The steroids within this category include Triamcinolone Acetonide (triamcinolone acetonide cream). Triamcinolone Acetonide (triamcinolone acetonide cream) is designated chemically as 9-Fluoro-11β,16α,17,21-tetrahydroxypregna-1,4-diene-3,20-dione cyclic 16,17-acetal using acetone. Together with the molecular formula of C24H31FO6 along with a molecular weight of 434.51. The formula is:
Each g of Triamcinolone Acetonide (triamcinolone acetonide cream) Cream USP, 0.1% includes 1 mg Triamcinolone Acetonide (triamcinolone acetonide cream) in a cream base consisting of cetyl alcohol, glyceryl monostearate, cetyl esters wax, isopropyl palmitate, polysorbate-60, polysorbate-80, propylene glycol and purified water.
Triamcinolone acetonide (triamcinolone acetonide cream) cream is approved for the relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.
Apply to the affected area a few times. Rub in lightly.
Occlusive dressings may be used for the management of both psoriasis or alternative recalcitrant problems. Rub a little bit of lotion until it evaporates. The groundwork leaving a thin coating pay using a nonporous movie that is pliable, and seal the borders. If necessary moisture could be provided by covering the lesion using a cotton fabric prior to the nonporous movie is implemented or by temporarily wetting the area with water before applying the medicine. The frequency of dressings is determined on an individual basis. It could be convenient to employ triamcinolone acetonide lotion under an occlusive dressing in the day and also to eliminate the dressing in the daytime (i.e., 12-hour occlusion). When using the 12-hour occlusion regimen cream ought to be implemented, without occlusion. Reapplication is vital at every dressing change.
Conditions that augment systemic absorption include the application of the more potent steroids, use over large surface areas, prolonged use, and the addition of occlusive dressings.
Therefore, patients receiving a large dose of a potent topical steroid applied to a large surface area or under an occlusive dressing ought to be evaluated periodically for evidence of HPA axis suppression by using the urinary free cortisol and ACTH stimulation tests, also for disability of thermal homeostasis. If HPA axis suppression or elevation of the body temperature happens, an effort ought to be made to take the medication, to decrease the frequency of program, substitute a less potent steroid, or utilize a sequential approach when using the technique.
Recovery of HPA axis function and homeostasis is usually prompt and complete upon discontinuation of this medication. Signs and symptoms of steroid withdrawal may occur, requiring supplemental systemic corticosteroids. At times, a patient can develop a sensitivity response to an occlusive dressing glue or material, and a replacement substance might be critical.
In the presence of dermatological infections, the use of an appropriate antifungal or antibacterial representative ought to be instituted. If a favorable response doesn’t occur promptly, the corticosteroid ought to be discontinued until the infection has been adequately controlled.
These trainings aren’t right for ophthalmic usage.
A sinus free cortisol evaluation and ACTH stimulation test may be useful in evaluating HPA axis suppression.
Long-term animal studies haven’t been performed to assess the carcinogenic possible or the effect on fertility of topical corticosteroids.
Studies to determine mutagenicity using prednisolone and hydrocortisone have shown negative results.
Corticosteroids are usually teratogenic in laboratory animals when administered systemically at relatively low dose levels. The more potent corticosteroids have been shown to become teratogenic following dermal program in lab animals. Therefore, topical corticosteroids should be used during pregnancy if the possible benefit justifies the possible risk. Drugs of this class shouldn’t be used extensively in massive amounts, or for prolonged amounts of time.
It isn’t known whether topical administration of corticosteroids could lead to sufficient systemic absorption to produce detectable levels in breastfeeding. Systemically administered corticosteroids are secreted into breast milk in quantities not going to have a deleterious effect on the baby. Caution ought to be exercised when topical corticosteroids are administered to a nursing woman.
Pediatric patients may demonstrate greater susceptibility to topical corticosteroid-induced HPA axis suppression and Cushing’s syndrome than mature patients because of a larger skin surface area to body weight ratio.
Hypothalamic-pituitary-adrenal (HPA) axis suppression, Cushing’s syndrome, and intracranial hypertension have been reported in pediatric patients receiving topical corticosteroids. Manifestations of adrenal suppression in pediatric patients include linear growth retardation, delayed weight gain, low plasma cortisol levels, and absence of response to ACTH stimulation. Manifestations of intracranial hypertension include bulging fontanelles, headaches, and bilateral papilledema.
Administration of topical corticosteroids to pediatric patients should be restricted to the least amount. Chronic corticosteroid therapy may interfere with the development and the growth of pediatric patients.
Topical corticosteroids share anti-inflammatory, antipruritic, and vasoconstrictive actions.
The mechanics of the anti-inflammatory action of topical corticosteroids is uncertain. Various laboratory procedures, including vasoconstrictor assays, are utilized to evaluate and predict potencies and/or clinical efficacies of the topical corticosteroids. There’s some evidence to indicate that a recognizable correlation exists between vasoconstrictor potency and therapeutic efficacy in man.
The magnitude of percutaneous absorption of topical corticosteroids is determined by several factors including the vehicle, the ethics of this epidermal barrier, and the use of occlusive dressings.
Topical corticosteroids can be absorbed from normal intact skin. Inflammation or alternative disease processes in the skin increase percutaneous absorption. Occlusive dressings substantially increase the percutaneous absorption of topical corticosteroids. Thus, occlusive dressings may be a valuable therapeutic adjunct for the treatment of resistant dermatoses (Watch DOSAGE AND ADMINISTRATION segment ).
Once absorbed through the skin, topical corticosteroids are handled through pharmacokinetic pathways similar to systemically administered corticosteroids. Corticosteroids are bound to plasma proteins in varying amounts. Corticosteroids are metabolized primarily in the liver and are then excreted by the kidneys. Some of the topical corticosteroids and their metabolites are also excreted into the bile.