrenal Axis Suppression and also Systemic Effects, under Cautions.)

Adverse local reactions may occur more frequently with the use of occlusive dressings, especially with prolonged therapy. (See Local Effects under Cautions.)

Do not use occlusive dressings on weeping or exudative lesions.

Do not use occlusive dressings in patients with primary skin infection.

Remove occlusive dressings covering large areas if body temperature increases; thermal homeostasis may be impaired.

Use plastic occlusive material with care to avoid the risk of suffocation.

Use of Fixed Combination

When used in fixed combination with other agents, consider the cautions, precautions, and contraindications associated with the concomitant agents.

Specific Populations

Pregnancy

Category C.

Lactation

Not known whether topical triamcinolone is distributed into milk. Caution advised if topical triamcinolone is used.

Pediatric Use

Safety and efficacy of triamcinolone acetonide paste not established.

Tight-fitting diapers or plastic pants should not be used on a child being treated with triamcinolone acetonide in the diaper area, since they may constitute occlusive dressings.

Children are more susceptible to topical corticosteroid-induced HPA-axis suppression and Cushing's syndrome than mature individuals because of a greater skin surface area-to-body weight ratio, especially when topical corticosteroids are applied to >20% of body surface area. The risk of adrenal suppression appears to increase with decreasing age. (See Systemic Effects under Cautions.)

Manifestations of adrenal suppression in children include linear growth retardation, delayed weight gain, low plasma cortisol concentrations, and lack of response to corticotropin (ACTH) stimulation.

Children also are at greater risk of glucocorticoid insufficiency during and/or after withdrawal of treatment.

Intracranial hypertension has occurred in children; manifestations include bulging fontanelles, headaches, and bilateral papilledema.

Striae has been reported in children treated inappropriately with topical corticosteroids.

Topical corticosteroid therapy in children should be limited to the minimum amount necessary for therapeutic efficacy; chronic topical corticosteroid therapy may interfere with growth and development.

Common Adverse Effects

Burning, itching, irritation, dryness, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis.

Interactions

Specific Drugs and Laboratory Tests

Pharmacokinetics

Absorption

Bioavailability

Topically applied triamcinolone can be absorbed through normal intact skin.

Percutaneous penetration can be increased by use of occlusive dressings and by presence of inflammation and/or other disease of the epidermal barrier (e.g., psoriasis, eczema).

Distribution

Extent

Not known whether topical triamcinolone is distributed into milk.

Elimination

Metabolism

Once absorbed through the skin, topically applied corticosteroids are metabolized primarily in the liver.

Elimination Route

Topical corticosteroids and metabolites are excreted by the kidneys and, to a lesser extent, in bile.

Stability

Storage

Topical

Cream and Ointment

15–30°C.

Paste

Tight containers at 15–25°C.

Lotion and Aerosol

Store according to the manufacturer’s directions.

Actions

• Produces anti-inflammatory, antipruritic, and vasoconstrictor actions, possibly resulting in part from steroid receptor binding.
• Precise mechanism of action for topical anti-inflammatory activity is unknown; therapeutic benefit in the management of corticosteroid-responsive dermatoses mediated primarily through anti-inflammatory, antipruritic, and vasoconstrictive actions.
• Anti-inflammatory effects may occur through induction of phospholipase A₂ inhibitory proteins (lipocortins); decreased arachidonic acid release from membrane phospholipids. Decreased arachidonic acid precursors may downregulate biosynthesis of potent inflammatory mediators (e.g., prostaglandins, leukotrienes).

Advice to Patients

• Importance of using only as directed, only for the disorder for which it was prescribed, and for no longer than prescribed; avoid contact with the eyes and only apply externally as directed. (See Topical Administration under Dosage and Administration.)
• Importance of informing patients that treated areas of the skin should not be bandaged or otherwise covered or wrapped as to be occlusive unless directed by a clinician.
• Importance of informing parents of children that if triamcinolone acetonide is applied in the diaper area that tight-fitting diapers or plastic pants should not be used since they may act as an occlusive dressing.
• Importance of reporting any local adverse reactions, especially those occurring under occlusive bandage, to a clinician.
• Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.
• Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.
• Importance of advising patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 09/2009. For the most current and up-to-date pricing information, please visit www.drugstore.com. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

AHFS Drug Information. © Copyright, 1959-2009, Selected Revisions July 2006. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.