Triamcinolone diacetate

Abstract: Epidural morphine injection followed by a steroid has been reported to be effective for the post-laminectomy pain ('failed back') syndrome. This double-blind, parallel study was undertaken to evaluate that mode of therapy. Twenty-two patients who had undergone at least one prior laminectomy, who were still symptomatic, were randomized to receive 50 mg of lidocaine epidurally with: (a) 75 mg triamcinolone diacetate (TR); or (b) 8 mg of preservative-free morphine (MP); or (c) both (TR and MP), at 1 month intervals for 3 consecutive months. The spinal interspace identified with the patients' pain complaint was the site of injection. For each treatment, patients were admitted to the Clinical Research Center for 24 h and their condition continuously monitored with a pulse oximeter and apnea monitor. Five to 7 patients in each group had pain relief for less than 1 month. No patient given morphine had pain relief for more than 1 month. Life-threatening ventilatory depression occurred in the group given triamcinolone and morphine. The use of morphine alone or combined with slow release triamcinolone does not appear to be appropriate for the treatment of the post-laminectomy pain syndrome.

Abstract: Multiple daily injections of triamcinolone diacetate to newborn rats result in decreased body and skin weight gain, which is related to a specific decrease of collagen polypeptide synthesis. The effects of glucocorticoid administration on protein synthesis of the dermis was determined by measurement of the incorporation of labeled proline. The percentage decrease in collagen synthesis in triamcinolone-treated animals was greater than that of non-collagen protein synthesis at all doses examined, indicating a selective effect of glucocorticoids on collagen synthesis. This selective decrease of collagen synthesis was greatest after multiple injections at higher doses of the steroid. DNA synthesis was also suppressed after multiple injections of steroid. Steroid administration resulted in a decrease in prolyl hydroxylase activity (EC 1.14.11.2) in a dose- and time-dependent manner. Lysyl hydroxylase activity (EC 1.14.11.4) was decreased to the same extent as prolyl hydroxylase activity, while glucose 6-phosphate dehydrogenase activity (EC 1.1.1.49) was unchanged and tyrosine aminotransferase activity (EC 2.6.1.5) was slightly elevated. Collagenase digestion of nascent polypeptide chains released from dermal polysomes demonstrated a selective, dose-dependent decrease in collagen polypeptide synthesis. Furthermore, collagen nascent chain synthesis was decreased to the same extent as hydroxyproline formation, indicating that glucocorticoids do not cause the synthesis and subsequent accumulation of underhydroxylated collagen.

Abstract: Injection of triamcinolone diacetate at a high intradermal site results in persistent scarring secondary to local vesiculation and ulceration. Histologically, early changes included necrosis of the epidermis, the small blood vessels, and the appendages; late changes included thinning of the epidermis, loss of rete peg formation, and vascular and collagen proliferation. Injection at a low intradermal site resulted in atrophy, pigmentary changes, and telangiectasia appearing as early as 14 days and lasting as long as ten months, depending on anatomical site. In the skin of the arms and back these changes occurred on the average at one month, lasting usually six months. In the skin of a calf these began as late as two months, lasting eight months or more. In skin of the scalp, these occurred at three weeks, lasting only three months. The histopathological changes consisted primarily of a decrease in mucopolysaccharide, which was associated with loss of elastic tissue, homogenization of collagen, epidermal atrophy, and degenerative changes in the appendages. These changes were reversible. Injection at a high subcutaneous site usually resulted in no cutaneous change clinically. A few sites developed mild transient reversible changes both histologically and clinically similar to those seen with low intradermal injections. No differences due to race were detected in this study. Likewise, differences attributable to age were not conclusive. The development of triamcinolone-induced atrophy is dependent upon the anatomical level of the injection within the skin as well as the local concentrations achieved. Consideration of depth of injection and of concentration should minimize the degree of atrophy resulting.