Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Steroid Side Effects for Dermatologists: What a Practicing Clinician Needs to Know in a Fast-Paced Clinic
Description
The presentation discusses critical aspects of systemic glucocorticoid side effects relevant for dermatology practitioners. It covers strategies for preventing gastrointestinal issues, particularly ulcers, emphasizing that while the risk of peptic ulcer disease linked to steroid use is often overstated, certain patients—particularly those on high doses in combination with NSAIDs or other risk factors—require careful management and possible prophylaxis. The speaker contrasts H2 blockers and PPIs for ulcer prevention, noting the need for selective use of PPIs due to long-term side effects. Endocrine complications, especially related to diabetes and adrenal suppression, are highlighted. The necessity of monitoring blood glucose levels in steroid users, particularly those with potential undiagnosed diabetes, is underscored. Tapering strategies for glucocorticoids to prevent adrenal insufficiency are also discussed. Additionally, the importance of early lipid screening in patients on steroids is stressed, with emphasis on maintaining LDL cholesterol levels below recommended thresholds. The emergence of newer lipid-lowering treatments emphasizes the need for dermatologists to collaborate with cardiologists to manage atherosclerosis risk in patients with conditions like lupus or dermatomyositis. Ultimately, the talk aims to equip clinicians with the knowledge to mitigate glucocorticoid-associated risks and advocate for their patients' overall health.
View moreConclusions
- Long-term use of high doses of glucocorticoids increases the risk of peptic ulcer disease especially when combined with ulcerogenic drugs like NSAIDs.
- Prophylaxis for peptic ulcer disease should be considered in patients on high-dose glucocorticoids or those with additional risk factors such as history of ulcer disease, smoking, or advanced age.
- H2 blockers are safer than proton pump inhibitors regarding long-term side effects but PPIs remain more effective in ulcer prevention.
- Routine monitoring of blood glucose is necessary for patients on glucocorticoids, especially those with risk factors for diabetes.
- Patients on glucocorticoids should have baseline hemoglobin A1C checked and monitored regularly for diabetes onset.
- Adrenal suppression is likely in patients taking high doses of glucocorticoids for extended periods and careful tapering is essential to avoid withdrawal symptoms.
- If signs of adrenal suppression arise, it is critical to check cortisol levels before tapering glucocorticoids even at low doses.
- There is a need for tighter lipid management in patients taking glucocorticoids, focusing on managing LDL cholesterol levels to reduce cardiovascular risk.
- Patients with lupus, dermatomyositis, and similar autoimmune conditions are at increased risk for atherosclerosis and should be routinely screened and managed appropriately.
- Newer treatments for managing high cholesterol in patients at risk of cardiovascular disease, such as PCSK9 inhibitors, should be considered.
- Caplan A et al, J Am Acad Dermatol 76:11-6, 2017
- Almadi MA et al, Lancet 404(10447):68-81, 2024
- Narum S, et al. BMJ Open 2014;4:e004587.
- Piper JM et al, Ann Intern Med 114:735, 1991
- Conn HO et al, J Intern Med 236:619, 1994
- Keyes E et al, IJWD 7:560-575, 2021