The risk for blood count changes is increased when combining triamcinolone with ACE inhibitors.Triamcinolone and other drugs can also influence each others concentrations in the body, amounting to pharmacokinetic interactions such as:
Rifampicin, phenytoin, carbamazepine and other inducers of the liver enzyme CYP3A4 speed up metabolization of triamcinolone and can therefore reduce its effectiveness. Conversely, CYP3A4 inhibitors such as ketoconazole and itraconazole can increase its concentrations in the body and the risk for adverse effects. Blood concentrations of ciclosporin can be increased. Pharmacology
Mechanism of action
Triamcinolone is a glucocorticoid that is about five times as potent as cortisol, but has very little mineralocorticoid effects. Pharmacokinetics
When taken by mouth, the drugs bioavailability is over 90%. It reaches highest concentrations in the blood plasma after one to two hours and is bound to plasma proteins to about 80%. The biological half-life from the plasma is 200 to 300 minutes; due to stable complexes of triamcinolone and its receptor in the intracellular fluid, the total half-life is significantly longer at about 36 hours.A small fraction of the substance is metabolized to 6-hydroxy- and 20-dihydro-triamcinolone; most of it probably undergoes glucuronidation, and a smaller part sulfation. Three quarters are excreted via the urine, and the rest via the faeces.Due to corticoids mechanism of action, the effects are delayed as compared to plasma concentrations.
Also advised are measures to avoid moisture build-up including keeping the groin region dry, avoiding tight clothing and losing weight if obese. People with athletes foot or tinea cruris can prevent spread by not lending their towels to others. Treatment
Tinea cruris is treated by applying antifungal medications of the allylamine or azole type to the groin region. Studies suggest that allylamines (naftifine and terbinafine) are a quicker but more expensive form of treatment compared to azoles (clotrimazole, econazole, ketoconazole, oxiconazole, miconazole, sulconazole). If the symptoms have been present for long or the condition worsens despite applying creams, terbinafine or itraconazole can be given by mouth.The benefits of the use of topical steroids in addition to an antifungal is unclear. There might be a greater cure rate but no guidelines currently recommend its addition. The effect of Whitfields ointment is also unclear, but when given, it is prescribed at half strength.Wearing cotton underwear and socks, in addition to keeping the groin dry and using antifungal powders are helpful. Prognosis and complications
Tinea cruris is not life-threatening and treatment is effective, particularly if the symptoms have not been present for long. However, recurrence may occur. The intense itch may lead to lichenification and secondary bacterial infection. Irritant and allergic contact dermatitis may be caused by applied medications. Epidemiology
Tinea cruris is common in hot-humid climates and is the second most common clinical presentation for dermatophytosis. It is uncommon in children. References
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