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Whether or not to use systemic corticosteroids to treat a skin disease - This Changed My Practice - Common side effects
Drug information provided by: IBM Micromedex. Prednisone provides relief for inflamed areas of the body. It is used to treat a number of different conditions, such as inflammation swellingsevere allergies, adrenal problems, arthritis, asthma, blood or bone marrow problems, endocrine problems, eye or vision problems, stomach or bowel problems, lupus, skin conditions, kidney problems, ulcerative colitis, and flare-ups of multiple sclerosis. Prednisone is a corticosteroid cortisone-like medicine or steroid.
It works on the immune system to help relieve swelling, redness, itching, and allergic reactions. In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:.
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals.
For non-prescription products, read the label or package ingredients carefully. Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of prednisone in children. However, pediatric patients are more likely to have slower growth and bone problems if prednisone is used for a long time.
Recommended doses should not be exceeded, and the patient should be carefully monitored during therapy. Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of prednisone in the elderly.
However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require caution and an adjustment in the dose for elderly patients receiving prednisone. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding. Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur.
In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive. Using this medicine with any of the following medicines is not recommended.
Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur.
Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:.
Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance for unwanted effects. Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.
Measure the concentrated liquid with the special oral dropper that comes with the package. If you use this medicine for a long time, do not suddenly stop using it without checking first with your doctor. You may need to slowly decrease your dose before stopping it completely. The dose of this medicine will be different for different patients.
Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. If you miss a dose of this medicine, take it as soon as possible.
However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.
Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. If you will be taking this medicine for a long time, it is very important that your doctor check you at regular visits for any unwanted effects that may be caused by this medicine. Blood or urine tests may be needed to check for unwanted effects.
Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away. If you are using this medicine for a long time, tell your doctor about any extra stress or anxiety in your life, including other health concerns and emotional stress.
Your dose of this medicine might need to be changed for a short time while you have extra stress. Using too much of this medicine or using it for a long time may increase your risk of having adrenal gland problems. Talk to your doctor right away if you have more than one of these symptoms while you are using this medicine: blurred vision, dizziness or fainting, a fast, irregular, or pounding heartbeat, increased thirst or urination, irritability, or unusual tiredness or weakness.
This medicine may cause you to get more infections than usual. Avoid people who are sick or have infections and wash your hands often. If you are exposed to chickenpox or measles, tell your doctor right away. If you start to have a fever, chills, sore throat, or any other sign of an infection, call your doctor right away.
Check with your doctor right away if blurred vision, difficulty in reading, eye pain, or any other change in vision occurs during or after treatment. Your doctor may want you to have your eyes checked by an ophthalmologist eye doctor. While you are being treated with prednisone, do not have any immunizations vaccines without your doctor's approval.
Prednisone may lower your body's resistance and the vaccine may not work as well or you might get the infection the vaccine is meant to prevent. In addition, you should not be around other persons living in your household who receive live virus vaccines because there is a chance they could pass the virus on to you.
Some examples of live vaccines include measles, mumps, influenza nasal flu vaccinepoliovirus oral formrotavirus, and rubella. Do not get close to them and do not stay in the same room with them for very long. If you have questions about this, talk to your doctor. This medicine may cause changes in mood or behavior for some patients.
Tell your doctor right away if you have depression, mood swings, a false or unusual sense of well-being, trouble with sleeping, or personality changes while taking this medicine. This medicine might cause thinning of the bones osteoporosis or slow growth in children if used for a long time. Tell your doctor if you have any bone pain or if you have an increased risk for osteoporosis. If your child is using this medicine, tell the doctor if you think your child is not growing properly.
Make sure any doctor or dentist who treats you knows that you are using this medicine. This medicine may affect the results of certain skin tests. Do not take other medicines unless they have been discussed with your doctor.
This includes prescription or nonprescription over-the-counter [OTC] medicines and herbal or vitamin supplements. Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.
Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:. Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
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Your doctor may decide not to treat you with this medication or change some of the other medicines you take. Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines. Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you.
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:. Take this medicine exactly as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered.
To do so may increase the chance for unwanted effects. Measure the oral liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.
Measure the concentrated liquid with the special oral dropper that comes with the package. If you use this medicine for a long time, do not suddenly stop using it without checking first with your doctor. You may need to slowly decrease your dose before stopping it completely. The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine.
For children, the recommended FTUs will depend on their age. A GP can advise you on this. If you use them correctly, topical corticosteroids rarely have serious side effects. The most common side effect of topical corticosteroids is a burning or stinging sensation when the medicine is applied.
However, this usually improves as your skin gets used to the treatment. If potent or very potent topical corticosteroids are used for a long time or over a large area, there's a risk of the medicine being absorbed into the bloodstream and causing internal side effects, such as:.
This is not a full list of all the possible side effects. For more information on side effects, see the leaflet that comes with the medicine. If you stop using topical corticosteroids after using them continuously for a long time usually over 12 months in adults , you may have a withdrawal reaction.
These can sometimes be severe. For reasons that are not known, high dose prednisone for example, greater than 20 milligrams a day predisposes some patients to joint damage, most often of the hips.
Many patients with avascular necrosis require joint replacements. Long—term steroid use may lead to cataract development in the eyes, which frequently require surgical removal. High dose prednisone predisposes some patients to acne, especially facial acne, as pictured below. The facial acne developed after several weeks of high steroid doses.
Health Care Professional Yes No. All information contained within the Johns Hopkins Vasculitis website is intended for educational purposes only. Physicians and other health care professionals are encouraged to consult other sources and confirm the information contained within this site.
Call if you're worried about a child under the age of 5 years. You may notice mood changes and mental health problems while taking prednisolone. Talk to your doctor or contact if you have any mood changes including:. In rare cases, it's possible to have a serious allergic reaction anaphylaxis to prednisolone.
You could be having a serious allergic reaction and may need immediate treatment in hospital. Taking prednisolone at higher doses for a long time can slow down the normal growth of children and teenagers. Your child's doctor will monitor their height and weight carefully for as long as they're taking this medicine.
This will help them spot any slowing down of your child's growth and change their treatment if needed.
Back to Prednisolone tablets and liquid. The higher the dose of prednisolone that you take and the longer you take it for, the greater the chance of side effects. You're less likely to get side effects if you take a relatively low dose of prednisolone daily.
If you have been taking prednisolone for more than a few weeks, check with your doctor before stopping it suddenly to reduce your chances of withdrawal side effects. Some side effects, such as stomach upset or mood changes, can happen straight away. Others, such as getting a rounder face, happen after weeks or months. These common side effects of prednisolone happen in more than 1 in people. There are things you can do to help cope with them:.
If you have to take prednisolone for more than a few weeks, it's likely that you'll put on weight. Prednisolone can make you hungrier and also can make you retain more water in your body. Try to eat well without increasing your portion sizes. Regular exercise will also help to keep your weight stable. Once you stop taking prednisolone, your appetite and the way your body retains water should return to normal. Take prednisolone with food to reduce the chances of stomach problems. It may also help if you avoid rich or spicy food while you're taking this medicine.
If symptoms carry on, ask your doctor if you may benefit from taking an additional medicine to protect your stomach. If you're feeling restless when you're trying to sleep, take prednisolone in the morning so the levels are the lowest at bedtime. Try wearing loose clothing and use a strong anti-perspirant.
If this does not help, talk to your doctor as you may be able to try a different medicine. Prednisolone can affect your mood in different ways. Talk to your doctor if you are finding it hard to cope. Speak to a doctor or pharmacist if the advice on how to cope does not help and any of these side effects bother you or last more than a few days. You are more likely to have a serious side effect if you take a higher dose of prednisolone or if you have been taking it for more than a few weeks.
Go to Call if you're worried about a child under the age of 5 years. You may notice mood changes and mental health problems while taking prednisolone. Talk to your doctor or contact if you have any mood changes including:. In rare cases, it's possible to have a serious allergic reaction anaphylaxis to prednisolone. You could be having a serious allergic reaction and may need immediate treatment in hospital. Taking prednisolone at higher doses for a long time can slow down the normal growth of children and teenagers.
Your child's doctor will monitor their height and weight carefully for as long as they're taking this medicine. This will help them spot any slowing down of your child's growth and change their treatment if needed. Even if your child's growth slows down, it does not seem to have much effect on their eventual adult height.
Talk to your doctor if you're worried. They'll be able to explain the benefits and risks of giving your child prednisolone. These are not all the side effects of prednisolone.
For a full list, see the leaflet inside your medicine packet. Page last reviewed: 24 February Next review due: 24 February Side effects of prednisolone tablets and liquid.
Common side effects These common side effects of prednisolone happen in more than 1 in people. There are things you can do to help cope with them: Weight gain If you have to take prednisolone for more than a few weeks, it's likely that you'll put on weight. Take prednisolone in the morning so the levels are the lowest at bedtime.
Information: You can report any suspected side effect using the Yellow Card safety scheme. Visit Yellow Card for further information.
Even at low doses, prednisone can cause skin issues. These include skin thinning, acne, excess hair growth (hirsutism), hair thinning, face redness, stripe-like. Prednisone oral tablet can cause a serious allergic reaction in some people. This reaction can cause a skin rash, which can include. Prednisone also causes “thin skin”. Patients on moderate to high doses of prednisone often notice that they bruise easily, even with only slight trauma. It works on the immune system to help relieve swelling, redness, itching, and allergic reactions. This medicine is available only with your. your mouth, face, lips, tongue or throat start swelling. You could be having a serious allergic reaction and may need immediate treatment in hospital. Long-term. Very potent topical corticosteroids are not usually prescribed for pregnant or breastfeeding women, or for very young children. To do so may increase the chance for unwanted effects.By Dr. Eileen Murray on October 3, Eileen Murray MD FRCPC biography and disclosures Disclosures: Served as a consultant for the pharmaceutical industry and participated in clinical research evaluating new therapies for psoriasis and atopic dermatitis. When I started out in dermatology, corticosteroids were the only systemic drug available to treat patients with severe allergic contact dermatitis ACD , atopic dermatitis AD , drug reactions and those with bullous diseases. Corticosteroids are potent and excellent immunosuppressive agents.
The main problem with systemic use is the high risk of drug interactions, as well as multiple serious acute and long-term side effects. It was the belief at the time that patients treated oral corticosteroids for short periods, two weeks or less for instance were not adversely affected by treatment.
Severe ACD caused by poison ivy was the disease I treated most frequently with systemic corticosteroids. Patients were given a two-week course of oral Prednisone, 50mg daily for seven days and 25mg daily for another seven total dose of mg.
Two weeks of treatment was necessary to prevent recrudescence and completely clear the eruption. The following article made me change the way I treated ACD and stimulated me to try to avoid using systemic corticosteroids when at all possible.
McKee et al 1 reported a group of male patients who had developed osteonecrosis six to thirty-three months after a single short-course of oral corticosteroids within three years of presentation. The mean steroid dose in equivalent milligrams of prednisone was range — mg. The mean duration of drug therapy was Osteonecrosis is a known complication of systemic corticosteroid use and was initially believed to occur only in patients who received high doses equivalent to more than mg of prednisone for extended periods 3 months or longer.
Each patient with ACD is instructed to apply a wet dressing 3,4 see Patient handout three times daily for 15 to 20minutes followed by the application of clobetasol propionate cream — the most potent topical corticosteroid. The patient continues the wet dressings daily until they are no longer itchy. Soon after changing my practice, I had a series of patients with severe, generalized ACD appearing two days post surgery.
Systemic treatment would have interfered with post operative healing. All of them were treated with the topical regime and had quick relief of itching. Their ACD cleared just as quickly as those patients I had previously treated with systemic corticosteroids. Psoriasis and chronic urticaria: do not treat either of these diseases with systemic corticosteroids!
Do not treat undiagnosed skin disease or itching with systemic corticosteroids:. A young man in the middle of the night presented to the emergency with a generalized rash and severe itching; so severe he was begging for relief. Three weeks previously he had been seen in a walk-in clinic and prescribed a one-week course of oral prednisone.
A week later, no better, he saw his family physician and was given an antifungal cream. Within the week, he was seen at another walk-in clinic and given a topical corticosteroid.
The rash continued to get worse culminating in his visit to emergency where he was being treated with IV Solu-Medrol and antihistamines. He had the most severe case of pityriasis rosea PR I have ever seen. I discontinued his corticosteroids, prescribed a day course of erythromycin and a compounded cooling lotion containing 0. By then his itch had subsided. His rash cleared within five days.
In this case, the initial treatment with oral corticosteroids had increased the severity of the disease so much that none of the physicians he saw subsequently were able to make a clinical diagnosis.
The etiology of PR is still not known. It may be a reaction to unknown triggers. Most cases are mild and resolve spontaneously without treatment. Recent studies have suggested an infectious etiology might be responsible.
Both oral erythromycin and acyclovir have been reported to clear patients with severe disease 5. An older male patient, within hours of inadvertently ingesting one cloxacillin capsule, presented with fever, facial swelling, diffuse erythema and numerous pin-sized non-follicular pustules.
He was otherwise well. I suggested that he be admitted and observed overnight. That evening, I found an article describing a series of patients with the same presentation — an unusual and rare drug reaction designated as acute generalized exanthematous pustulosis. The good news, it resolves spontaneously within a few days. I stopped at the hospital early the next morning.
I was too late; his physician had treated him with overnight with IV solu-medrol. Treating with topical corticosteroid is sometimes as effective for skin disease as the systemic drug:. There is evidence to show that treating severe bullous diseases with potent topical corticosteroids can be as effective as treating with systemic. Topical treatment is very much safer as very little of the drug is absorbed even with open lesions.
Also, as the skin heals even less corticosteroid is absorbed. Bullous pemphigoid most common in elderly patients is now often treated with topical corticosteroids alone or in combination with high doses of tetracycline and niacinamide 6,7.
Patients who may require systemic corticosteroids include patients with severe or unresponsive disease or those intolerant to other treatment. Diseases most frequently treated include drug reactions, AD, nummular dermatitis, ACD, bullous pemphigoid and lichen planus. From: Murray Eileen, Diagnosing Skin Diseases: A diagnostic tool and educational resource for pediatricians and primary care givers.
Note: Wet dressings are cool and soothing, antipruritic, and antiseptic. They also enhance absorption of topical medications. They are the epitome of a treatment that always helps and never harms. For skin diseases with weeping or crusting a wet dressing open to the air dries the lesions.
If the skin is dry an occluded wet dressing increases moisture retention. Physicians began using wet dressings several hundred years ago. Solutions were compounded by surgeons treating wounded soldiers. Many lives were saved because the wet dressings greatly reduced the risk of infection.
Karl August Burow, -a German surgeon, an inventor of both plastic surgery and wound healing techniques. Whether or not to use systemic corticosteroids to treat a skin disease.
View Results. Read More 2 Comments. The information presented here is interesting, but anecdotal. If I am to weigh the risk and benefit of offering oral steroids to my patients I need to get a sense of how likely such adverse events are.
I agree with Dr. Murray that it is important to know that this complication happens in the 50mg per day dosing range, and I thank her for her contribution — but a decision to abandon a traditional and highly effective treatment requires a better sense of absolute risk.
The orthopaedic surgeon who put together the osteonecrosis case series discussed in this article sees a highly select population of those who suffer such complications. What was the denominator? Having written perhaps prescriptions for oral steroids I have never seen this complication — although clearly that is too small a sample size to be meaningful.
The next time your local Division of Family Practice gets together count heads, and years of practice, and ask how many cases of osteonecrosis secondary to oral steroids the group has seen. I thank Dr. Scott Garrison for his thoughtful comments. Statistics are not my thing so am not able to provide a sense of absolute risk. I do think that the large cohort study by Dr. Feng-Chen Kao provides compelling evidence for the association of systemic corticosteroid use with both fracture-related arthroplasty and fracture-unrelated surgery.
In a group of 21, users matched with non-users followed over 12 years, the hazard ratio HR was double for steroid users over non-users. The HR increased with increased steroid dosage, particularly in those with fracture-unrelated arthropathy. The adjusted HR increased from 3. I think the most important point is that systemic corticosteroids are not a substitute for topical corticosteroids. They are a potent, broad-spectrum immunosuppressive agent and need to be prescribed with the same cautions you would use with any other immunosuppressive agent.
Topical corticosteroids are potent immunosuppressants but with normal use, rarely cause systemic symptoms. Our skin is an excellent barrier. I remember seeing a sixteen-year-old girl who had been prescribed clobetasol cream to treat her atopic dermatitis. It cleared her disease. However, she continued to apply it to her skin every morning after her shower to prevent the eczema from coming back.
She continued the daily treatment for a year. By that time, she had developed severe striae over her arms and legs. She was assessed by an endocrinologist and had no evidence of adrenal suppression. Notify me of followup comments via e-mail. You can also subscribe without commenting.
Whether or not to use systemic corticosteroids to treat a skin disease By Dr. Eileen Murray on October 3, Dr. What I did before When I started out in dermatology, corticosteroids were the only systemic drug available to treat patients with severe allergic contact dermatitis ACD , atopic dermatitis AD , drug reactions and those with bullous diseases. What changed my practice The following article made me change the way I treated ACD and stimulated me to try to avoid using systemic corticosteroids when at all possible.
What I do now 1. Allergic contact dermatitis: Each patient with ACD is instructed to apply a wet dressing 3,4 see Patient handout three times daily for 15 to 20minutes followed by the application of clobetasol propionate cream — the most potent topical corticosteroid.
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