Corticosteroids, including prednisone, are a class of powerful drugs that reduce inflammation and suppress the immune system. They are prescribed for a wide variety of conditions, including rheumatoid arthritis (RA) and lupus, as well as multiple sclerosis, some types of cancer, asthma and skin rashes – including those caused by poison ivy. They can be prescribed short-term – until a rash clears up or until another drug can take effect, for example – or they may be used long-term. Corticosteroids come in skin creams, injections and inhaled forms; however, this study examined only people who took them orally.
There is some evidence that sun exposure can accelerate steroid-induced skin atrophy, the development of which can be limited by protecting the skin, particularly the face and arms, from the sun. Daily use of a broad-spectrum sunscreen (UVB and UVA block) and appropriate protective clothing is recommended. 10 , 12 - 14 Patients on corticosteroids should also be encouraged to regularly use moisturisers on their arms and legs, as these may reduce bruising and tearing of the skin from minor trauma. 11 Evidence suggests that topical tretinoin can increase the epidermal thickness of sun-damaged atrophic skin, but long-term use may be necessary. 14 In dermatological practice, topical retinoids are used to help reverse skin atrophy caused by sun exposure or corticosteroid use.
Decreases in bone mineral density (BMD) have been observed with long-term administration of products containing inhaled corticosteroids, including flunisolide. The clinical significance of small changes in BMD with regard to long-term outcomes is unknown. Monitor patients with major risk factors for decreased bone mineral content, such as prolonged immobilization, family history of osteoporosis , postmenopausal status, tobacco use, advanced age, poor nutrition, or chronic use of drugs that can reduce bone mass (., anticonvulsants and corticosteroids) and treat with established standards of care.