The Systemic Cost of Intralesional Triamcinolone for Paediatric Keloids
https://doi.org/10.15605/jafes.041.S1
- Author:
Naveen Nair Gangadaran
1
;
Mastura Ibrahim
1
;
Meenal Mavinkurve
2
Author Information
1. Department of Paediatrics, Hospital Tuanku Ja’afar
2. Department of Paediatrics, International Medical University
- Publication Type:Journal Article
- MeSH:
Child;
Keloid;
Triamcinolone
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):144-145
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Intralesional triamcinolone acetonide (TAC) is an accepted
management option for paediatric keloid. TAC is a corticosteroid with five times the potency of hydrocortisone
and acts by inhibiting fibroblast growth and thus keloid
size. Dermatological adverse effects of TAC are common,
but repeated high-dose intralesional TAC can cause the
rare complication of Cushing syndrome and suppression
of the hypothalamic–pituitary–adrenal (HPA) axis.
Case:We report the case of an 11-year-old female referred for
worsening lower limb striae and low serum cortisol. Prior
to referral, intralesional TAC was administered by a general
practitioner to a left lower limb keloid which had developed
following an orthopedic intervention. A total of five
injections were administered over 4 months: a cumulative
dose of 150 mg (equivalent to 700 mg hydrocortisone).
The last dose was administered 6 months prior to referral.
The morning serum cortisol was low (<13.8 nmol/L) with
a concomitantly low adrenocorticotropic hormone (ACTH
0.41 pmol/L) level, consistent with suppression of the HPA axis secondary to exogenous steroids. Renin (84.80
mU/L), aldosterone (280.40 pmol/L), testosterone (0.31
nmol/L), estradiol (85.9 pmol/L) and thyroid function were
normal. Physiological oral hydrocortisone replacement was
promptly commenced, with education on adrenal crisis and
sick days while awaiting recovery of the HPA axis.
Conclusion:This case illustrates the serious complication of Cushing
syndrome with secondary HPA axis suppression due to
repeated intralesional TAC therapy for paediatric keloid
scars. Factors such as appropriate paediatric doses, size
of the keloid, site of injection (dermal, not subcutaneous),
and frequency of injections should all be given due
consideration before using TAC. Clinicians prescribing
steroids to children should be aware that suppression of the
HPA axis is a very real and life-threatening complication
and that steroids should be prescribed judiciously.
- Full text:2026081017155057020EP_P020.pdf
