Triamcinolone Acetonide Suspension Research Articles

Off-Label Use of Ketorolac

In Response: We were initially concerned about the possible adverse effects of alcohol contained in ketorolac (10% wt/vol) on articular cartilage. However, in our study [1], we diluted ketorolac (60 mg/2 mL) in a volume of 30 mL 0.25% bupivacaine. The resultant alcohol content (0.7% wt/vol) is less than that of sterile triamcinolone acetonide suspension (0.9% wt/vol) (Steris Laboratories, Phoenix, AZ), which has Food and Drug Administration approval for intraarticular administration. Furthermore, clinical studies using in vitro bovine cartilage have revealed that ketorolac has no effect on degradation of cartilage matrix [2]. In fact, ketorolac appears to have a protective effect on articular cartilage by preventing the release of cytokines, including interleukin-1, which has been shown to play a pivotal role in triggering excessive cartilage degradation under inflammatory conditions. In our most recent study with intraarticular ketorolac [3], we have demonstrated that equally effective analgesia can be obtained with intraarticular morphine. We have thus recommended that clinicians use intraarticular bupivacaine along with (the less expensive) preservative-free morphine. Due to the cost, we do not recommend the routine "off-label" use of intraarticular ketorolac; however, we do believe that it can be safely administered in the intraarticular space for those patients in whom morphine is medically contraindicated. Scott S. Reuben, MD Neil R. Connelly, MD Department of Anesthesiology Baystate Medical Center and the Tufts University School of Medicine Springfield, MA 01199

Alopecia Areata in Korea (1982–1994)

I clinically studied 905 patients with alopecia areata (AA) who visited the Department of Dermatology, College of Medicine, Chung Ang University, from January of 1982 to February of 1994. The purpose of the study was to evaluate the clinical manifestations and compare the effects of treatment with intralesional injection of triamcinolone acetonide suspension and immunotherapy with dinitrochlorobenzene (DNCB) or diphenylcyclopropenone (DPCP). The results were as follows: 1) The incidence of AA among all out-patients (59,970) was 1.5% (905 cases), and the ratio of males to females was 1.3:1 (512:393). 2) The age distribution showed high incidences in the third (41.8%) and fourth decades (20.0%). 3) The family history was contributory in 104 cases (11.5%). 4) The relapse rate was 17.5% (158 cases). 5) Almost half of the patients had a solitary lesion (408 cases, 46.7%). 6) The most common site of predilection was the occipital region of the scalp in both male and female patients. 7) Associated diseases were seborrheic dermatitis, atopic dermatitis, hepatitis, hypertension, open heart surgery, thyroid disease, pulmonary disease, and vitiligo in order of frequency. 8) The effect of treatment on the patients who had bald patches less than 50 cm2 was not significantly statistically different between intralesional injection of triamcinolone acetonide and immunotherapy with DNCB or DPCP. 9) In cases with bald areas more than 50 cm2, including alopecia totalis and universalis, DNCB or DPCP immunotherapy showed better therapeutic effects than did intralesional injection of triamcinolone acetonide.

Allergic Reaction to Intralesional Triamcinolone Acetonide: A Case Report

Corticosteroids can sensitize patients when used orally, parenterally, or intralesionally. We report delayed-type hypersensitivity to intralesional sterile triamcinolone acetonide suspension USP (Kenalog-40), which is rarely reported in the literature. Report of a Case. A 60-year-old woman presented for treatment of an 18-cm sternal hypertrophic scar. Treatment of this scar with an intralesional corticoid 3 years earlier had resulted in erythema and pruritus along the entire length of the midline scar approximately 12 to 18 hours after injection. The reaction resolved in approximately 3 weeks without treatment. Because of the earlier reaction, a test dose of 0.2 mL of intralesional sterile triamcinolone acetonide suspension USP (Kenalog-40) was injected in a 2-cm chest tube scar inferior to her sternal scar. About 8 hours later, she noticed erythema and pruritus along the length of the horizontal scar and superior margin of the sternal scar, which resolved over a 2-week period. She denied any previous contact allergies. She had

Treatment of a Nocardia brasiliensis Mycetoma With Sulfamethoxazole and Trimethoprim, Amikacin, and Amoxicillin and Clavulanate

REPORT OF A CASE A 29-year-old Mexican man who had lived in the United States for 15 years was referred to the dermatology clinic at the Los Angeles County/University of Southern California Medical Center, Los Angeles, for evaluation of a possible mycetoma of the right foot. The disorder had started 8 years before, when the patient injured his foot with a blunt metal object at work. Subsequently, multiple sinus tracts draining blood and pus had formed on the foot. Empiric treatment with combinations of dapsone, rifampin and isoniazid, sulfamethoxazole and trimethoprim, gentamicin, ampicillin, tetracycline, and intralesional triamcinolone acetonide suspension had been unsuccessful. The patient had no relevant medical history, no allergies to medications, and used tobacco and alcohol occasionally. On physical examination, the right foot and ankle were firm, swollen, and in fixed plantar flexion. Multiple crusted, friable nodules and sinus tracts draining serosanguinous and purulent material were seen (Fig

Pseudocyst of the Auricle

<i>To the Editor</i>.—The article by Cohen and Grossman¹on the "Pseudocyst of the Auricle" was very good. However, their conclusion that "corticosteroids do not play a role in the management of pseudocyst of the auricle" based on two cases, one by systemic treatment and another by intralesional injection, seems to be contrary to my experience with the latter. The technique used is to first cleanse the area with an antiseptic, then inject a local anesthetic with epinephrine into the skin overlying the swelling. A 22-gauge needle is then inserted into the pseudocyst and the fluid is aspirated. The first syringe is removed and a second syringe with the steroid is attached. The cavity is then flushed with triamcinolone acetonide suspension (10 mg/mL) (Kenalog 10) through the same needle that was left in place. The cavity is then aspirated once more to remove the excess steroid. Occasionally, pressure may

Release of nickel into fluid stored in the reservoir of Dermo-Jets.

Release of nickel into triamcinolone acetonide suspensions stored in the reservoir of a Dermo-Jet was demonstrated by electrothermal atomic absorption spectrometry. Increased urinary nickel excretion was found for three days following intradermal injections (with the Dermo-Jet) of triamcinolone acetonide in patients suffering from alopecia areata. The dimethylglyoxime test showed that the internal rod of the reservoir as well as metallic internal parts of the nozzle leached appreciable amounts of nickel, even before any clinical use.

Surface Area Measurements of Psoriatic Corneocytes: Effects of Intralesional Steroid Therapy

Quantitative measurements of surface areas of corneocytes from the desquamating portion of psoriatic lesions in 11 patients showed that psoriatic corneocytes were much smaller (27%) than corneocytes from noninvolved normal skin in the same patients. Corneocyte surface areas gradually increased in size following one intralesional injection of triamcinolone acetonide suspension and were almost normal approximately 6 weeks after treatment. These findings support other observations suggesting that rapidly proliferating epidermal cells have smaller surface areas than normal cells.

Herpes simplex keratitis treatment with vitamin A.

We produced chronic experimental herpetic keratitis by dropping PH-strain herpes simplex virus on scarified rabbit corneas and then injecting the rabbits subconjunctivally with low doses of corticosteroid (namely, triamcinolone acetonide suspension). Vitamin-A-treated rabbits developed milder, more rapidly healing epithelial lesions than untreated rabbits. Whereas most of the untreated rabbits developed moderate or severe stromal disease, most of the vitamin-A-treated rabbits developed only mild stromal disease or none at all.

EXPERIMENTAL EFFECTS ON SURROUNDING FIBROUS CAPSULE FORMATION FROM PLACING STEROID IN A SILICONE BAG-GEL PROSTHESIS BEFORE IMPLANTATION

Soft-gel miniprostheses of silicone were implanted subcutaneously into 75 male rats. Groups of prostheses were preinjected with saline, a commercial form of triamcinolone acetonide, or a suspension of crystalline triamcinolone acetonide. The softness of the prosthesis mound later was measured objectively, and the capsules surrounding the implants were analyzed by histology, SEM, and chemistry, at various intervals up to 120 days after implantation. The control implants developed a normal laminar capsule. With an incidence increasing up to 100 percent at 120 days, the steroid-treated implants were surrounded by capsules lacking an inner membrane. The inner membrane of the laminar capsule had a high protein content (relative to normal tissue) and a relatively reduced collagen content, while the diffuse capsule resulting from the TA treatment had a high protein content and a high collagen content (about the same as normal tissue). No differences were found in the softness of the mounds of the implanted prostheses. The effect of the TA treatment was explained on the basis of its collagenolytic effect, which could gradually erode the normal capsule membrane. Capsule firmness could not be related to the architecture or the protein or collagen content in our findings. We hypothesize that normal capsule firmness may be related to the amount and kind of interconnection between the loose outer zone of connective tissue and the surrounding tissue.

Posttraumatic Phycomycosis of the Anterior Segment

Keratomycosis and infection of the anterior chamber with a Rhizopus sp (phycomycosis, mucormycosis) developed in a 24-year-old man following a perforating injury of the cornea with a soil-contaminated screwdriver. The infection was documented by positive cultures of the corneal wound and of the anterior chamber and by histopathologic studies. Phycomycosis of the eye usually occurs in the setting of systemically impaired host resistance. The patient had no underlying disease that wound predispose him to this infection but the treatment with topical 0.1% dexamethasone and triamcinolone acetonide suspension injected into the sub-Tenon's space following the injury may have impaired his local immunologic defenses. Excisional keratoplasty played an important role in the successful management of this case.

Effect of corticosteroids on seasonal increases in IgE antibody

We analyzed seasonal changes in IgE antibodies to ragweed antigens in 28 patients with ragweed hay fever during the 1972 pollination season. Thirteen patients were treated with an injection of 60 mg. of triamcinolone acetonide suspension and 16 mg. of methylprednisolone orally on 3 successive days shortly after the onset of their symptoms in late August. Fifteen patients were untreated and served as controls. Serum samples were obtained in July (control group) or just prior to steroid treatment in August, and from both groups in mid-September and finally in mid-October. Initially, IgE antibody levels did not differ between the groups. IgE antibody increased after pollen exposure in both groups, but there was no significant difference in the increases. In contrast, symptom scores were significantly less in patients treated with steroids (P < 0.01). The results indicate that corticosteroid treatment does not prevent the seasonal increase in IgE antibody after pollen exposure but does significantly reduce the severity of hay fever symptoms.

Treatment of acquired subglottic stenosis.

Four children, who had undergone major cardiac surgery, were treated for severe subglottic stenosis following prolonged endotracheal intubation and assisted respiration. Following removal of the endotracheal tube, all required tracheotomy after varying lengths of time. An adequate airway and good voice was obtained in each with injections of triamcinolone acetonide suspension combined with hyaluronidase, and gentle dilatations. This treatment greatly reduced the needed time of tracheotomy maintenance from that required with the previously recommended conservative management consisting of dilatations only. It also avoided the use of alloplastic stents which frequently resulted in a deformed larynx and poor voice.

CLINICAL EVALUATION OF INTRALESIONAL TRIAMCINOLONE.

The therapeutic effect of the intralesional injection of various concentrations of triamcinolone acetonide suspensions, in a variety of dermatologic conditions, was evaluated in a controlled, double-blind clinical study. No appreciable objective difference was noted in the response to concentrations of 2.5, 5, and 10 mg per milliliter.

Psoriasis and lichen planus of nalis. Treatment with triamcinolone.

Dystrophy of fingernails due to psoriasis or lichen planus is a constant embarrassment to patients so affected, especially if their occupation involves meeting members of the public. The treatment for these conditions until the present has been unsatisfactory¹and any reasonable method of therapy which offers hope of success merits investigation. Since the advent of triamcinolone, attention has been drawn to the favorable effect of this steroid on psoriasis, both by systemic administration²and by injection directly in the lesion.³In a personal communication, Weiner⁴has mentioned the beneficial results which he has obtained in the treatment of psoriasis of the nails by injection of triamcinolone acetonide suspension directly into the matrix of the involved nail. He found that growth of healthy nail appeared within several weeks, and improvement persisted for as long as the period of observation (up to one year) in some cases. In

The intralesional use of triamcinolone acetonide in psoriasis. A double blind study.

The effectiveness of the treatment of psoriatic lesions by the intralesional injections of triamcinolone acetonide has been demonstrated by many investigators. 1-3 In a double blind study of psoriatic patients triamcinolone acetonide by intralesional injection was indeed found to be effective in clearing the lesion of psoriasis. Its efficacy was markedly greater than hydrocortisone or prednisolone tertiary butyl acetate. Material and Method All patients in this study were hospitalized and had no other form of systemic or topical therapy. In order to avoid the possibility of systemic effect the amount of triamcinolone acetonide injected was limited to 0.2 ml. of 1% suspension. The control material was the vehicle alone to which hydrocortisone acetate was added to make a 0.4% suspension to simulate the cloudy appearance of the triamcinolone acetonide suspension. Hydrocortisone acetate in this concentration was found to be totally ineffective in the treatment of psoriatic plaques. The suspensions were