Dosage guidance:
Clinical considerations: The potency classifications of topical triamcinolone products are provided in the table. In general, start with the lowest-potency agent appropriate for the condition severity and application site. Vehicle, concentration, site of application, use of occlusive dressings, and other factors can alter potency. Optimal response depends on choosing a vehicle that is appropriate for body location, lesion characteristics, and patient preference.
Vehicle |
Strength |
Potency (According to the US Classification System) |
---|---|---|
a Goldstein 2019; Tadicherla 2009 | ||
Cream, Ointment |
0.5% |
High (group 3) |
Aerosol spray |
(delivering ~0.2 mg per 2-second spray) |
Medium (group 4) |
Cream, Ointment, Oral/Dental Paste |
0.1% |
Medium (group 4) |
Ointment |
0.05% |
Medium (group 4) |
Lotion |
0.1% |
Lower-mid (group 5) |
Ointment |
0.025% |
Lower-mid (group 5) |
Cream, Lotion |
0.025% |
Low (group 6) |
Aphthous stomatitis (recurrent), mild to moderate: Note: Initiate at first indication of an outbreak.
Triamcinolone 0.1% (oral/dental paste): Topical: Apply a small amount to the lesion 2 to 4 times daily until healed; do not rinse afterwards and avoid eating or drinking for 30 minutes after application (Ref).
Atopic dermatitis (eczema): Note: Concurrent use of emollients (applied liberally) is recommended. In the management of corticosteroid-responsive dermatoses, lower-potency agents are often preferred for sites at increased risk for corticosteroid-induced skin atrophy (eg, face, intertriginous areas). However, use of higher-potency agents in these areas can be appropriate for certain indications when prescribed under the guidance of a dermatologist. See "Note" at the top of the "Dosing: Adult" field for potency guidance.
Mild disease: Triamcinolone 0.025% (ointment, cream, lotion) or 0.1% (lotion): Topical: Apply once or twice daily to affected areas for 2 to 4 weeks (Ref).
Moderate to severe disease: Triamcinolone 0.05% (ointment), 0.1% (ointment, cream), ~0.2 mg/spray (aerosol spray), or 0.5% (ointment, cream): Topical: Apply once or twice daily to affected areas for 2 to 4 weeks (Ref); in patients with improvement, maintenance therapy is suggested with an intermittent application once daily for 2 consecutive days per week (eg, weekends) or 2 to 3 times per week to previously affected areas for up to 16 weeks. Note: For areas affecting the face, groin, or other areas with skin folds, lower-potency preparations are generally recommended (unless limited to short-term use [5 to 7 days] and then switched to lower potency) (Ref).
Duration of therapy: Topical corticosteroids are generally well tolerated when used appropriately. Treatment courses of ~2 weeks are common for certain chronic skin conditions; however, longer or repeated intermittent courses can be appropriate, particularly when prescribed under the guidance of a dermatologist. Conversely, a shorter course may be sufficient depending upon response and when used for minor self-limiting skin conditions (Ref).
Contact dermatitis: Note: If condition does not show prompt improvement (eg, within 1 to 2 weeks), reassess diagnosis and choice of treatment; consider evaluation by an experienced specialist (Ref). In the management of corticosteroid-responsive dermatoses, lower-potency agents are often preferred for sites at increased risk for corticosteroid-induced skin atrophy (eg, face, intertriginous areas). However, use of higher-potency agents in these areas can be appropriate for certain indications when prescribed under the guidance of a dermatologist. See "Note" at the top of the "Dosing: Adult" field for potency guidance.
Allergic contact dermatitis (localized), mild to moderate:
Face and/or flexural areas: Triamcinolone: 0.025% (cream, lotion, ointment), 0.05% (ointment), 0.1% (cream, lotion, ointment): Topical: Apply once or twice daily to affected areas for 1 to 2 weeks; thereafter, may consider tapering (eg, with every other day application) over the subsequent 2 weeks (Ref).
Hands, feet, or nonflexural areas: Triamcinolone 0.5% (cream, ointment): Topical: Apply once or twice daily to affected areas for 2 to 4 weeks, or until resolution of symptoms (Ref).
Irritant contact dermatitis (localized), mild to moderate, acute or chronic: Note: In general, ointments are the preferred vehicle.
Face and/or flexural areas: Triamcinolone 0.025% (cream, lotion, ointment) or 0.1% (lotion): Topical: Apply once or twice daily to affected areas for 1 to 2 weeks; thereafter, may consider tapering (eg, with every other day application) over the subsequent 2 weeks (Ref).
Nonfacial and/or nonflexural areas: Triamcinolone 0.5% (cream, ointment): Topical: Apply once or twice daily to affected areas for 2 to 4 weeks (Ref).
Duration of therapy: Topical corticosteroids are generally well tolerated when used appropriately. Treatment courses of ~2 weeks are common for certain chronic skin conditions; however, longer or repeated intermittent courses can be appropriate, particularly when prescribed under the guidance of a dermatologist. Conversely, a shorter course may be sufficient depending upon response and when used for minor self-limiting skin conditions (Ref).
Genital pruritus (due to dermatitis) (adjunct): Note: Use with conservative measures (eg, keeping area clean and dry, removal of offending agents). An evaluation for the underlying cause is essential as the etiology may be due to an infectious, neoplastic, systemic, or other process requiring definitive management.
Vulvar dermatitis, mild: Triamcinolone 0.025% (cream, ointment, lotion), 0.05% (ointment), or 0.1% (cream, ointment, lotion): Topical: Apply to affected area once or twice daily for 2 to 4 weeks; therapy can be continued indefinitely at the minimum frequency for effective control of pruritus (goal <14 days per month). Ointments are preferred (Ref).
Psoriasis, plaque (limited disease): Note: In the management of corticosteroid-responsive dermatoses, lower-potency agents are often preferred for sites at increased risk for corticosteroid-induced skin atrophy (eg, face, intertriginous areas). However, use of higher-potency agents in these areas can be appropriate for certain indications when prescribed under the guidance of a dermatologist. See "Note" at the top of the "Dosing: Adult" field for potency guidance.
Face and/or intertriginous areas: Triamcinolone 0.025% (cream, lotion): Topical: Apply twice daily until lesions resolve; a common treatment course is 2 weeks (Ref).
Duration of therapy: Topical corticosteroids are generally well tolerated when used appropriately. Treatment courses of ~2 weeks are common for certain chronic skin conditions; however, longer or repeated intermittent courses can be appropriate, particularly when prescribed under the guidance of a dermatologist. Conversely, a shorter course may be sufficient depending upon response and when used for minor self-limiting skin conditions (Ref).
Seborrheic dermatitis: Note: Administer alone or in combination with a topical antifungal. In the management of corticosteroid-responsive dermatoses, lower-potency agents are often preferred for sites at increased risk for corticosteroid-induced skin atrophy (eg, face, intertriginous areas). However, use of higher-potency agents in these areas can be appropriate for certain indications when prescribed under the guidance of a dermatologist. See "Note" at the top of the "Dosing: Adult" field for potency guidance.
Face, trunk, and/or intertriginous areas: Triamcinolone 0.025% (cream, lotion): Topical: Apply once or twice daily until symptoms subside (usually 1 to 2 weeks) (Ref).
Chest or upper back: Triamcinolone 0.05% (ointment), 0.1% (cream, ointment), or ~0.2 mg/spray (aerosol spray): Topical: Apply once or twice daily until symptoms subside (usually 1 to 2 weeks) (Ref).
Duration of therapy: Topical corticosteroids are generally well tolerated when used appropriately. Treatment courses of ~2 weeks are common for certain chronic skin conditions; however, longer or repeated intermittent courses can be appropriate, particularly when prescribed under the guidance of a dermatologist. Conversely, a shorter course may be sufficient depending upon response and when used for minor self-limiting skin conditions (Ref).
Stasis dermatitis (off-label use): Note: In the management of corticosteroid-responsive dermatoses, lower-potency agents are often preferred for sites at increased risk for corticosteroid-induced skin atrophy (eg, face, intertriginous areas). However, use of higher-potency agents in these areas can be appropriate for certain indications when prescribed under the guidance of a dermatologist. See "Note" at the top of the "Dosing: Adult" field for potency guidance.
Triamcinolone 0.1% (ointment) or 0.5% (ointment): Topical: Apply once or twice daily for 1 to 2 weeks; due to risk of skin atrophy and ulceration, avoid prolonged use (Ref).
Duration of therapy: Topical corticosteroids are generally well tolerated when used appropriately. Treatment courses of ~2 weeks are common for certain chronic skin conditions; however, longer or repeated intermittent courses can be appropriate, particularly when prescribed under the guidance of a dermatologist. Conversely, a shorter course may be sufficient depending upon response and when used for minor self-limiting skin conditions (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing. Use the lowest effective dose.
(For additional information see "Triamcinolone (topical): Pediatric drug information")
Dosage guidance:
Dosing: Dosage should be based on severity of disease and patient response; use smallest amount for shortest period of time to avoid HPA axis suppression. Therapy should be discontinued when control is achieved.
Dermatoses (corticosteroid-responsive, including contact/atopic dermatitis): Infants, Children, and Adolescents: Topical:
Cream, Ointment:
0.025% or 0.05%: Apply thin film to affected areas 2 to 4 times daily
0.1% or 0.5%: Apply thin film to affected areas 2 to 3 times daily
Lotion: 0.025% or 0.1%: Apply 3 to 4 times daily
Spray: Apply to affected area up to 3 to 4 times daily
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Reactions listed are based on reports for other agents in this same pharmacologic class and may not be specifically reported for topical triamcinolone.
Frequency not defined:
Dermatologic: Acneiform eruption, allergic contact dermatitis, atrophic striae, desquamation, folliculitis, hypertrichosis, hypopigmentation, local dryness, maceration of the skin, miliaria, perioral dermatitis, skin atrophy, skin blister
Endocrine & metabolic: Cushing syndrome, glycosuria, HPA-axis suppression, hyperglycemia
Gastrointestinal: Oral mucosa changes (paste; atrophy or maceration)
Infection: Secondary infection
Local: Application site burning, application site irritation, application site pruritus
Hypersensitivity to triamcinolone or any component of the formulation
Oral topical formulations only: Fungal, viral, or bacterial infections of the mouth or throat
Concerns related to adverse effects:
• Adrenal suppression: May cause hypercortisolism or suppression of hypothalamic-pituitary-adrenal (HPA) axis, particularly in younger children or in patients receiving high doses for prolonged periods. HPA axis suppression may lead to adrenal crisis.
• Immunosuppression: Prolonged use may result in fungal or bacterial superinfection; discontinue if dermatological infection persists despite appropriate antimicrobial therapy.
• Sensitization: Topical use has been associated with local sensitization (redness, irritation); discontinue if sensitization is noted.
• Systemic effects: Topical corticosteroids may be absorbed percutaneously. Absorption may cause manifestations of Cushing syndrome, hyperglycemia, or glycosuria. Absorption is increased by the use of occlusive dressings, application to denuded skin, or application to large surface areas.
Special populations:
• Older adult: Because of the risk of adverse effects associated with systemic absorption, topical corticosteroids should be used cautiously in the elderly in the smallest possible effective dose for the shortest duration.
• Pediatric: Children may absorb proportionally larger amounts after topical application and may be more prone to systemic effects. HPA axis suppression, intracranial hypertension, and Cushing syndrome have been reported in children receiving topical corticosteroids. Prolonged use may affect growth velocity; growth should be routinely monitored in pediatric patients.
Dosage form specific issues:
• Administration: Aerosol solution: Do not apply to underarms or groin unless directed by a health care professional; if improvement is not seen within 2 weeks, contact prescriber. Product is flammable; avoid heat, smoking, or flames when applying.
• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer’s labeling.
Other warnings/precautions:
• Appropriate use: For external use only; avoid contact with eyes. Do not use occlusive dressings on weeping or exudative lesions and general caution with occlusive dressings should be observed; discontinue if skin irritation or contact dermatitis should occur; do not use in patients with decreased skin circulation.
• High-potency products: Avoid the use of high-potency steroids on the face.
• Oral cavity application: Do not apply paste to skin or eyes. When used as a topical agent in the oral cavity, if significant regeneration or repair of oral tissues has not occurred in seven days, re-evaluation of the etiology of the oral lesion is advised.
Topical corticosteroids may be absorbed percutaneously. The extent of absorption is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, age of the patient, prolonged duration of use, and the use of occlusive dressings. Percutaneous absorption of topical steroids is increased in neonates (especially preterm neonates), infants, and young children. Hypothalamic-pituitary-adrenal (HPA) suppression may occur, particularly in younger children or in patients receiving high doses for prolonged periods; acute adrenal insufficiency (adrenal crisis) may occur with abrupt withdrawal after long-term therapy or with stress. Infants and small children may be more susceptible to HPA axis suppression or other systemic toxicities due to larger skin surface area to body mass ratio; use with caution in pediatric patients.
Some dosage forms may contain propylene glycol; in neonates large amounts of propylene glycol delivered orally, intravenously (eg, >3,000 mg/day), or topically have been associated with potentially fatal toxicities which can include metabolic acidosis, seizures, renal failure, and CNS depression; toxicities have also been reported in children and adults including hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution (AAP 1997; Shehab 2009).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Aerosol Solution, External, as acetonide:
Kenalog: 0.147 mg/g (63 g, 100 g)
Generic: 0.147 mg/g (63 g, 100 g)
Cream, External, as acetonide:
Triderm: 0.1% (28.4 g [DSC]); 0.5% (454 g) [contains propylene glycol]
Generic: 0.025% (15 g, 80 g, 454 g); 0.1% (15 g, 30 g, 80 g, 453.6 g, 454 g); 0.5% (15 g)
Lotion, External, as acetonide:
Generic: 0.025% (60 mL); 0.1% (60 mL)
Ointment, External, as acetonide:
Trianex: 0.05% (430 g [DSC])
Tritocin: 0.05% (430 g [DSC])
Generic: 0.025% (15 g, 80 g, 454 g); 0.05% (110 g, 430 g); 0.1% (15 g, 30 g, 80 g, 453.6 g, 454 g); 0.5% (15 g)
Paste, Mouth/Throat, as acetonide:
Kourzeq: 0.1% (5 g) [vanilla flavor]
Oralone: 0.1% (5 g)
Generic: 0.1% (5 g)
Therapy Pack, External, as acetonide:
Sila III: 0.1% (1 ea [DSC])
Triasil: 0.1% (1 ea)
May be product dependent
Aerosol solution (Kenalog External)
0.147 mg/g (per gram): $10.09
Aerosol solution (Triamcinolone Acetonide External)
0.147 mg/g (per gram): $3.89
Cream (Triamcinolone Acetonide External)
0.025% (per gram): $0.30
0.1% (per gram): $0.24 - $0.42
0.5% (per gram): $0.67 - $0.76
Cream (Triderm External)
0.5% (per gram): $1.04
Lotion (Triamcinolone Acetonide External)
0.025% (per mL): $0.63 - $1.25
0.1% (per mL): $0.71 - $1.50
Ointment (Triamcinolone Acetonide External)
0.025% (per gram): $0.13 - $0.14
0.05% (per gram): $1.56 - $2.27
0.1% (per gram): $0.37 - $0.39
0.5% (per gram): $0.67
Paste (Kourzeq Mouth/Throat)
0.1% (per gram): $15.75
Paste (Oralone Mouth/Throat)
0.1% (per gram): $17.91
Paste (Triamcinolone Acetonide Mouth/Throat)
0.1% (per gram): $16.12 - $16.63
Therapy Pack (Triasil External)
0.1% (per each): $3,610.00
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Cream, External, as acetonide:
Aristocort C: 0.5% (15 g, 50 g) [contains benzyl alcohol]
Aristocort R: 0.1% (15 g, 30 g, 500 g) [contains benzyl alcohol]
Triaderm: 0.025% ([DSC]); 0.1% (15 g, 500 g)
Ointment, External, as acetonide:
Aristocort R: 0.1% (30 g)
Triaderm: 0.1% ([DSC])
Paste, Mouth/Throat, as acetonide:
Oracort: 0.1% (7.5 g)
Oral/dental paste: Do not apply paste to skin or eyes. Apply small amount into oral cavity until thin, smooth film develops; do not rub in; spreading the paste may result in a granular, gritty sensation and crumbling; apply at bedtime to allow contact of the medication with the lesion overnight; if more frequent application is necessary, apply after meals.
Topical products: In general, for optimal absorption, apply topical corticosteroids to moist skin immediately after bathing or after wet soaks. Occlusive dressings will also enhance drug absorption, often by a factor of 10 (Ref). Occlusive dressing may be used if instructed by a health care professional.
Aerosol spray: For external use only. Avoid heat, flame, or smoking when using. Avoid eyes and do not inhale if spraying near face. Container may be used upright or inverted. When using the spray button, spray at a distance of 3 to 6 inches from affected area. For hard-to-reach areas, insert the spray tube applicator into spray button and twist to seat. Point tube end away from body and face. Ensure the tube applicator is clean prior to use and wash after use. Move spray tube while applying, touching the surface of the affected area.
Cream, ointment, lotion: For external use only; avoid contact with eyes.
Topical: Dermal application: For external use only. Do not use on open skin; avoid contact with eyes; wash hands after use.
Cream, ointment: Apply a thin film sparingly. May be used with occlusive dressings for management of psoriasis or recalcitrant conditions. If an infection develops, discontinue use of occlusive dressings.
Lotion: Apply topical sparingly to affected areas as a thin film. May be used with occlusive dressings for management of psoriasis or recalcitrant conditions. If an infection develops, discontinue use of occlusive dressings.
Spray: Avoid heat, flame, or smoking when using. Do not inhale if spraying near face. Container may be used upright or inverted. When using the spray button, spray at a distance of 3 to 6 inches from affected area. For hard to reach areas, insert the spray tube applicator into spray button and twist to seat. Point tube away from body and face. Be sure the tube applicator is clean prior to use and wash after use. Move spray tube while applying, touching the surface of the affected area. Do not use tight fitting diapers or plastic pants on a patient being treated in the diaper area, as this constitutes an occlusive dressing. Occlusive dressing may be used if instructed by a health care professional; monitor for infection.
Aphthous stomatitis: Oral/dental paste: Adjunctive treatment and temporary relief of symptoms associated with oral inflammatory and ulcerative lesions resulting from trauma.
Corticosteroid-responsive dermatoses (eg, atopic dermatitis, contact dermatitis, vulvar dermatitis, psoriasis, seborrheic dermatitis): Topical: Relief of inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses.
Stasis dermatitis
Kenalog may be confused with Ketalar
TAC (occasional abbreviation for triamcinolone) is an error-prone abbreviation (mistaken as tetracaine-adrenaline-cocaine)
KIDs List: Medium, high, and very high potency topical corticosteroids, when used in neonates and infants <1 year of age for diaper dermatitis, are identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list; use should be avoided due to risk of adrenal suppression; systemic absorption is higher in pediatric patients than adults (strong recommendation; low quality of evidence) (PPA [Meyers 2020]).
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
CYP3A4 Inhibitors (Strong): May increase the serum concentration of Triamcinolone (Topical). Risk C: Monitor therapy
Nirmatrelvir and Ritonavir: May increase the serum concentration of Corticosteroids (Topical). Risk C: Monitor therapy
Topical corticosteroids may be used for the treatment of corticosteroid-responsive dermatosis, such as atopic dermatitis in patients planning a pregnancy (Vestergaard 2019).
Systemic bioavailability of topical corticosteroids is variable (integrity of skin, use of occlusion, etc) and may be further influenced by trimester of pregnancy (Chi 2017). In general, the use of topical corticosteroids is not associated with a significant risk of adverse pregnancy outcomes; however, there may be an increased risk of low birth-weight infants following maternal use of potent or very potent topical products, especially in high doses, although this risk is likely to be low (Andersson 2021; Chi 2015; Chi 2017).
When first-line treatments, such as emollients, are insufficient, topical corticosteroids may be used for the treatment of atopic dermatitis in pregnant patients (Vestergaard 2019). Topical corticosteroids are classified by potency; the medication and formulation (eg, cream, gel, and/or salt form) contribute to the potency classification (Oakley 2021; Stacey 2021; Tadicherla 2009). In general, use of the least potent product in limited amounts is recommended during pregnancy. Mild to moderate potency corticosteroids are preferred; potent to very potent topical corticosteroids should only be used as alternative therapy in limited amounts under obstetrical care. Pregnant patients should avoid application of topical corticosteroids to areas with high percutaneous absorption (eg, armpit, skin folds, vulva) (Chi 2017) and caution should be used when applying to areas prone to striae formation (eg, abdomen, breast, thighs) (Vestergaard 2019).
It is not known if sufficient quantities of triamcinolone are absorbed following topical administration to produce detectable amounts in breast milk; however, systemic corticosteroids are present in breast milk.
Although the manufacturer recommends that caution be used, topical corticosteroids are generally considered acceptable for use in patients who are breastfeeding (Butler 2014; WHO 2002).
Avoid application of topical corticosteroids to the nipple and areola area until breastfeeding ceases; hypertension was noted in a breastfed infant when a high-potency topical corticosteroid was applied to the nipple (AAD-NPF [Elmets 2021]; Butler 2014; Leachman 2006). If needed, apply topical corticosteroids immediately after breastfeeding then clean nipples prior to the next feeding (Vestergaard 2019).
Skin atrophy; HPA axis suppression. When used in the oral cavity (topical paste), if significant regeneration or repair of oral tissues has not occurred in seven days, re-evaluation of the etiology of the oral lesion is advised.
Topical corticosteroids have anti-inflammatory, antipruritic, and vasoconstrictive properties. May depress the formation, release, and activity of endogenous chemical mediators of inflammation (kinins, histamine, liposomal enzymes, prostaglandins) through the induction of phospholipase A2 inhibitory proteins (lipocortins) and sequential inhibition of the release of arachidonic acid. Triamcinolone has intermediate to high range potency (dosage-form dependent).
Absorption: Topical corticosteroids are absorbed percutaneously. The extent is dependent on several factors, including epidermal integrity (intact vs abraded skin), formulation, and the use of occlusive dressings.
Metabolism: Hepatic
Half-life elimination: Biologic: 18 to 36 hours
Excretion: Urine (40%); feces (60%, some via biliary excretion)
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