title: Cushing's syndrome after intralesional triamcinolone acetonide: a systematic review of the literature and multinational survey.
abstract: BACKGROUND
  Intralesional triamcinolone acetonide (TAC) is a well-established treatment for keloids and hypertrophic scars. The present text provides a systematic review of all previously reported cases of Cushing's syndrome resulting from intralesional TAC in an effort to discover whether an association exists between dosage or frequency of injection and the subsequent development of Cushing's syndrome. Data collected from a multinational survey of plastic surgeons is presented and discussed to understand current trends in the use of TAC. Recommendations for early recognition of Cushing's syndrome, TAC dosages in children, and follow up guidelines are presented.
  
  
  METHODS
  A systematic review of the literature from 1950 to 2012 was performed to evaluate outcomes following intralesional TAC used for the treatment of scars. A confidential survey was sent to 4125 plastic surgeons, 102 responses from 9 countries were received.
  
  
  RESULTS
  A total of 18 cases of Cushing's syndrome after intralesional TAC have been reported in the English world literature. Survey data reveals that at least 30% (25/84) of plastic surgeons exceed the recommended dosage of TAC and 47% (46/97) are not aware of Cushing's syndrome as a possible complication of intralesional TAC.
  
  
  CONCLUSIONS
  Cushing's syndrome resulting from intralesional TAC has been reported multiple times in the literature. Published literature suggests that TAC administered within the most recent recommendations does not appear to place adult patients at increased risk for developing Cushing's syndrome. Children appear to be most at risk for developing Cushing's syndrome and yet insufficient recommendations currently exist with regard to their safe dosage. Intralesional dosage should not exceed 30 mg per month in children while noting that at least one reported case of Cushing's syndrome resulted from a smaller dose. Diligent follow up and patient education is advised for any patient treated with TAC so that complications can be recognized and addressed promptly.
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. rafifredman@gmail.com
authors.forename: Rafi
authors.initials: R
authors.lastname: Fredman
authors.forename: Mayer
authors.initials: M
authors.lastname: Tenenhaus
mesh_terms: D000328:Adult; D000367:Age Factors; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D002648:Child; D002921:Cicatrix / Q000188:drug therapy; D003480:Cushing Syndrome / Q000139:chemically induced*; D004305:Dose-Response Relationship, Drug; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D015552:Injections, Intralesional; D010818:Practice Patterns, Physicians'; D014222:Triamcinolone Acetonide / Q000009:adverse effects*
chemical_list: D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D014222:Triamcinolone Acetonide