Pitfalls of systemic and local corticosteroid treatment

Corticosteroids were first used for therapeutic purposes in patients with rheumatoid arthritis and topically for relief in the case of skin exanthem. With increasing medical knowledge, the indications for their administration have been expanded to include a broad spectrum of clinical conditions. In an acute single-use setting, there is no contraindication to the administration of corticosteroids which can often be life-saving. With long-term treatment, one has to take into consideration the possible risks of adverse side effects resulting from the nature of corticosteroids as agents that provide coping with stress situations, thus increasing blood pressure and blood glucose levels, ensure fluid retention in the body, and mobilize stocks and reserves. In the case of systemic administration, the following have to be expected: destabilization of diabetes or manifestation of prediabetes, decompensation of hypertension, dyslipidaemia, risk of developing gastrointestinal ulcerations due to increased acidity, risk of thromboembolic complications, and negative psychological effects on the patient. There is a significant risk of reactivation of tuberculosis in patients with a positive history. Topical administration of corticosteroids is used, in particular, in pulmonology, allergology, and dermatology, allowing to minimize the occurrence of systemic adverse side effects. However, even this administration is associated with some adverse effects resulting from negative effects on fibrous tissue, i.e. skin and adnexa atrophy, atrophy of subcutaneous fibrous tissue including its function in antigen detection and presentation, and impaired wound healing. During the course of systemic or local corticosteroid treatment, maximum safety of the patient must be ensured through education of both the patient and the carers as well as by a more thorough monitoring of parameters indicating an unfavourable course.

Keywords: steroids, long term administration, diabetes mellitus, tuberculosis, immunosupression.