Suggested guidelines for screening and management of tuberculosis in patients taking oral glucocorticoids - an important but often neglected issue

One third of the world's population is infected with tuberculosis and its incidence is increasing. Systemic glucocorticoids are the mainstay of immunosuppressive therapy for immunobullous diseases and collagen vascular diseases in dermatology. Patients who are given prolonged glucocorticoid therapy may be at risk for both the acquisition of primary tuberculosis and the reactivation of nonactive tuberculosis. The purpose of this article is to highlight the importance of screening for tuberculosis and its management in this group of patients, as there are no published guidelines in the dermatology literature on this subject. We summarize the methods used for tuberculosis screening, give an account of treatment regimens for the various types of tuberculosis infection, and suggest a practical approach to screening and management of tuberculosis in patients receiving long-term glucocorticoid therapy.