Can I administer a Kenalog (triamcinolone acetonide) shot in the office to a patient who has completed oral prednisone and still has a poison ivy rash?

From the Guidelines

Yes, you can administer a Kenalog (triamcinolone acetonide) injection in the office to a patient who has completed oral prednisone but still has a persistent poison ivy rash. A typical dose would be 40-60 mg of triamcinolone acetonide administered intramuscularly, though the exact dose should be tailored to the severity of the rash and the patient's body weight 1. Before administering, confirm the patient has no contraindications such as systemic fungal infections, hypersensitivity to the medication, or certain immunocompromised states, as outlined in the guidelines for intralesional corticosteroid use 1. Also, verify when they completed their oral prednisone course, as ideally there should be minimal overlap between systemic steroid treatments. The Kenalog injection works by suppressing the inflammatory response and immune system activity that's causing the persistent rash. It provides a longer-acting anti-inflammatory effect than oral prednisone, often lasting 1-6 weeks, which can be beneficial for stubborn poison ivy reactions that haven't fully resolved with oral treatment. Inform the patient they may experience temporary side effects including elevated blood sugar, mood changes, or injection site discomfort, as well as potential adverse effects such as atrophy, pigmentary changes, and telangiectasias, hypertrichosis, infections, impaired wound healing, contact allergic dermatitis, sterile abscess, steroid acne, or anaphylaxis, angioedema, and urticaria 1. Key considerations for administration include:

• Dosing: 40-60 mg of triamcinolone acetonide intramuscularly
• Contraindications: systemic fungal infections, hypersensitivity, certain immunocompromised states, active infections, uncontrolled diabetes, heart failure, or severe hypertension
• Potential side effects: elevated blood sugar, mood changes, injection site discomfort, atrophy, pigmentary changes, telangiectasias, hypertrichosis, infections, impaired wound healing, contact allergic dermatitis, sterile abscess, steroid acne, anaphylaxis, angioedema, and urticaria.

From the FDA Drug Label

The initial dose of triamcinolone acetonide injectable suspension may vary from 2.5 mg to 100 mg per day depending on the specific disease entity being treated DOSAGE SYSTEMIC The suggested initial dose is 60 mg, injected deeply into the gluteal muscle In the treatment of acute exacerbations of multiple sclerosis, daily doses of 160 mg of triamcinolone for a week followed by 64 mg every other day for one month are recommended

The patient can be given a Kenalog (triamcinolone acetonide) shot in the office, but the dosage should be determined based on the specific disease entity being treated, in this case, poison ivy rash. A common dose for such conditions is 40 mg to 80 mg, depending upon patient response and duration of relief. However, it's crucial to consider the patient's overall clinical status and potential risks associated with corticosteroid therapy, as outlined in the drug label 2 and 2. Caution should be exercised, especially since the patient has just completed oral prednisone, to avoid potential adverse effects such as adrenal insufficiency or increased risk of infection.

From the Research

Administration of Kenalog Shot

• The patient has completed their last day of oral prednisone and still has a poison ivy rash, prompting consideration of a Kenalog (triamcinolone acetonide) shot in the office.
• There is no direct evidence in the provided studies regarding the administration of a Kenalog shot for poison ivy rash after completing oral prednisone.
• However, the studies suggest that the treatment of poison ivy dermatitis with oral corticosteroids may not be optimized, with shorter durations of treatment associated with increased risk of return visits 3.
• The use of systemic corticosteroids, such as oral prednisone, is a common treatment approach for poison ivy dermatitis, but the ideal duration of treatment is not well established 4, 3.
• In the absence of direct evidence, it is unclear whether administering a Kenalog shot would be an effective treatment approach for this patient's persistent poison ivy rash.

Considerations for Treatment

• The patient's completion of oral prednisone and ongoing rash may indicate a need for further treatment or alternative approaches.
• The studies highlight the importance of considering the duration of treatment and the potential for undertreatment or overtreatment of poison ivy dermatitis 4, 3.
• Healthcare providers should consider the individual patient's needs and circumstances when determining the best course of treatment for poison ivy dermatitis.