When is triamcinolone (corticosteroid) indicated for use?

When to Use Triamcinolone

Triamcinolone is indicated for inflammatory and pruritic corticosteroid-responsive dermatoses, inflammatory nodulocystic acne, intra-articular injection for juvenile idiopathic arthritis and gout, and as intranasal therapy for allergic rhinitis. 1

Dermatologic Indications

Acne Vulgaris

• Use intralesional triamcinolone acetonide for inflammatory nodulocystic acne and acne keloidalis 2
• Inject triamcinolone acetonide 10 mg/mL (may be diluted to 5 or 3.3 mg/mL with sterile normal saline) directly into nodular acne lesions 2
• For acne keloidalis, inject triamcinolone acetonide -10 into inflammatory follicular lesions 2
• For hypertrophic scars and keloids, use triamcinolone acetonide -40 2
• This treatment flattens most acne nodules within 48 to 72 hours 2
• Intralesional triamcinolone is efficacious for occasional or particularly stubborn cystic lesions but is not an effective strategy for patients with multiple lesions 2

Corticosteroid-Responsive Dermatoses

• Use triamcinolone acetonide ointment for relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses 1
• For recurrent lesions in children, consider intralesional triamcinolone hexacetonide (5-10 mg/mL) over triamcinolone acetonide, as it provides more complete and longer duration of clinical response 3

Rheumatologic Indications

Juvenile Idiopathic Arthritis (JIA)

• Intra-articular glucocorticoids are strongly recommended as part of initial therapy for active oligoarthritis 2
• Triamcinolone hexacetonide is strongly recommended over triamcinolone acetonide for intra-articular injections in JIA, as randomized trials and observational studies demonstrate more durable clinical responses 2
• Use intra-articular glucocorticoids as adjunct therapy in polyarticular JIA when arthritis is preventing ambulation or interfering with important daily activities 2
• Intra-articular injections may not be appropriate for large numbers of joints or joints injected multiple times; escalate to systemic therapy in these situations 2

Gout

• For acute gout involving 1-2 large joints, use intra-articular corticosteroids as an appropriate option 2
• Dose intra-articular corticosteroid therapy based on the size of the involved joint(s) 2
• Combine intra-articular corticosteroids with oral corticosteroids, NSAIDs, or colchicine as needed 2
• For polyarticular gout where intra-articular injection is impractical, use intramuscular triamcinolone acetonide 60 mg as a single dose, followed by oral prednisone or prednisolone 2

Early Rheumatoid Arthritis

• Among intra-articular corticosteroids, triamcinolone hexacetonide is the most effective for relieving local symptoms of inflammation 2
• Use intra-articular steroids as an adjunct to DMARDs for relieving local joint symptoms 2

Respiratory Indications

Asthma

• Consider intramuscular triamcinolone acetonide for highly select older steroid-dependent asthma patients who remain functionally crippled despite maximal medical therapies 4
• High-dose intramuscular triamcinolone (360 mg) can resolve asthma symptoms within 1 week in severe, chronic, steroid-dependent asthma, with response durations ranging from 3 to 24 months 4
• Use triamcinolone acetonide aerosol (400-1,400 mcg/day in 4 divided doses) as effective replacement for systemic corticosteroid therapy in severe, chronic asthma 5
• This approach allows oral corticosteroids to be stopped or reduced while maintaining asthma control and restoring adrenal cortical function 5

Allergic Rhinitis

• Use intranasal triamcinolone acetonide 110-220 mcg once daily as first-line therapy for moderately severe seasonal allergic rhinitis with predominantly nasal symptoms 6
• Also indicated for perennial allergic rhinitis in children and adults 6
• Triamcinolone acetonide reduces symptoms within the first day of administration 6
• Once symptoms are controlled, reduce dosage from 220 to 110 mcg/day without loss of effect 6

Critical Contraindications

• Do not inject at sites of active infections such as impetigo or herpes 2
• Avoid in patients with previous hypersensitivity to triamcinolone 2
• Avoid large injections in patients with active tuberculosis or systemic fungal infection 2
• Do not use in extensive plaque psoriasis, pustular psoriasis, or erythrodermic psoriasis 2
• Contraindicated in active peptic ulcer disease, uncontrolled diabetes, heart failure, or severe hypertension 2
• Avoid in severe depression or psychosis 2

Important Safety Considerations

• Local overdose of intralesional triamcinolone can result in atrophy, pigmentary changes, telangiectasias, and hypertrichosis 2
• Repeated injections can suppress the hypothalamic-pituitary-adrenal axis 2
• Monitor for infections, impaired wound healing, sterile abscess, and steroid acne 2
• In children, avoid long-term continuous use due to risk of skin atrophy, growth suppression, and HPA axis suppression 3
• Use the minimum effective amount and consider periodic breaks in treatment 3
• Rare but serious reactions include anaphylaxis, angioedema, and urticaria 2