Side effects of short-term oral corticosteroids

Background: Physicians frequently prescribe short-term corticosteroids (CSs) to treat acute and self-limiting diseases. Standard texts and articles do not usually discuss the possible, although infrequent, risks of short-term CSs. Objective: To demonstrate that side effects, although uncommon, can occur with short-term CSs and that these can occasionally be serious. Methods: Medline peer review literature in English (1985-2006) was searched to identify the potential risks of CSs. Standard textbooks of dermatology, gastroenterology, ophthalmology, pharmacology, respirology, and rheumatology were reviewed. Because the results showed some factual discordance and a dearth of precise data, the results for each body system were reviewed with two relevant clinical specialists at North York General Hospital (with at least 20 years' experience). Further information was obtained from a questionnaire of 200 physicians in North York General Hospital and by feedback from an additional 100 physicians during a presentation of this material at the American Academy of Dermatology. Results: Short-term CSs are generally safe, but there have been numerous reports of associated avascular necrosis and a few cases of fatal varicella-zoster in immunocompetent patients. Severe mood changes and psychotic reactions rarely occur unpredictably with short-term CSs. These events are rare, and most treatments with short-term CSs are problem free. Conclusions: Problems are infrequent, but patients must be informed of all material risks and treatment options. Thorough chart documentation is required, and patient consent must be given. CS doses should be as low as possible, and CS courses should be as infrequent and as short as possible. The literature reviewed in this article clearly indicates that a short course of CS of 1 week, in the absence of specific contraindications, is unlikely to be harmful (psychotic or prepsychotic episodes possibly excepted).