Oral Steroids

Oral corticosteroids are powerful drugs that we doctors use in many clinical situations.  Unfortunately, as I have too frequently observed in my lengthening medical career, we often see too much of a good thing.  Even short courses of oral steroids can frequently cause significant side effects and should only be prescribed after very careful consideration of the benefits AND the risks.  I will be blunt to say that, in too many instances, patients in Emergency Rooms and urgent care centers are prescribed oral steroids without what I would accept as adequate evaluation of that ratio.  Please allow me to summarize a recent medical article from Archives of Diseases in Children by researchers Aljebab, Choonara, and Conroy that will illustrate my point.  These doctors conducted a comprehensive review of research articles of  3200 children ages 28 days to 18 years receiving < 14 days of oral steroid treatment

They found that the most common side effect seen with even short term steroid use was vomiting  (5.4%), which was more common with dexamethasone (“decadron”) as opposed to prednisolone (“orapred”).  Mood swings occur in 4.7%–anxiety, hyperactivity, aggression.  This appears to be dose dependent–much more at 2mg/kg/dose than 1 mg/kg/dose.  Next was sleep disturbance at 4.3%.  1/3 of children had blood pressure elevations to 120/90  and an equal number experienced significant weight gain during their short oral steroid course.

Infection was a more serious side effect occurring in 0.9% of children in their study, including one child who, tragically, died of overwhelming infection caused by immune suppression from oral steroid treatment.  Perhaps the greatest concern was suppression of the “hypothalamic-pituitary axis (HPA)”–the vital mechanism that maintains normal, life supporting cortisol production by the adrenal glands.  Fully 81% of children on short courses of oral steroids had biochemical evidence of this problem.  Fortunately none of the observed children experienced any clinically significant medical event secondary to HPA suppression.  But a worrisome observation, to say the least.

So, as we can see, this is not benign intervention and the decision to use oral steroids must be thoughtfully evaluated in each individual instance.  In my > 30 years experience, I find that mild to moderate exacerbation of respiratory problems like asthma or croup can be very well managed by inhaled steroids or at most a single dose of oral steroids.  Most rashes and hives, no matter how unsightly or uncomfortable for the patient, are well controlled with topical steroid preparations and oral antihistamines.

I encourage you to discuss with me any use of oral steroids recommended for your child.  I’m here so we can make this important decision together.

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Summer’s here and the time is right…

So, summer’s here, and the time is right, for “dancing in the street” (Mama’s and the Papa’s) or “fighting in the streets”(Rolling Stones).  Well, whatever you do in the streets and especially on the beaches, don’t forget the sun screen.

Remember to:

  1. Use at least 1 oz/application
  2. Apply 15′ before exposure
  3. Reapply every 3 hours or so, especially if bathing or engaged in activities involving profuse sweating
  4. Remember “tricky areas” like the backs of feet and knees, tops of ears, back of the neck, even the soles of your feet
  5. Extra protection for areas with freckles or moles
  6. Creams and lotions are probably more effective than sprays

The concern for melanoma–relatively rare but severe form of skin cancer–must be respected with increased sun exposure.  Many factors increase the risk, including fair skin, sunburn, multiple or atypical moles (>5mm), family history of skin cancer and melanoma, history of a variety of non-dermatologic cancers (thyroid, lymphoma, leukemia), as well as certain autoimmune disorders like Crohn’s and ulcerative colitis, so be extra conscientious about sunscreen in these situations.

Be sure to contact me or your dermatologist for lesions that develop :

  • bleeding
  • color change
  • inflammation
  • itching
  • open sores
  • pain
  • change in size
  • change in texture

Remember that coloring from the sun is the skin’s attempt to limit the damage done from that UV light exposure and that the effects of that damage are cumulative over a lifetime.  No one is young and beautiful forever but tell your sons and DAUGHTERS that they can stay beautiful longer if they treat their skin well.  Another good thing to remember is that there is no chemical protection that can match a hat on your head or a shirt on your back.

And as always: common sense.  Its the summer.  So be careful, but go outside and have fun.

Send along questions or comments, and thanks for following