From the FDA Drug Label
If HPA axis suppression or elevation of the body temperature occurs, an attempt should be made to withdraw the drug, to reduce the frequency of application, substitute a less potent steroid, or use a sequential approach when utilizing the occlusive technique. The risks of using triamcinolone injections before subcutaneous hormone pellet insertion include:
- HPA axis suppression: The use of triamcinolone may suppress the hypothalamic-pituitary-adrenal (HPA) axis, which can lead to various systemic effects.
- Elevation of body temperature: Triamcinolone may cause an increase in body temperature.
- Steroid withdrawal symptoms: If the drug is withdrawn, patients may experience signs and symptoms of steroid withdrawal, requiring supplemental systemic corticosteroids 1. It is essential to exercise caution when using triamcinolone injections, especially in pediatric patients, as they may be more susceptible to systemic toxicity due to their larger skin surface area to body weight ratio.
From the Research
Triamcinolone injections before hormone pellet insertion should be avoided due to significant risks, as they can increase infection risk, impair wound healing, and cause local tissue atrophy, as supported by the most recent study 2 that highlights the potential for serious infections following corticosteroid injections. The primary concern is that corticosteroids like triamcinolone suppress local immune function and inflammation, which can increase infection risk at the pellet insertion site. Additionally, corticosteroids may impair proper wound healing, potentially leading to delayed closure of the insertion site, extrusion of the pellet, or formation of excessive scar tissue. These medications can also cause local tissue atrophy and thinning, which might compromise the structural integrity of the subcutaneous pocket where the pellet is placed. From a pharmacological perspective, triamcinolone could potentially interact with the hormones in the pellet, altering their release rate or effectiveness, as suggested by studies on the pharmacokinetics of subcutaneous testosterone pellets 3. If local anesthesia is needed for the procedure, lidocaine without epinephrine is generally preferred as it provides adequate pain control without the immunosuppressive effects of corticosteroids. Patients experiencing post-insertion discomfort are better managed with appropriate non-steroidal anti-inflammatory medications rather than corticosteroid injections. Some studies have explored the use of triamcinolone injections for various conditions, including lipomas 4 and capsular contracture 5, but these do not directly address the risks associated with its use prior to hormone pellet insertion. The most critical consideration is the potential for increased infection risk, as demonstrated by the outbreak of joint and cutaneous infections caused by non-tuberculous mycobacteria after corticosteroid injection 2, emphasizing the need for caution when using triamcinolone injections in this context. Key points to consider include:
- Increased infection risk at the pellet insertion site
- Impaired wound healing and potential for delayed closure or extrusion of the pellet
- Local tissue atrophy and thinning compromising the structural integrity of the subcutaneous pocket
- Potential interaction with hormones in the pellet altering their release rate or effectiveness
- Preference for lidocaine without epinephrine for local anesthesia and non-steroidal anti-inflammatory medications for post-insertion discomfort.