title: Systemic glucocorticoids: important issues and practical guidelines for the dermatologist.
abstract: BACKGROUND
  The potent anti-inflammatory and immunosuppressive effects of systemic glucocorticoids have led to their wide use in the treatment of dermatologic diseases. However, glucocorticoids have been designated the "archetypal double-edged sword of medicine" as a result of their various potential adverse side effects. Dermatologists face major challenges in their usage and require knowledge of both the risks related to their usage and strategies with which to manage them.
  
  
  OBJECTIVE
  This brief review includes an evidence-based, strategic approach to the general risk management of systemic glucocorticoids with a focus on preventing glucocorticoid-induced osteoporosis (GIOP).
  
  
  METHODS
  We assess which classes of corticosteroid are most likely to provoke allergic cross-reactions and outline the mechanism for glucocorticoid resistance. We examine how glucocorticoids both help and impair normal physiology.
  
  
  RESULTS
  Five reactivity groups are defined, based on the structural and clinical characteristics of glucocorticoids. Tests for allergy reactions and mechanisms for glucocorticoid resistance are described. Guidelines for the prevention and treatment of GIOP are introduced.
  
  
  CONCLUSIONS
  Glucocorticoids play an important teleologic role in maintaining blood glucose levels adequate for brain function by inducing a catabolic state through the production of carbohydrates at the expense of proteins and fat stores. It is hoped that the various recommendations for the protection of patients treated with systemic glucocorticoids will provide physicians with practical guidelines for prescribing.
authors: Department of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.|Department of Dermatology, Ha'emek Medical Center, Afula, Israel.
authors: Roni P
authors: RP
authors: Dodiuk-Gad
authors: Metabolic Bone Diseases Unit, Rambam Health Care Campus, Haifa, Israel.|Department of Endocrinology, Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
authors: Sophia
authors: S
authors: Ish-Shalom
authors: Department of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.|Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors: Neil H
authors: NH
authors: Shear
mesh_terms: D003880:Dermatology; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D010024:Osteoporosis / Q000139:chemically induced / Q000517:prevention & control; D017410:Practice Guidelines as Topic
chemical_list: D005938:Glucocorticoids