Is Triamcinolone (a corticosteroid) associated with an increased risk of truancy in children and adolescents?

Triamcinolone and Risk of Truancy in Children and Adolescents

Based on the available evidence, there is no established association between triamcinolone (a corticosteroid) and increased risk of truancy in children and adolescents.

Evidence Review

The guidelines and research evidence do not specifically mention truancy as an adverse effect of triamcinolone administration in any form (intralesional, intranasal, or systemic).

Neuropsychiatric Effects of Triamcinolone

When examining potential neuropsychiatric effects that could theoretically contribute to school attendance issues:

• The American College of Rheumatology guidelines for juvenile idiopathic arthritis (JIA) list "severe depression or psychosis" as contraindications for intralesional triamcinolone acetonide, but do not mention truancy or school avoidance behavior 1.

• For intranasal triamcinolone acetonide used in allergic rhinitis, the most common side effects include pharyngitis, epistaxis, and cough, with no mention of behavioral or psychiatric effects that could lead to truancy 1.

Systemic Effects and Absorption

• Intranasal triamcinolone acetonide is not significantly absorbed into the systemic circulation and does not suppress hypothalamic-pituitary-adrenal (HPA) axis function at therapeutic dosages 2.

• Studies in children receiving daily intranasal triamcinolone acetonide for 12 months showed no effect on height and bodyweight, suggesting minimal systemic absorption 3.

• For topical application, a study examining 0.1% triamcinolone acetonide ointment applied four times daily for six weeks in children with severe atopic eczema found no notable adrenal suppression 4.

Potential Concerns with Systemic Administration

When triamcinolone is administered systemically or through intralesional injection with significant absorption:

• In rare cases, systemic absorption of triamcinolone acetonide can lead to Cushing's syndrome, as reported in children receiving intralesional injections for urethral strictures 5.

• For intramuscular triamcinolone acetonide used in nephrotic syndrome, growth velocity decreased during treatment but returned to normal after discontinuation 6.

Clinical Implications

1. Route of Administration Matters:

   • Intranasal and topical triamcinolone have minimal systemic absorption and are unlikely to cause behavioral effects.
   • Intralesional and intramuscular injections have greater potential for systemic effects but truancy is not among reported adverse events.

2. Monitoring Recommendations:

   • For intranasal triamcinolone: No specific monitoring for behavioral changes is recommended in guidelines 1.
   • For intralesional triamcinolone: Monitor for local effects (atrophy, pigmentary changes) and potential HPA axis suppression with repeated injections 1.

3. Alternative Considerations:

   • For JIA, triamcinolone hexacetonide is strongly recommended over triamcinolone acetonide for intraarticular injections due to better efficacy 1.
   • If behavioral changes are a concern, other treatment options should be considered based on the specific condition being treated.

Conclusion

There is no evidence in the provided guidelines or research to suggest that triamcinolone administration is associated with truancy in children and adolescents. When prescribing triamcinolone, clinicians should follow standard monitoring practices for the specific formulation being used, but specific monitoring for truancy or school avoidance is not indicated based on current evidence.