Cushing's syndrome in postburn children following intralesional triamcinolone injection

Intralesional triamcinolone acetonide has been used extensively for the treatment of hypertrophic and keloid scars. Complications are few, usually being local skin color changes, prominent vascular markings, or subcutaneous atrophy. Cushing's syndrome following intralesional administration of triamcinolone acetate has only been described twice, both in adult patients. This paper reports on two pediatric cases of Cushing's syndrome following treatment of hypertrophic burn scars with intralesional triamcinolone acetonide. The first child, 10 years of age, was treated for hypertrophic burn scars of the back. The second child, age 21 months, was treated for hypertrophic burn scars of the face. In both, intralesional triamcinolone acetate therapy was initiated 3 months postburn injury and in neither child was the maximum recommended dose exceeded. In both children, Cushing's manifestations developed 1 to 2 weeks postinjection and resolved in 6 to 8 weeks with no treatment or permanent sequelae. Consultation with endocrinologists revealed no concurrent disease process. It appears that these two pediatric patients may have had a form of hypersensitivity to triamcinolone acetonide, as Cushing's syndrome was not the result of an overdose. In conclusion, intralesional triamcinolone acetonide should be used with an increased degree of caution in the pediatric population.