Niveles sericos de Triamcinolona

Published in Dermatology

Journal Scan / Research · May 31, 2020

Serum Triamcinolone Levels During Intensive, Inpatient Wet-Dressing Therapy

Clinical and Experimental Dermatology

TAKE-HOME MESSAGE

• Twenty-nine adult patients hospitalized for intensive wet-dressing therapy underwent measurement of serum triamcinolone (TAC) levels 24 and 48 hours after wet-dressing therapy. Patients typically had TAC 0.1% cream applied beneath wet dressings for 2 to 3 hours, and treatment was repeated every 6 to 8 hours. Patients had a range of skin conditions, including eczematous dermatitis (n=19), psoriasis (n=4), lichenoid dermatitis (n=2), cutaneous T-cell lymphoma (n=2), pemphigus foliaceous (n=1), and subacute cutaneous lupus erythematosus (n=1) at baseline. Median body surface area was 1.98 m2.

• At 24 hours, median TAC level was 0.33 µg/dL, with a range of 0.15 to 1.1 µg/dL. Levels were undetectable in 4 patients. Twenty-two patients had available data 48 hours after initiation of therapy. Mean TAC level was 0.30 µg/dL, with a maximum level of 1.2 µg/dL, and the level was significantly associated with the number of dressing changes. For comparison, a previous study demonstrated a serum TAC level of 51.7 µg/dL 3 hours after a 40-mg TAC intramuscular injection. Although there is detectable absorption of TAC with intensive wet-dressing therapy, it is very low compared with systemic steroid treatment.

– Caitlyn T. Reed, MD

Abstract 

BACKGROUND

Wet dressings combined with topical corticosteroids are beneficial for patients with generalized and refractory dermatosis; however, to our knowledge, serum levels after topical corticosteroid absorption during intensive therapy have not been reported previously.

AIM

To examine serum levels of triamcinolone acetonide (TAC) after topical corticosteroid application during intensive wet-dressing therapy.

METHODS

We performed a retrospective study of adult patients admitted for inpatient wet-dressing therapy from 7 November 2015 to 24 June 2016. Data were collected on sex, age, body surface area, TAC serum levels, number of wet-dressing changes after 24 and 48 h, and type of wet dressing.

RESULTS

In total, 29 patients (14 men, 15 women) were assessed. Median [interquartile range (IQR)] age was 57 years (51.5-67.0 years) and involved body surface area was 1.98 m2 (1.88-2.15) m2 . Before the 24-hour blood draw, patients had received 1-3 dressing changes. Median (IQR) TAC level at 24 h was 0.33 µg/dL (0.20-0.58 µg/dL), with no significant difference noted between the number of dressing changes and TAC serum level. At 48 h, results of a serum TAC test were available for 22 patients with 2-6 dressing changes. Mean (IQR) serum level was 0.30 µg/dL (0.30-0.87 µg/dL). For each additional dressing change, there was an estimated 0.21 µg/dL increase in TAC serum level (95% CI 0.11-0.31; P < 0.001). TAC serum level was not significantly associated with sex, age, body surface area or dressing type.

CONCLUSIONS

Intensive, inpatient wet-dressing therapy is associated with detectable TAC serum levels. However, we suspect that topical TAC has a primarily local therapeutic effect on the skin.

Clinical and Experimental Dermatology

Serum Triamcinolone Levels During Intensive, Inpatient Wet-Dressing Therapy

Clin Exp Dermatol 2020 May 14;[EPub Ahead of Print], SA Mirza, AB Wentworth, JA Harvey, AG Bridges, MJ Camilleri, RA El-Azhary, MT McEvoy, JC Sartori Valinotti, DA Wetter, MDP Davis 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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