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- Presentation
Steroid Side Effects for Dermatologists: What a Practicing Clinician Needs to Know in a Fast-Paced Clinic
Description
The discussion focuses on the side effects of systemic steroids, particularly from gastrointestinal, endocrine, and lipid perspectives. It highlights the importance of managing peptic ulcer disease, emphasizing that while steroids alone do not increase ulcer risk, concurrent use of NSAIDs and other factors necessitate precautions. Diabetes risk associated with steroid use is examined, recommending baseline glucose checks and monitoring for patients with additional risk factors like age and weight. Adrenal suppression is reviewed, stressing careful tapering of steroids for long-term users to avoid potentially life-threatening symptoms of adrenal insufficiency. The discussion also covers atherosclerosis and lipid management, urging dermatologists to screen for high LDL and other cardiovascular risks, particularly in patients with a history of conditions like lupus or diabetes. The importance of referring patients to specialists for managing hypertension and hyperlipidemia while outlining stricter LDL targets for those at high risk is noted. Overall, clinicians are reminded of their role in identifying and managing these complications when prescribing steroids.
View moreConclusions
- Systemic glucocorticoids do not significantly increase the risk of peptic ulcer disease when used alone.
- Proton pump inhibitors should only be used for patients on NSAIDs or those with peptic ulcer risk factors when using glucocorticoids.
- Diabetes screening is essential for older patients and those with a higher BMI starting systemic glucocorticoids.
- Routine blood glucose monitoring should be conducted for patients on glucocorticoids to prevent hyperglycemia.
- Patients using high doses of glucocorticoids for longer than three weeks are at risk of adrenal suppression and require careful tapering.
- Patients with a history of Cushing's syndrome and those on more than 20mg/day of prednisone for extended periods also need monitoring for adrenal suppression.
- It is crucial to inform patients on glucocorticoids about the potential for adrenal crisis and the importance of stress dosing in the event of illness or surgery.
- Patients should be monitored for steroid withdrawal syndrome when tapering off glucocorticoids.
- Elevated LDL cholesterol levels in patients on glucocorticoids necessitate evaluation and treatment to manage cardiovascular risk.
- There is a need for tighter lipid control in patients with autoimmune diseases who are on glucocorticoids.
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