Triamcinolone Indications and Dosing Guidelines
Triamcinolone acetonide is indicated for inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses, inflammatory nodulocystic acne, acne keloidalis, allergic rhinitis, and asthma, with specific formulations and dosing regimens depending on the condition being treated. 1, 2, 3
Dermatological Indications
Corticosteroid-Responsive Dermatoses
- Formulation: Cream (0.025%, 0.1%, 0.5%)
- Dosing:
- 0.025% cream: Apply to affected area 2-4 times daily
- 0.1% or 0.5% cream: Apply to affected area 2-3 times daily
- Rub in gently 1
- Occlusive Dressing Technique:
- For psoriasis or recalcitrant conditions
- Apply thin coating, cover with nonporous film
- Can use 12-hour occlusion (evening to morning)
- Discontinue if infection develops 1
Inflammatory Nodulocystic Acne and Acne Keloidalis
- Formulation: Intralesional injection
- Dosing:
- Nodular acne: 10 mg/mL (may be diluted with sterile normal saline to 5 or 3.3 mg/mL)
- Acne keloidalis: 10 mg/mL into inflammatory follicular lesions
- Hypertrophic scars and keloids: 40 mg/mL 3
- Efficacy: Flattens most acne nodules in 48-72 hours
- Limitations: Not effective for patients with multiple lesions 3
Psoriasis
- Formulation: Intralesional injection
- Dosing: Up to 20 mg/mL every 3-4 weeks, with injection volume varying based on lesional size and affected area 3
Respiratory Indications
Allergic Rhinitis
- Formulation: Nasal spray (55 μg per spray)
- Dosing:
- Ages 2-5 years: 1 spray per nostril daily
- Ages 6-11 years: 2 sprays per nostril daily
- Ages ≥12 years: 2 sprays per nostril 1-2 times per day 3
- Efficacy: Reduces symptoms of allergic rhinitis within the first day of administration 4
- Availability: Over-the-counter 3
Asthma
- Formulation: Inhalation aerosol (100 μg per puff)
- Dosing:
- Efficacy: Significant improvements in symptoms, pulmonary function, and rescue medication use within 1-2 weeks 6
Systemic Use
Severe Asthma (Intramuscular)
- Formulation: Injectable suspension
- Dosing: High-dose intramuscular triamcinolone (360 mg over three days) has shown efficacy in severe, chronic, life-threatening asthma 7
Atopic Dermatitis (Oral)
- Formulation: Oral tablets
- Dosing: 0.5-1.0 mg/kg
- Duration: Short-term use only with taper
- Note: Generally avoided in adults and children with atopic dermatitis due to potential short-term and long-term adverse effects 3
Contraindications
- Hypersensitivity to triamcinolone or any components
- Active infections at injection site (impetigo, herpes)
- For large injections: active tuberculosis or systemic fungal infection
- Extensive plaque psoriasis, pustular psoriasis, or erythrodermic psoriasis
- Active peptic ulcer disease
- Uncontrolled diabetes, heart failure, or severe hypertension
- Severe depression or psychosis 3
Adverse Effects
Local (Topical/Intralesional)
- Skin atrophy, pigmentary changes, telangiectasias, hypertrichosis
- Impaired wound healing
- Contact allergic dermatitis (from preservative)
- Sterile abscess
- Steroid acne 3
Systemic
- Repeated injections can suppress the hypothalamic-pituitary-adrenal axis
- Anaphylaxis, angioedema, and urticaria (rare)
- For oral use: hypertension, glucose intolerance, gastritis, weight gain, decreased bone density, adrenal suppression, emotional lability 3
Monitoring
- For long-term systemic use: blood pressure, ophthalmologic examination, HPA axis suppression testing, bone density evaluation (adults), growth velocity measurement (children) 3
- For intranasal use: No significant HPA axis suppression at therapeutic doses 4, 8
Special Considerations
- Pediatric use: Growth monitoring required for long-term use
- Urticaria: Intralesional triamcinolone can be considered for localized itching 9
- Asthma: Inhaled triamcinolone has been shown to be more effective than salmeterol monotherapy for persistent asthma 3
Always consider the risk-benefit ratio when prescribing triamcinolone, particularly for long-term use, and use the lowest effective dose for the shortest duration possible.