A prospective observational study evaluating hypothalamic-pituitary-adrenal axis alteration and efficacy of intramuscular triamcinolone acetonide for steroid-responsive dermatologic disease

Severe alopecia areata (AA) can have an unpredictable clinical course and become refractory to contact immunotherapy. Novel treatment options include low-dose interleukin-2 and Janus kinase inhibitors; however, these treatments are still under investigation. Therefore, we evaluated the efficacy and safety of intramuscular (i.m.) triamcinolone acetonide (TAC) as a rescue therapy for refractory AA. We retrospectively analysed efficacy, adverse effects and relapse rate of i.m. TAC monthly in 27 patients with refractory AA. We defined AA as refractory if the patient showed an unsatisfactory response to both systemic treatment (not i.m. TAC) and the consecutive diphenylcyclopropenone immunotherapy. The initial systemic treatment of other forms of corticosteroids and/or cyclosporin was used to control extensive AA involving more than 25% of the scalp. Administration of i.m. TAC for 3-6 months resulted in a 63.0% response rate, and all patients showed inactive disease after treatment. Final hair regrowth negatively correlated with initial scalp involvement (Spearman r = -0.595, P = 0.001). All patients showed complete recovery of adrenocortical reserve within 3 months after the last injection. Adverse effects of systemic steroid therapy were observed only in female patients (dysmenorrhea and osteoporosis). i.m. TAC may provide a valuable therapeutic option to manage active hair loss and facilitate hair regrowth in refractory AA, especially in male patients.

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“…Reddy et al 12 evaluated the use of i.m. TAC in the treatment of steroid-responsive dermatological diseases, concluding that i.m.…”

Section: Discussionmentioning

confidence: 99%

“…Although i.m. TAC is an important therapeutic option in various steroid‐responsive dermatoses, concerns regarding the adverse effects of systemic steroids have limited the use of this drug . In this study, we report our 5 years' experience with i.m.…”

Section: Introductionmentioning

confidence: 99%

Intramuscular triamcinolone acetonide: An undervalued option for refractory alopecia areata

Seo

Lee

Hwang

et al. 2016

The Journal of Dermatology

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“…30–60 mg doses every 6 weeks) has not been shown to cause secondary adrenal insufficiency or iatrogenic CS, despite temporary HPA‐axis suppression. [19]…”

Section: Discussionmentioning

confidence: 99%

Serum triamcinolone levels during intensive, inpatient wet‐dressing therapy

et al. 2020

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Summary Background Wet dressings combined with topical corticosteroids are beneficial for patients with generalized and refractory dermatosis; however, to our knowledge, serum levels after topical corticosteroid absorption during intensive therapy have not been reported previously. Aim To examine serum levels of triamcinolone acetonide (TAC) after topical corticosteroid application during intensive wet‐dressing therapy. Methods We performed a retrospective study of adult patients admitted for inpatient wet‐dressing therapy from 7 November 2015 to 24 June 2016. Data were collected on sex, age, body surface area, TAC serum levels, number of wet‐dressing changes after 24 and 48 h, and type of wet dressing. Results In total, 29 patients (14 men, 15 women) were assessed. Median [interquartile range (IQR)] age was 57 years (51.5–67.0 years) and involved body surface area was 1.98 m2 (1.88–2.15) m2. Before the 24‐hour blood draw, patients had received 1–3 dressing changes. Median (IQR) TAC level at 24 h was 0.33 µg/dL (0.20–0.58 µg/dL), with no significant difference noted between the number of dressing changes and TAC serum level. At 48 h, results of a serum TAC test were available for 22 patients with 2–6 dressing changes. Mean (IQR) serum level was 0.30 µg/dL (0.30–0.87 µg/dL). For each additional dressing change, there was an estimated 0.21 µg/dL increase in TAC serum level (95% CI 0.11–0.31; P < 0.001). TAC serum level was not significantly associated with sex, age, body surface area or dressing type. Conclusions Intensive, inpatient wet‐dressing therapy is associated with detectable TAC serum levels. However, we suspect that topical TAC has a primarily local therapeutic effect on the skin.

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“…12 Whilst there are no quality studies of oral corticosteroid use for the management of atopic dermatitis, [13][14][15][16][17] they are widely prescribed, with a high satisfaction rating by patients. 7,18 Similarly, the studies of intramuscular triamcinolone, 19,20 intravenous methylprednisolone 21 or subcutaneous ACTH depot 22,23 are all of low quality, although they do indicate short-term response. A 4-week study in 26 children with severe atopic dermatitis compared combined oral and nasal beclomethasone dipropionate (1200 lg/day) to placebo.…”

Section: Corticosteroids (Oral Intramuscular Intravenous)mentioning

confidence: 99%

Managing atopic dermatitis with systemic therapies in adults and adolescents: An Australian/New Zealand narrative

Rademaker

Agnew

Andrews³

et al. 2019

Aust J Dermatology

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With the rapid development of new, targeted therapies for the treatment of moderate/severe atopic dermatitis, it is opportune to review the available conventional systemic agents. We assess the published evidence for systemic therapies for atopic dermatitis and amalgamate this with real‐world experience. Discussions are centred on when systemic therapy should be considered, which drug(s), what dose, how to sequence or combine these therapies, how long they should be continued for and what is considered success.

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A prospective observational study evaluating hypothalamic-pituitary-adrenal axis alteration and efficacy of intramuscular triamcinolone acetonide for steroid-responsive dermatologic disease

Cited by 20 publications

References 9 publications

Intramuscular triamcinolone acetonide: An undervalued option for refractory alopecia areata

Intramuscular triamcinolone acetonide: An undervalued option for refractory alopecia areata

Serum triamcinolone levels during intensive, inpatient wet‐dressing therapy

Managing atopic dermatitis with systemic therapies in adults and adolescents: An Australian/New Zealand narrative

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