Triamcinolone acetonide cream

Triamcinolone is one of the corticosteroids that is given in the form of acetonide. It is used as an anti-inflammatory agent. This drug can be used for topical purposes in the form of cream, where it can be used in the treatment of eczema or inflammation associated with allergic conditions. It can control pruritus and reduce itching. This drug is also available as an injection, where it is used to treat inflammatory disorders such as rheumatoid arthritis. For this purpose, it is given as an intra-articular injection. It can also be given as an intra-lesion injection, and it can even be used for the treatment of ocular inflammation. In many systemic inflammatory disorders, triamcinolone acetonide can be given by the systemic route. However, when administered topically as a cream, it is important to understand how it works, how to use it, and what precautions should be taken.

Precautions

Triamcinolone can be applied to the skin by topical route. When it is applied to the affected area, it is going to be absorbed into the skin, which can reduce the inflammatory response. But few of the molecules can enter deeper into the skin, where they can be absorbed into the systemic circulation, resulting in systemic side effects. Particularly, it can suppress the HPA-axis, hypothalamus pituitary, and adrenal axis. Because of the suppression of the HPA-axis due to the auto-inhibitory mechanism, cortisol is somewhat less released from the adrenal cortex.

Systemic absorption of triamcinolone is more pronounced in children, so in children it should be carefully applied. A small quantity should be applied in order to reduce systemic absorption. Due to the suppression of the HPA-axis, triamcinolone can produce various effects, such as hyperglycemia, which leads to increased blood glucose levels, and glucosuria, which results in increased glucose levels within the urine.

It can also produce various symptoms collectively known as Cushing's syndrome, resulting in increased weight gain, fat deposition, and elevated blood glucose. All these can be observed because of the suppression of the HPA-axis. So care should be taken to avoid systemic absorption, and this cream should be applied only to the affected area at a low concentration to reduce the systemic effects.

Since triamcinolone is available as a cream, it can be applied to the affected area, but that area should not be covered with bandages or surgical dressings. Any occlusive dressing may increase systemic absorption, which increases systemic side effects. That's why bandages and occlusive dressings are not preferred with triamcinolone acetate cream.

How does it work?

Within the inflammatory cells, triamcinolone can enter, and it can act on the glucocorticoid receptors present within the cytoplasm. So once they activate the glucocorticoid receptor, they can interact with the DNA within the nucleus. Triamcinolone can bind to these glucocorticoid receptors, where it is going to be internalized into the nucleus and then dimerized. After dimerization, these glucocorticoid receptors can produce gene transcription, which results in the synthesis of mRNA. Now this mRNA acts as a template for the ribosome, where it can produce various proteins such as lipocortin-1 and annexin-A1. These proteins can produce an anti-inflammatory response as well as control the inflammatory cascade.

Similarly, few of the inflammatory mediators can activate their corresponding receptors, thereby stimulating one of the pathways NFkB, nuclear factor kappa B. This NFkB can interact with the DNA, resulting in gene transcription, but this time it produces genes that are going to release inflammatory mediators, so this increases inflammation. Now, triamcinolone can inhibit this NFkB pathway, thereby inhibiting the release of inflammatory mediators. In this way, triamcinolone acetonide acts as an anti-inflammatory agent.

In many of the cells, inflammatory stimuli may result in the activation of phospholipase A2, which can act on the phospholipids, resulting in the cleavage of the phospholipids, which can produce one of the intermediate arachidonic acids. This arachidonic acid is a C-20 fatty acid that can be converted into various mediators by different types of enzymes. Among them, COX is one type of enzyme. This COX can act on this arachidonic acid, such that it is going to be converted into various prostaglandins such as PGE2, PGI2, and thromboxane A2, all of which can increase inflammation as well as platelet aggregation.

Triamcinolone is now a corticosteroid that can stimulate the release of Annexin-A1. Annexin-A1 can block this phospholipase A2 activity so that it can inhibit the release of prostaglandins. Similarly, triamcinolone can also inhibit the COX pathway, so these prostanoids are somewhat less synthesized. Through all of these actions, triamcinolone acetonide can produce an anti-inflammatory response.

Side effects

Since this drug is applied locally as a cream, it can produce local side effects. So this drug can produce a burning sensation, itching, dryness of the skin, and irritation. It can also increase excessive hair growth in the local area and on the skin, and it can produce acne-type skin eruptions. This drug can also produce some allergic contact dermatitis; in such conditions, this drug should be carefully given, and finally, this drug can also produce hypopigmentation, resulting in decreased pigmentation within the skin.

How do I use it?

Triamcinolone acetonide is given as a cream for topical purposes; it is also available as a suspension, but for topical purposes, it is given as a cream. It is available in different strengths. For instance, it is available in 0.025 percent low strength, where this drug is going to be applied to the affected area around two to four times daily. It is also available in 0.1 percent and 0.5 percent, and at these strengths, this drug is going to be applied around two to three times in order to reduce the systemic exposure.