Triamcinolone Acetonide topical

General

• Consider location of the lesion and the condition being treated when choosing a dosage form.b

• Creams are suitable for most dermatoses, but ointments may also provide some occlusion and are usually used for the treatment of dry, scaly lesions.b

• Lotions are probably best for treatment of weeping eruptions, especially in areas subject to chafing (e.g., axilla, foot, groin).b Lotions, gels, and aerosols may be used on hairy areas, particularly the scalp.b

• Formulation affects percutaneous penetration and subsequent activity; extemporaneous preparation or dilution of commercially available products with another vehicle may decrease effectiveness.b

• Patients applying a topical corticosteroid to a large surface area and/or to areas under occlusion should be evaluated periodically for evidence of hypothalamic-pituitary-adrenal (HPA)-axis suppression by appropriate endocrine testing (e.g., ACTH stimulation, plasma cortisol, urinary free cortisol).a (See Hypothalamic-Pituitary-Adrenal Axis Suppresion and also Systemic Effects, under Cautions.)

Administration

Topical Administration

For dermatologic use only; avoid contact with eyes.a

The area of skin to be treated may be thoroughly cleansed before topical application to reduce the risk of infection; however, some clinicians believe that, unless an occlusive dressing is used, cleansing of the treated area is unnecessary and may be irritating.b

Apply cream, lotion, or ointment sparingly in a thin film and rub gently into the affected area.c

Use the 0.5% cream and 0.5% ointment only in the treatment of dermatoses that are refractory to treatment with lower concentrations.c

To apply triamcinolone acetonide aerosol, spray an area about the size of the patient’s hand for about 2 seconds from a distance of about 7.5–15 cm.c

For use in the mouth, press a small amount (about 0.6 cm) of the 0.1% paste to the lesion without rubbing until a thin film develops; a larger amount may be required to cover some lesions.c

After a favorable response is achieved, frequency of application or concentration (strength) may be decreased to the minimum necessary to maintain control and to avoid relapse; discontinue if possible.b

Dermatologic preparations of triamcinolone acetonide usually should not be used with occlusive dressings unless directed by a clinician.a However, when appropriate, occlusive dressings may be used as directed by a clinician to augment efficacy of triamcinolone preparations when treating severe or resistant dermatoses.c (See Occlusive Dressings under Cautions.)

Soak or wash the affected area to remove scales; apply a thin film of cream, lotion, or ointment; rub gently into the lesion; and apply another thin film.b Cover affected area with a thin, pliable plastic film and seal it to adjacent normal skin with adhesive tape or hold in place with a gauze or elastic bandage.b

If affected area is moist, incompletely seal the edges of the plastic film or puncture the film to allow excess moisture to escape.b For added moisture in dry lesions, apply cream, ointment, or lotion and cover with a dampened cloth before the plastic film is applied or briefly soak the affected area in water before application of the drug and plastic film.b

Thin polyethylene gloves may be used on the hands and fingers, plastic garment bags may be used on the trunk or buttocks, a tight shower cap may be used for the scalp, or whole-body suits may be used instead of plastic film to provide occlusion.b

Frequency of occlusive dressing changes depends on the condition being treated; cleansing of the skin and reapplication of the corticosteroid are essential at each dressing change.b

Occlusive dressing is usually left in place for 12–24 hours and therapy is repeated as needed.b Although occlusive dressing may be left in place for 3–4 days at a time in resistant conditions, most clinicians recommend intermittent use of occlusive dressings for 12 hours daily to reduce the risk of adverse effects (particularly infection) and systemic absorption and for greater convenience.b

The drug and an occlusive dressing may be used at night, and the drug or a bland emollient may be used without an occlusive dressing during the day.b

In patients with extensive lesions, sequential occlusion of only one portion of the body at a time may be preferable to whole-body occlusion.b (See Occlusive Dressings under Cautions.)

Dosage

Available as triamcinolone acetonide; dosage expressed in terms of the salt.a c

Pediatric Patients

Administer the least amount of topical preparations that provides effective therapy.a (See Pediatric Use under Cautions.)

Apply appropriate preparations of triamcinolone acetonide sparingly 2–4 times daily.a c

Apply 0.1 and 0.5% creams 2–3 times daily according to severity of the condition.a

Apply aerosol 3–4 times daily.c

Adults

Apply appropriate preparations of triamcinolone acetonide sparingly 2–4 times daily.a c

Apply 0.1 and 0.5% creams 2–3 times daily according to severity of the condition.a

Apply aerosol 3–4 times daily.c

Apply paste at bedtime and, if necessary, 2 or 3 times daily, preferably after meals.c If substantial regeneration or repair of oral tissues does not occur after 7 days, further investigate the etiology of the lesions.c

Specific Drugs and Laboratory Tests

Before using triamcinolone, tell your doctor or pharmacist if you are allergic to it; or to other corticosteroids (e.g., hydrocortisone, prednisone); or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: poor blood circulation, immune system problems.

Do not use if there is an infection or sore present in the area to be treated.

Rarely, using corticosteroid medications for a long time or over large areas of skin can make it more difficult for your body to respond to physical stress. Therefore, before having surgery or emergency treatment, or if you get a serious illness/injury, tell your doctor or dentist that you are using this medication or have used this medication within the past few months.

Though it is unlikely, this medication may slow down a child's growth if used for a long time. The effect on final adult height is unknown. See the doctor regularly so your child's height can be checked.

During pregnancy, this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

It is not known whether this drug passes into breast milk when applied to the skin. Other medications in this class pass into breast milk when taken by mouth. Consult your doctor before breast-feeding.