Can triamcinolone be prescribed for toddlers with inflammatory conditions?

From the Guidelines

Triamcinolone can be prescribed for toddlers in certain situations, such as for the treatment of juvenile idiopathic arthritis (JIA), but it should be done with caution and under a doctor's supervision. The medication is available in different forms, including topical creams, ointments, nasal sprays, and injectable formulations. For toddlers, doctors typically prescribe the lowest effective dose for the shortest duration possible to minimize potential side effects, as recommended by the 2021 American College of Rheumatology guideline for the treatment of JIA 1.

Key Considerations

• Common uses in toddlers include treating skin conditions like eczema, allergic reactions, or inflammatory conditions.
• Dosing depends on the specific formulation, the child's weight, and the condition being treated.
• For topical applications, a thin layer applied to affected areas once or twice daily is common, while nasal sprays might be prescribed at 1-2 sprays per nostril daily.
• Parents should be aware that long-term use of corticosteroids like triamcinolone in children may potentially affect growth and development, as noted in the 2021 guideline 1.
• Side effects can include skin thinning with topical use or, with systemic absorption, immune suppression and adrenal gland effects.

Recommendations

• Intraarticular glucocorticoids (IAGCs) are strongly recommended as part of initial therapy for active oligoarthritis, with triamcinolone hexacetonide being the preferred agent 1.
• Oral glucocorticoids are conditionally recommended against as part of initial therapy for active oligoarthritis, but may be used to quickly alleviate severe symptoms when an IAGC is not available or feasible 1.
• The use of IAGCs, such as triamcinolone hexacetonide, has been shown to be effective in achieving and maintaining remission in children with JIA, as supported by published randomized trials and large observational studies 1.

Important Notes

• Always follow the pediatrician's instructions exactly, never increase the dose without medical advice, and report any concerning symptoms promptly.
• The 2021 American College of Rheumatology guideline for the treatment of JIA emphasizes the importance of clinical judgment and shared decision-making in everyday care of individuals with JIA, particularly in the context of limited high-quality evidence 1.

From the FDA Drug Label

Pediatric patients may demonstrate greater susceptibility to topical corticosteroid induced HPA axis suppression and Cushing’s syndrome than mature patients because of a larger skin surface area to body weight ratio Administration of topical corticosteroids to children should be limited to the least amount compatible with an effective therapeutic regimen. Chronic corticosteroid therapy may interfere with the growth and development of children.

Triamcinolone can be prescribed for toddlers, but with caution and in limited amounts, as they may be more susceptible to systemic toxicity and HPA axis suppression due to their larger skin surface area to body weight ratio 2. Close monitoring is necessary to avoid potential adverse effects on growth and development.

From the Research

Use of Triamcinolone in Toddlers

• There is limited information available on the use of triamcinolone in toddlers, but a case report published in 2020 3 highlights the risks of systemic absorption when prescribing topical medications in the diaper area of an infant.
• The report emphasizes the importance of caution and proper follow-up when prescribing even mid-potency steroids to pediatric patients.
• Other studies focus on the use of triamcinolone in various conditions such as respiratory inflammation, rheumatoid arthritis, and inflammatory dermatoses, but do not specifically address its use in toddlers 4, 5, 6, 7.
• The available evidence suggests that triamcinolone can be used in children, but its use should be carefully considered and monitored due to the potential risks of systemic absorption and adrenal insufficiency.

Safety and Efficacy

• A study published in 2014 6 found that intra-articular injections of triamcinolone acetonide and triamcinolone hexacetonide have a low side effect profile and can provide good clinical benefit for up to 6 months.
• Another study published in 2010 7 found that intralesional steroid (usually triamcinolone acetonide) is safe and effective in treating inflammatory dermatoses such as psoriasis and localized dermatitis.
• However, these studies do not specifically address the use of triamcinolone in toddlers, and more research is needed to determine its safety and efficacy in this age group.

Prescribing Considerations

• When considering prescribing triamcinolone to a toddler, it is essential to weigh the potential benefits against the potential risks and to carefully monitor the child for signs of systemic absorption and adrenal insufficiency 3.
• The dosage and duration of treatment should be carefully considered, and the child should be closely monitored for any adverse effects.
• Further research is needed to provide guidance on the safe and effective use of triamcinolone in toddlers.