Is Triamcinolone, Topical Safe in Breastfeeding

I am a breastfeeding mother and i want to know if it is safe to use Triamcinolone, Topical? Is Triamcinolone, Topical safe for nursing mother and child? Does Triamcinolone, Topical extracts into breast milk? Does Triamcinolone, Topical has any long term or short term side effects on infants? Can Triamcinolone, Topical influence milk supply or can Triamcinolone, Topical decrease milk supply in lactating mothers?

A corticosteroid with a mainly glucocorticoid action and anti-inflammatory effects of similar strength to that of prednisolone.Systemic administration (oral, injection), inhaled (bronchial, nasal), intra-articular, intravitreous and topical.Indicated in the treatment of rheumatic diseases and collagen, inflammatory bowel disease, dermatitis, asthma, rhinitis, etc. This comment is about systemic, intra-articular and ophthalmic triamcinolone. Since the last update we have not found published data about its excretion in breast milk. Administration of intra-articular triamcinolone in the wrist (Smuin 2016) or via an epidural in the cervical area (McGuire 2012) caused a temporary decrease in the production of milk lasting between one and four weeks that was resolved in both cases via the continuation and stimulation of breastfeeding. The same has occurred, with a shorter duration, following the intra-articular administration of methylprednisolone (Babwah 2013). Although after the administration of triamcinolone, both intraocular (Shen 2010, Degenring 2004), and epidural (Hooten 2016), elimination half-life is about 22-25 days, plasma levels are indetectable or very low, not clinically significant. The maximum concentration peak after these types of administration occurs at 24 hours (Hooten 2016, Shen 2010, Degenring 2004). There is consensus among experts that, in general, neither systemic corticoids nor inhaled ones present a breastfeeding contraindication (National Asthma Education 2004). The low plasma levels obtained after ophthalmic administration suggest a very low risk during breastfeeding. Corticoids are of commonally used in pediatrics and have no side effects when they are used in isolation or in short-term treatments. Until there is more published data about this drug in relation to breastfeeding, alternatives with a safer known pharmacokinetic profile for breastfeeding may be preferable (greater protein binding, lesser half-life and less oral bioavailability), especially during the neonatal period and in case of prematurity. If used during breastfeeding it is advisable to monitor milk production. See below the information of these related products:

Topical triamcinolone has not been studied during breastfeeding. Since only extensive application of the most potent corticosteroids may cause systemic effects in the mother, it is unlikely that short-term application of topical corticosteroids would pose a risk to the breastfed infant by passage into breastmilk. However, it would be prudent to use the least potent drug on the smallest area of skin possible. It is particularly important to ensure that the infant's skin does not come into direct contact with the areas of skin that have been treated. Only the lower potency corticosteroids should be used on the nipple or areola where the infant could directly ingest the drugs from the skin. Only water-miscible cream or gel products should be applied to the breast because ointments may expose the infant to high levels of mineral paraffins via licking.[1] Any topical corticosteroid should be wiped off thoroughly prior to nursing if it is being applied to the breast or nipple area.

Topical application of a corticosteroid with relatively high mineralocorticoid activity (isofluprednone acetate) to the mother's nipples resulted in prolonged QT interval, cushingoid appearance, severe hypertension, decreased growth and electrolyte abnormalities in her 2-month-old breastfed infant. The mother had used the cream since birth for painful nipples.[2]

Relevant published information was not found as of the revision date. Adequate endogenous adrenocorticoid levels are necessary for normal lactation.[2]