(Purple striae to the left)
(dorsal fat pad pictured above)
Many patients with require corticosteroid treatment for their underlying medical condition. Unfortunately, there are many complications of these drugs - a discussion with patients of the risks, benefits, and alternatives of corticosteroid therapy should be performed prior to starting therapy.
Skin & Soft Tissue: thinning of the skin and easy bruising. Cushingoid features are common, which include central obesity, dorsal fat pad, weight gain, purple striae, and moon facies.
Eyes: cataract formation and glaucoma.
Metabolic: hyperglycemia and hyperlipidemia.
Central Nervous System: sleep disturbances, mood changes, hypomania, and overt psychosis.
Cardiovascular: Increased risk of myocardial infarction and stroke - likely stemming from the metabolic abnormalities. Patients may be at an increased risk of hypertension and congestive heart failure from fluid-retention.
Gastrointestinal: Patients are at an increased risk of developing gastritis, ulcer formation, and GI bleeding - especially when concomitantly taking NSAIDS.
Musculoskeletal: There is the rare but dreaded avascular necrosis of the hip, and commonly osteopenia and osteoporosis which can result in fragility fractures. Patients may also develop proximal muscle weakness from a steroid-induced myopathy.
Infection: Steroids are immune modulators and patients are at an increased risk of infection - perhaps from decreased phygocytic function or a blunted cytokine response.
Pregnancy: Steroids may be a risk factor for cleft-palate development in the fetus.
(another complication of steroids pictured to the left)