From the FDA Drug Label
INDICATIONS AND USAGE Triamcinolone acetonide cream, 0.1% is indicated for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses. DOSAGE AND ADMINISTRATION Apply triamcinolone acetonide cream USP, 0. 1% as appropriate, to the affected area two to three times daily. The patient was using triamcinolone daily, but the recommended dosage is two to three times daily 1 1.
- The patient's daily usage may not be in line with the recommended dosage.
- It is important to follow the recommended dosage to avoid any potential side effects. The decision to stop using triamcinolone and prescribe Clobetasol seems cautious, given the patient's history of using triamcinolone for an extended period.
From the Research
I strongly recommend discontinuing triamcinolone and starting a non-steroidal treatment, such as pimecrolimus, to minimize the risk of skin thinning, increased susceptibility to infections, and steroid-dependent dermatitis, as daily long-term use of topical steroids can have severe consequences on morbidity, mortality, and quality of life. This 62-year-old male patient has been inappropriately using triamcinolone daily for two years to treat a chronic rash on his forearms that developed after chemical exposure at work. According to a study published in the Journal der Deutschen Dermatologischen Gesellschaft 2, pimecrolimus has been shown to be effective in treating atopic dermatitis with minimal side effects, making it a suitable alternative to topical corticosteroids.
The patient's history of chemical exposure at work suggests that the underlying cause of the rash may be occupational dermatitis, which may require additional interventions beyond topical treatment. A follow-up appointment in one month will allow assessment of the response to treatment and consideration of alternative therapies if needed. During treatment, the patient should avoid further chemical irritants and use gentle, fragrance-free soaps and moisturizers.
Some key points to consider in the treatment of this patient include:
- Avoiding further chemical irritants to prevent exacerbation of the condition
- Using gentle, fragrance-free soaps and moisturizers to minimize skin irritation
- Considering alternative therapies, such as pimecrolimus, to minimize the risk of skin thinning and steroid-dependent dermatitis
- Scheduling a follow-up appointment to assess the response to treatment and consider additional interventions if needed, as suggested by studies on the treatment of atopic dermatitis and seborrheic dermatitis 3, 4, 5.