title: A prospective observational study evaluating hypothalamic-pituitary-adrenal axis alteration and efficacy of intramuscular triamcinolone acetonide for steroid-responsive dermatologic disease.
abstract: BACKGROUND
  The lack of recommendations regarding dosing and administration, an undetermined risk of hypothalamic-pituitary-adrenal axis alteration, and the unknown effectiveness of intramuscular (IM) corticosteroid injection to treat dermatologic disease may be deterrents to use.
  
  
  OBJECTIVE
  We sought to evaluate presence and duration of iatrogenic Cushing syndrome and secondary adrenal insufficiency in patients receiving IM triamcinolone acetonide (TAC), and to assess physician- and patient-reported outcomes.
  
  
  METHODS
  We conducted a prospective observational study of 14 patients given the diagnosis of steroid-responsive dermatologic disease who received either 1 or 2 doses 6 weeks apart of IM TAC. Baseline and follow-up cortisol, adrenocorticotropic hormone, Physician and Subject Global Assessments of Disease Activity Scale score, and the visual analog scale score of pruritus were evaluated at 6-week intervals.
  
  
  RESULTS
  Although mean total cortisol was significantly decreased at 6 and 12 weeks compared with baseline, IM TAC did not result in iatrogenic Cushing syndrome or secondary adrenal insufficiency in any patient. Mean Physician and Subject Global Assessments of Disease Activity Scale scores were significantly improved at 6 and 12 weeks compared with baseline. Mean visual analog scale pruritus scores were significantly improved at 6 weeks compared with baseline.
  
  
  CONCLUSIONS
  The study was limited by the cohort size and a lack of a comparator group.
  
  
  CONCLUSIONS
  IM TAC appears safe when administered as 2 injections at 6-week intervals. Significant improvement was noted across a number of steroid-responsive dermatoses. These results may provide a guide to dosing, frequency, and administration for dermatologists considering the use of IM TAC in the appropriate clinical contexts.
authors.affiliation: Department of Dermatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
authors.forename: Shalini
authors.initials: S
authors.lastname: Reddy
authors.forename: Sonia
authors.initials: S
authors.lastname: Ananthakrishnan
authors.forename: Amit
authors.initials: A
authors.lastname: Garg
mesh_terms: D000309:Adrenal Insufficiency / Q000517:prevention & control; D000328:Adult; D015331:Cohort Studies; D003480:Cushing Syndrome / Q000517:prevention & control; D003872:Dermatitis / Q000175:diagnosis / Q000188:drug therapy; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004485:Eczema / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D007273:Injections, Intramuscular; D008010:Lichen Planus / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000175:diagnosis / Q000188:drug therapy*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide
keywords: ACTH; BMI; Cushing syndrome; HPA; IM; MTC; PGA; Physician Global Assessment of Disease Activity Scale; SAI; SGA; Subject Global Assessment of Disease Activity Scale; TAC; VAS; adrenal insufficiency; adrenocorticotropic hormone; body mass index; cortisol; hypothalamic-pituitary-adrenal; intramuscular; morning total cortisol; secondary adrenal insufficiency; steroid; triamcinolone; triamcinolone acetonide; visual analog scale