Is intramuscular (IM) kenalog (triamcinolone) 80 and oral prednisone for 7 days an appropriate initial treatment for a patient who developed a spreading red itchy patch near her right eye after petting a stray cat?

From the Guidelines

Intramuscular Kenalog (triamcinolone) 80 mg plus oral prednisone for 7 days is not an appropriate initial treatment for a spreading red itchy patch near the eye after contact with a stray cat. This presentation suggests either contact dermatitis or possibly cat scratch disease, and the recommended approach would be less aggressive. For suspected allergic contact dermatitis, a topical steroid like hydrocortisone 1% or triamcinolone 0.1% cream applied 2-3 times daily for 7-10 days would be more appropriate initial therapy, as suggested by management guidelines for pruritus 1. If infection is suspected (especially after animal contact), evaluation for bacterial infection might warrant topical or oral antibiotics, with azithromycin being a potential option for cat scratch disease, as indicated by a study on the treatment of cat scratch disease 1. The combination of high-dose intramuscular corticosteroid plus oral prednisone represents significant systemic steroid exposure with potential side effects including mood changes, elevated blood glucose, and immunosuppression, which could be particularly problematic given the potential for cat scratch disease to have a variable course, including the possibility of extranodal disease 1. This dual steroid approach is excessive for a localized reaction and could mask signs of infection if present. Additionally, the periocular location requires careful consideration, as steroid treatments near the eye should be monitored for potential ocular complications. A medical evaluation is recommended before treatment to determine the exact nature of the reaction. Key considerations in management include:

• Topical steroids for localized reactions
• Antibiotics for suspected bacterial infections, such as cat scratch disease
• Avoidance of excessive systemic steroid use to prevent masking of infection signs and potential side effects
• Careful monitoring of periocular steroid treatments for ocular complications.

From the FDA Drug Label

Allergic states: Control of severe or incapacitating allergic conditions intractable to adequate trials of conventional treatment in asthma, atopic dermatitis, contact dermatitis, drug hypersensitivity reactions, perennial or seasonal allergic rhinitis, serum sickness, transfusion reactions. The patient's symptoms of a spreading red itchy patch near her right eye after petting a stray cat could be indicative of an allergic reaction, such as contact dermatitis.

• Intramuscular (IM) kenalog (triamcinolone) 80 may be considered for the treatment of severe or incapacitating allergic conditions, including contact dermatitis.
• Oral prednisone for 7 days may also be used to treat allergic reactions, but the specific duration and dosage should be determined based on the severity of the condition and the patient's response to treatment. Given the potential for an allergic reaction, IM kenalog 80 and oral prednisone for 7 days could be an appropriate initial treatment, but it is essential to monitor the patient's response and adjust the treatment as needed 2.

From the Research

Treatment Options for Red Itchy Patch

• The patient's symptoms, which include a spreading red itchy patch near her right eye after petting a stray cat, may be indicative of an allergic reaction or cat scratch disease.
• There is limited direct evidence to support the use of intramuscular (IM) kenalog (triamcinolone) 80 and oral prednisone for 7 days as an initial treatment for this condition 3, 4, 5, 6, 7.
• However, corticosteroids such as triamcinolone and prednisone have been used to treat various inflammatory skin conditions and allergic reactions, including those caused by cat scratches 4, 5, 6.
• Topical corticosteroids are often considered a first-line treatment for inflammatory skin conditions, but the use of IM and oral corticosteroids may be considered in more severe cases or when topical treatment is not effective 3, 7.
• The choice of corticosteroid and route of administration should be based on the severity of the symptoms, the patient's medical history, and the potential risks and benefits of treatment 6, 7.

Considerations for Corticosteroid Use

• The use of corticosteroids, including triamcinolone and prednisone, can be associated with adverse effects, such as skin atrophy, striae, and systemic reactions 3, 6.
• The risk of adverse effects increases with prolonged use, high potency, and application to sensitive areas such as the face 3.
• Patients with a history of allergic reactions to corticosteroids may require alternative treatments or closer monitoring 6.
• The efficacy of topical versus oral corticosteroids may depend on various factors, including the potency of the corticosteroid, the frequency of application, and patient compliance 7.