What causes facial swelling when taking prednisone. How long does prednisone moon face last. Can prednisone side effects be minimized. What are the emotional impacts of prednisone-induced facial changes. How to cope with appearance changes from prednisone.

The Phenomenon of Prednisone-Induced Facial Swelling

Prednisone, a corticosteroid medication commonly prescribed for inflammatory conditions, can lead to a distinctive side effect known as “moon face.” This facial swelling is characterized by a round, puffy appearance of the cheeks and neck. While not medically dangerous, it can significantly impact a person’s self-image and quality of life.

Why does prednisone cause facial swelling? The medication alters the body’s fat distribution, leading to increased fat deposits in specific areas, including the face. This redistribution, combined with fluid retention, results in the characteristic moon-like appearance.

Key Facts About Prednisone-Induced Facial Swelling:

• It’s more common with long-term use and higher doses
• Not everyone taking prednisone will experience this side effect
• The swelling is typically reversible once the medication is tapered or discontinued
• It’s considered a cosmetic issue rather than a medical concern

Beyond the Face: Other Physical Changes Caused by Prednisone

Facial swelling isn’t the only visible change prednisone can cause. The medication’s impact on fat distribution can lead to other noticeable physical alterations:

• Supraclavicular fat pads: Fat accumulation around the base of the neck and collarbone
• “Buffalo hump”: A fatty deposit on the back of the neck
• Abdominal weight gain: Increased fat storage in the midsection

Are these changes permanent? Fortunately, most prednisone-induced physical changes, including facial swelling and fat redistribution, tend to reverse once the medication is tapered and discontinued. However, the timeline for improvement can vary depending on the duration and dosage of prednisone use.

The Emotional Toll of Prednisone-Induced Appearance Changes

While the physical changes caused by prednisone may not pose direct health risks, their impact on emotional well-being can be significant. Many patients, especially younger individuals, struggle with the sudden and dramatic alterations to their appearance.

Common Emotional Responses to Prednisone-Induced Changes:

• Decreased self-esteem
• Social anxiety
• Depression
• Frustration with treatment

How can patients cope with these emotional challenges? It’s crucial to address both physical and mental health concerns. Open communication with healthcare providers, seeking support from mental health professionals, and connecting with others who have similar experiences can all be beneficial strategies.

Minimizing Prednisone Side Effects: Strategies and Considerations

While some side effects of prednisone are unavoidable, there are steps that can be taken to minimize their impact:

1. Use the lowest effective dose: Work with your doctor to find the minimum dose that controls your symptoms
2. Consider alternative delivery methods: In some cases, topical or inhaled corticosteroids may be options with fewer systemic side effects
3. Practice a healthy lifestyle: Maintain a balanced diet and regular exercise routine to help counteract weight gain and muscle weakness
4. Take the medication as prescribed: Never abruptly stop prednisone without medical supervision
5. Monitor for side effects: Keep your healthcare provider informed of any new or worsening symptoms

Is it possible to completely avoid prednisone side effects? While it’s challenging to eliminate all potential side effects, these strategies can help reduce their severity and impact on daily life.

The Crucial Importance of Proper Prednisone Tapering

One of the most critical aspects of prednisone treatment is the tapering process. Abruptly stopping the medication can lead to serious health consequences due to its impact on the body’s natural cortisol production.

Why is tapering necessary?

• Allows the body to gradually resume natural cortisol production
• Prevents withdrawal symptoms
• Reduces the risk of adrenal crisis

How is prednisone typically tapered? The tapering schedule depends on several factors, including the duration of treatment, dosage, and individual patient characteristics. Generally, the dose is reduced slowly over weeks or months, with frequent monitoring by a healthcare provider.

Long-Term Effects of Prednisone: What Patients Should Know

While many side effects of prednisone are temporary, long-term use of the medication can lead to more persistent health concerns:

• Osteoporosis: Increased risk of bone loss and fractures
• Diabetes: Altered blood sugar metabolism
• Cataracts and glaucoma: Increased risk of eye problems
• Cardiovascular issues: Potential for high blood pressure and increased cholesterol
• Muscle weakness: Particularly in the legs and arms

How can patients mitigate these long-term risks? Regular check-ups, bone density scans, blood sugar monitoring, and eye exams are crucial for patients on long-term prednisone therapy. Additionally, calcium and vitamin D supplements may be recommended to support bone health.

Balancing Benefits and Risks: When Is Prednisone the Right Choice?

Despite its potential side effects, prednisone remains a valuable medication for many conditions. Its ability to rapidly reduce inflammation makes it an essential tool in treating various autoimmune and inflammatory disorders.

Conditions commonly treated with prednisone:

• Inflammatory bowel diseases (Crohn’s disease, ulcerative colitis)
• Rheumatoid arthritis
• Asthma and COPD exacerbations
• Severe allergic reactions
• Certain skin conditions

How do doctors determine if prednisone is appropriate? The decision to use prednisone involves carefully weighing the potential benefits against the risks for each individual patient. Factors considered include the severity of the condition, alternative treatment options, and the patient’s overall health status.

Navigating Life on Prednisone: Practical Tips for Patients

For patients prescribed prednisone, managing daily life while dealing with side effects can be challenging. Here are some practical strategies to help:

1. Schedule medication times carefully: Taking prednisone in the morning can help minimize sleep disturbances
2. Manage diet: Focus on low-sodium, potassium-rich foods to help counteract fluid retention
3. Stay active: Regular exercise can help maintain muscle strength and bone density
4. Protect your skin: Prednisone can increase sun sensitivity, so use sunscreen and protective clothing
5. Monitor your mental health: Be aware of mood changes and seek support if needed
6. Keep a symptom diary: Track side effects and share this information with your healthcare provider

How can patients effectively communicate with their healthcare team about prednisone concerns? Be proactive in discussing side effects, ask questions about alternative treatments, and don’t hesitate to seek a second opinion if you’re unsure about your treatment plan.

The Future of Corticosteroid Therapy: Emerging Alternatives and Research

As medical science advances, researchers are exploring alternatives to traditional corticosteroids like prednisone that may offer similar benefits with fewer side effects:

• Selective glucocorticoid receptor agonists (SEGRAs): Designed to target inflammation more precisely
• Biologic therapies: Targeted treatments for specific inflammatory pathways
• Novel drug delivery systems: Methods to reduce systemic exposure and focus on affected areas

What progress has been made in developing prednisone alternatives? While research is ongoing, several promising therapies are in clinical trials. However, it’s important to note that prednisone remains a crucial medication for many conditions, and any new treatments will require extensive testing to ensure safety and efficacy.

In conclusion, while prednisone-induced facial swelling and other side effects can be challenging, understanding these impacts and working closely with healthcare providers can help patients navigate treatment more effectively. As research continues, the hope is that future therapies will offer the powerful anti-inflammatory benefits of prednisone with a reduced risk of side effects.

Facial Swelling Caused by Prednisone

Prednisone “moon face” is often thought of as an annoying side effect, though it can certainly impact your quality of life, and is worth addressing. Not everyone experiences all the side effects of prednisone, and some people taking this drug might not experience facial swelling at all.

Corticosteroid drugs such as prednisone are commonly used to treat inflammatory bowel disease (IBD) and many other inflammatory conditions. These drugs are frequently prescribed because they are inexpensive and often work quickly to squelch inflammation.

Lara Antel / Verywell 

Prednisone and most other steroid drugs given intravenously or by mouth have several potential side effects. Some side effects can be quite serious and others are considered more of a nuisance than a threat to health. One side effect that is associated with the long-term use of steroids is the development of a round, or moon-shaped, face.

How Prednisone Causes Facial Swelling

One of the more visible effects of long-term use of high dosages of prednisone is swelling in the cheeks and in the neck. Prednisone might also cause weight gain and redistribution of fat deposits in some people. This leads to fat going to specific areas of the body, including the face, abdomen, and the back of the neck. 

When the fat winds up around the base of the neck and the collarbone it’s called “supraclavicular fat pads.” Fat on the back of the neck is sometimes referred to as a “buffalo hump.” These are the types of prednisone side effects that can certainly lead to a lot of unhappiness in someone who is taking this drug.

The Emotional Toll of Facial Swelling

Facial mooning can be a difficult side effect to deal with for anyone and especially for younger patients (which often includes those with IBD). It is a visible side effect and it changes a person’s appearance, sometimes quite drastically.

These changes in the cheeks and the neck often lead to patients feeling unattractive and unhappy at a time when they are already feeling ill. Despite its drastic effect on appearance, this side effect of prednisone is actually not medically dangerous and is considered largely cosmetic.

The good news is that prednisone moon face will go down when the drug is discontinued. Usually, side effects such as moon face start to go away when the dosage is about 10 mg/day.

Takeaway

Prednisone moon face is not a dangerous side effect. The facial roundness will typically decrease once the steroid is tapered down and discontinued.

Side Effects

Some of the side effects of prednisone can best be avoided by minimizing the dose as much as possible with the help of your physician. However, there are some side effects of prednisone that are considered long-lasting and medically dangerous. Any troubling side effects while taking prednisone should be discussed with a physician.

Brianna Gilmarti / Verywell

Importance of Tapering

Because prednisone is a steroid, it affects the body’s natural production of cortisol. If the prednisone is stopped too quickly, the body may not be able to adjust, and there could be serious health effects.

Prednisone cannot be stopped suddenly—the dosage must be tapered down. This means that when a physician determines that the dose can be lowered, it’s lowered slowly over a period of days or months.

How fast or slow the dosage is lowered depends on how long it has been taken, and how much was taken. Prednisone that is taken for a long time at high doses may need to be lowered very slowly, usually every week or few weeks.

Coping

Such drastic changes in a person’s appearance because of a drug is upsetting. When people are prescribed prednisone, they’re not well, to begin with, and adding on a cosmetic adverse effect doesn’t help the situation.

It is crucial for people with IBD to take care of their mental health as well as their physical health. Talk to a gastroenterologist about the potential for the side effects of prednisone, as well as how to avoid them and when they will go away.

If prednisone side effects are causing feelings of sadness or depression, a primary care provider or gastroenterologist can make a recommendation to a mental health professional. Even a few visits with a counselor can go a long way towards improving how people with IBD feel about their disease and their quality of life.

8 Prednisone Side Effects + How to Minimize Them – Cleveland Clinic

Whether you’re attacked by poison ivy or have inflammatory bowel disease symptoms that affect your quality of life, taking prednisone can be a game-changer. But there’s a catch: Prednisone is known for a host of side effects that range from annoying to intolerable.

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“By teaming up with your doctor and practicing good old-fashioned self-care, you can minimize or even eliminate prednisone side effects,” says family medicine doctor Donald Ford, MD.

What is prednisone?

Prednisone is a strong anti-inflammatory steroid and jack-of-all-trades that is prescribed to treat conditions such as:

• Poison ivy.
• Sore throat.
• Inflammation in different parts of
  the body.
• Inflammatory arthritic conditions,
  such as rheumatoid arthritis, psoriatic arthritis and polymyalgia rheumatica.
• IBD, including Crohn’s disease and
  ulcerative colitis.

Prednisone mimics cortisol, your body’s “fight-or-flight” hormone. Cortisol’s many responsibilities include keeping inflammation at bay. “When we use prednisone as a treatment, we’re usually trying to either reduce inflammation directly or moderate the body’s inflammatory response,” says Dr. Ford.

How to counteract prednisone side effects

Compromised immune system

Turns out, prednisone’s greatest asset is also its
greatest weakness. The very action that makes prednisone so effective — its
ability to mute the immune system and relieve symptoms — can also lead to an increased
risk of illness and infection, since your body’s defenses are low.

What you can do: Practice healthy
lifestyle habits, including getting enough sleep and eating healthfully. “Treat
yourself well,” Dr. Ford says. “Anything you can do to stay healthy is going to
benefit you and reduce some of the problems associated with prednisone.”

Fluid retention

Fluid retention is one of prednisone’s most famous
side effects. “‘Moon face’ is common, which is swelling in the face that can
occur after you’ve been on steroids for a long time,” Dr. Ford notes. “You can also
get swelling in the legs and midsection.”

What you can do: “Prednisone alters how the body processes salt, so staying on a
low-salt diet can help to some degree,” he says. “And exercise can help keep
excess weight off.”

Hyperactivity

While prednisone is not a stimulant, it can make you
feel more alert or jittery. “It doesn’t really interrupt sleep, but some
patients find it keeps them awake when they don’t want to be,” Dr. Ford says.

What you can do: “If it’s possible, we
recommend you take your whole dose in the morning,” he recommends. “Then hopefully,
that sense of extra alertness will dissipate by bedtime.”

Stomach upset

Prednisone may cause gastrointestinal symptoms when you
take it on an empty stomach.

What you can do: This one is pretty
simple: Take your dose with food.

High blood sugar

If you typically have normal blood sugar levels, file
this side effect under no big deal. But if you’re one of the millions of
Americans with diabetes, this is something to watch out for.

What you can do: If you have diabetes, double
down on controlling and monitoring your blood sugar. And if you get your
prednisone and diabetes medications from different doctors, make sure they’re
aware of each other.

These healthy habits can affect your sugar levels, too:

• Use strategies (such as
  meditation) to cope with and reduce stress.
• Eat more fruits, vegetables, whole
  grains, and low-fat or skim milk and cheeses.
• Be active — shoot for exercise
  most days of the week.
• Get adequate rest (ideally seven
  to nine hours each night).

High white blood cell count

Curiously enough, prednisone raises white blood cell
counts on lab tests, Dr. Ford says. These are immunity cells that protect you
from disease. “What’s happening is that prednisone releases white blood cells from
your tissues into your bloodstream. The number goes up on a blood test, because
the cells have ‘moved’ there. But the actual white blood cell count is not
increasing, so it’s most likely fine.”

What you can do: Take a breath, and stay calm. You
don’t need to do anything (for once!)

Bone density loss

Long-term steroid use (longer than a month) can lead to loss of bone density, which also ups your risk for bone fractures. Some patients lose as much as 10% to 20% of their bone mass in the first six months of treatment.

What you can do: Talk with your doctor about your personal risk. “We typically start screening for bone density at age 65. But if somebody is younger and on chronic prednisone, then we would do bone density tests earlier and begin osteoporosis treatment if necessary.”

Symptoms related to mood

Mood issues may be connected to prednisone’s penchant for making you feel energized. “You may get that initial revved-engine feeling followed by a down,” notes Dr. Ford. “Long-term, we don’t think it causes depression, but it can certainly make your mood more volatile.”

What you can do: Your doctor can change your dose or add another medication to counteract any effects on your mood. And keep loved ones in the loop so they can give you any extra support you need.

How prednisone dosage impacts side effects

Most steroid side effects only occur when people take prednisone
long-term. For non-chronic issues, you might take it only for a couple of
weeks.

“We also try to start you on a high dose and then
rapidly lower it, which also minimizes side effects,” Dr. Ford explains. “That
way, you get the benefit of a strong anti-inflammatory burst to settle down the
reaction. Then the prednisone stays in your system long enough at lower levels so
the whole reaction can turn itself off.”

For longer-term prescriptions, doctors may taper down dosages gradually to get them as low as possible without the return of symptoms. “We typically aim for a dose that’s about 5 to 7 milligrams a day,” says Dr. Ford.

“We’re trying to roughly match how much cortisol the body produces, though many patients will be on a higher or lower dose than that.”

The right prednisone
dosage helps your body fire on all cylinders and reduces potential side
effects. But if you hit a symptom sweet spot, it doesn’t mean you no longer
need to take it.

“Don’t stop taking prednisone without checking with your doctor
first,” Dr. Ford cautions. “Stopping it suddenly will likely bring back the
symptoms we’re trying to control. ”

Sarah Hyland Gets Real About Dealing With Prednisone ‘Moon Face’

Modern Family star Sarah Hyland has been open about her experience with kidney dysplasia, a condition that causes the kidneys to develop abnormally, and the fact that she underwent a kidney transplant in 2012. Now, she’s sharing information with fans about “moon face,” swelling caused by prednisone, one of the medications she now has to take regularly.

On Saturday, Hyland posted a video to Instagram stories about her skin-care routine, The Mighty reports. First, she showed fans a facial serum that she likes to use. Then she took out a facial massage roller and said, “I use this thing to roll my face out. I don’t know if it works or not.” She then went on to explain that she likes to “roll her face out” because of the prednisone she takes.

Prednisone is a synthetic steroid hormone that mimics the actions of cortisol, a hormone that your body naturally produces, James J. Galligan, Ph. D., a professor of pharmacology and toxicology and director of the neuroscience program at Michigan State University, tells SELF. “Prednisone is most often used as an anti-inflammatory drug as it suppresses the immune system,” he explains, adding that people who have had a kidney transplant often take the drug to help prevent their transplanted kidney from being rejected by their immune system.

Unfortunately, prednisone has a lot of side effects—and some of them are serious.

“When we use prednisone, we’re always thinking of how to get people off of it quickly and how to use the least amount,” Lynn M. Ludmer, M.D., a rheumatologist at Baltimore’s Mercy Medical Center, tells SELF. It may be prescribed for many conditions, including severe allergic reactions, asthma, arthritis, and lupus, the Mayo Clinic explains.

Side effects include something that patients refer to as “moon face,” which is basically extreme facial swelling. “People do get swollen cheeks when taking prednisone for a long time,” Dr. Ludmer says. But the swelling isn’t just limited to the cheeks—some patients will get what’s called a “buffalo hump” at the base of their neck as well. Neither of these effects are harmful, Dr. Galligan says, “but [they] can make the patient feel socially uncomfortable as their appearance changes markedly.”

Other side effects can be more serious. People often lose muscle when they are on prednisone for an extended period of time, and the suppression of the immune system can make patients susceptible to infection, Dr. Galligan says. “Prednisone can also cause some patients to become restless and they might have difficulty sleeping,” he says. Some patients may also develop osteoporosis if they’ve been on the drug for several months, and blood pressure and blood sugar issues can also surface, Dr. Ludmer says.

Many of the harmful side effects of prednisone can surface after just a few weeks of being on the drug, Dr. Ludmer says, which is why prescribing it is something doctors take seriously. “This isn’t a candy kind of medication,” Dr. Ludmer says. “It’s something that needs to be monitored.”

Although facial rolling makes sense as a treatment for swelling in theory, it’s unlikely to actually help all that much.

Dr. Ludmer says this is the first she’s even heard of this as a possible way to beat the facial swelling associated with prednisone. “It is not likely to be very helpful,” Dr. Galligan says. That’s because the swelling is a product of prednisone actually changing a person’s fat distribution, which can cause someone to have more fat in their face, he explains. Using a roller over the area will massage the fat, but it won’t make it go away permanently.

My journey with steroids

*Disclaimer* This is not to be taken as medical advice, it is just my personal experience of these drugs. Please consult your own doctors before making any changes to your medication regime.

On the 20th June 2017 I left my rheumatologists office with a tub of pills which I was excited to take. Excited because I had been really sick for months and this was the first mention of ‘treatment’ I had yet to have. Excited because I had not yet read the full list of horrific side effects or experienced the effects of taking steroids. I didn’t know that I would be stuck on these pills for the next 2.5 years.

I was put on Prednisone to treat Lupus (SLE) whilst waiting for the other drugs I was started on to kick in. Prednisone is a type of corticosteroid. It helps by reducing inflammation. It also damps down your immune system, which can help in autoimmune illnesses in my case Lupus, where my immune system mistakenly attacks its own tissues. (NHS, 2019)

Steroid Moon Face: During & After

Prednisone Side Effects

I was so desperate for some relief from my symptoms ; however even I was taken a back when I read the side effects. The most common include:

· weight gain

· increased appetite

· sleep problems

· restlessness, irritability, aggression or agitation and mood changes

· sweating a lot, acne and rashes

· swelling of the fingers, hands, feet, or lower leg

· blurred vision and dizziness

· decrease in the amount of urine

· fast, slow, pounding heartbeat

· headache

· numbness or tingling in the arms or legs

· pounding in the ears

· shortness of breath

And these are just the short term effects! Taking high doses of steroids for more than a few weeks can start to affect how the body works. The body holds on to fluid, creating the ‘moon face’ look and change in body shape. Blood pressure can start to raise due to changes in your cardiovascular system. The body changes how it tolerates glucose and in some cases you can develop steroid-induced diabetes. It can effect how the body metabolises calcium and vitamin D which can lead to bone loss and osteoporosis. The immune system is suppressed which is what is intended, but this increases the risk of catching other infections, colds or flus (or corona virus!). Plus it suppresses your adrenal system from producing cortisol (as its artificially supplying cortisol) which can result in underactivity of the adrenal glands later.

Reading and understanding all of that is a A LOT to take on. Why on earth would you want to take a drug that causes almost as many issues as the reason you are taking it? Mostly you because you have no choice. I lost count of how many health professionals told me ‘oh steroids are awful for you’. Yes thank you, I didn’t choose to be on them! So if you are on steroids, ignore the the judgement from others. I am pretty sure you hate being on them as much as the haters love saying how bad steroids are for you.

My Experience

When I first took them I remember I didn’t fall asleep for about 3 days. I was in Australia at the time and called my mum (where it was daytime in the UK) wide awake at 3am. I had so much energy and mum said I was quite literally bouncing. My eyes were so wide I’m surprised my eyes didn’t pop out. I literally was buzzing off of them.

This sounds great except I still felt so exhausted. I was desperate to sleep but my body said no to that. It was the weirdest feeling and thankfully after a few days I did manage to get a little sleep each night.

My moon face started to kick in after about 3 months, and then stayed pretty much constant throughout. Some times I look back on photos and barely recognise myself.

During Steroids, Being off steroids 3 Months

I had a crazy increase in appetite. When I first saw ‘weight gain’ as a common side effect, I didn’t think it would happen to me as I usually have so much nausea, vomiting and stomach pain I can’t eat much anyway. But I have never craved all the carbs before, I literally couldn’t stop eating! Combined with increase appetite I was exercising less and less due to joint pain and swelling and still being so unwell. Plus steroids mean you put on a lot of water weight and this is weird because it changes the shape of your body. I got really big shoulders, puffiness around my armpits and my back. My legs also ballooned out so quickly I have my first ever stretch marks. Over 2 years I put on 11kg and my body shape did really change.

When I was on high doses I did notice a strange range of emotions. One memorable night I went from hysterical laughing to bursting into tears with 0. 1 seconds leaving my boyfriend incredibly scared and confused. D also reports I was more moody but its hard to know if this was the steroids or just the effect Lupus was having on my mental health!

Coming off Steroids

For me it was a long journey. I had to wait until I was well enough to not need steroids anymore and it took a long time to get up to a therapeutic dose of Azathioprine and for Hydroxychloroquine to work. I would start to reduce my dose and then my rheumatologist would tell me to go back up or tell me to stop decreasing and keep it stable. It felt like I was yo-yoing for months and months and I thought I would never get down to a lower dose.

When I finally could start to lower my dose, I used the regime my rheumatologist recommended, dropping down 5mg at a time until I got to 10mg and then dropping 1mg a week. The big jumps were okay, but once I got to 10mg I really struggled. Each time I dropped I had the weirdest side effects, sometimes it was my calfs cramping so much I couldn’t walk. Another time my scalp was on fire and had a crazy flaking scalp. My body could not tolerate the speed of reduction and I ended up staying at a dose for weeks on end before I would drop down another 1mg terrified of what random symptoms would be thrown at me.

I realised my body wasn’t coping and I needed to go down even slower. I started the following schedule: dropping 1mg over 7 weeks! Each week I took it down by 1mg for one extra day which took forever, but worked for me. I didn’t have any side effects and before I knew it I was below 5mg for the first time in almost 2 years which felt amazing!!

I had accepted that I may have to stay on 5mg steroids long term. This was as I had been on steroids for so long my body might be able to cope without them or if my lupus was still active it may have needed more support. 5mg is a low enough dose that the side effects are minimal, but still therapeutic with symptoms. But I decided to try to keep going down from 5mg and see how my body responds. I kept going and after 2.5 years of steroids I was finally freeee!

Post-Steroids

I get a lot of questions about how long until the side effects such as moon face and weight gain took to subside. As soon as I got below 10mg I felt like the crazy appetite started to ease, and the water weight started to come off once I hit 5mg. My face gradually became less round but I found it often got worse in the evenings or when over tired – but after about 3-4 months completely off steroids I finally got my chin and cheek bones back!

It took me a good few months before I felt like I had my ‘normal’ body back. As my steroid appetite left me, my lack of appetite returned so I then went the other way and lost all my steroid weight and more over the next few months. But 6 months later I feel like I have a better balance at a healthy weight!

My tips with Steroids

I hope this hasn’t put you off as they are important part of your treatment and as much as the side effects suck, and they do really suck, steroids are there to keep you alive! It’s cruel when your illness already takes so much from you and then this drug comes along and changes your appearance and your mood. As much as we say what we look like doesn’t matter, its part of our identity and it’s horrible when that changes. But trust that it will come back, you will be you again and in the meantime here are my tips:

1. Always take your dose at the same time and do not miss a dose. Set alarms, use an app, get friends and family to help you remember

2. If you can, take them in the morning after food as that helps with the insomnia at night

3. Carry a little ‘steroid card’ with you so that if you have an accident they know you are on steroids

4. Try to stay as active as your body manages and try to maintain a healthy diet throughout – but equally try not to stress about weight gain and your body shape changing, know it is temporary

5. Take vitamin D and calcium supplements to prevent long term effects of steroids

6. Make a realistic plan to come down steroids and listen to your body. There is no shame in going slower, or even super super slow like I did

7. Help your family and friends understand the side effects so they can support you

8. Know that this will pass and there will be a time where you can reduce your dose and hopefully come off them!

Lots of love,

Zoe xx

Weight Gain: The Unwanted Side Effect of Prednisone for UC

The Connection Between Prednisone and Weight Gain

Weight gain in people taking prednisone is linked to how long you take the drug, says Rudolph Bedford, MD, a gastroenterologist at Providence Saint Joseph’s Health Center in Los Angeles, California. The longer you’re on prednisone, the more likely you are to gain weight. Why does this happen? In addition to prednisone increasing appetite, Dr. Bedford says the drug also causes fluid retention, which leads to swelling, often of the hands, legs, and feet, along with the face. Prednisone may also interrupt a normal sleep-wake cycle, leading to inadequate sleep and a disruption of the hormones that help regulate appetite, says Kate Scarlata, RDN, a Boston-based dietitian who lists inflammatory bowel diseases like UC as one of her specialties.

How to Control Weight Gain on Prednisone

If weight gain is particularly bothersome, talk to your doctor about modifying your drug regimen. You should never stop taking medicine on your own. Steroids need to be tapered slowly under your doctor’s guidance. According to the Hospital for Special Surgery, rapid withdrawal of steroids may cause fatigue, joint pain, muscle stiffness, or fever.

Your doctor may be able to prescribe a different corticosteroid, like budenoside. This alternative is “quickly metabolized by the liver, thereby reducing corticosteroid-related side effects, and appears to be as effective as prednisone,” says Bedford.

Furthermore, employing a few simple nutritional strategies while you’re on prednisone can help you avoid the worst of the weight gain — and stay healthier overall, says Scarlata:

1. Reduce sodium intake. Minimize canned and processed foods, soy sauce, cold cuts, chips, and other salty snacks, because high-sodium foods contribute to water retention.
2. Choose low-calorie sources of calcium. Another prednisone side effect is the risk for bone mineral loss, so boosting calcium intake is important. But be careful about which calcium-rich foods you’re consuming. Some, like whole milk, also contain a lot of fat. Instead, try lower-calorie sources of calcium, like low-fat dairy, broccoli, kale, and chia seeds, says Scarlata, and consider a supplement.
3. Consume more potassium. Increased potassium intake can combat water retention, notes Bedford. Good sources of this important mineral include oranges, grapefruit, bananas, kiwifruit, spinach, collard greens, and tomatoes.
4. Opt for healthy fats. Don’t fall into the trap of low- and nonfat everything, Scarlata says. Small portions of healthy fats boost nutrition and help control hunger between meals. “Include a small handful of nuts, seeds, olive oil, fatty fish — like salmon or tuna — or avocado at every meal, as tolerated,” she says.
5. Stick with a schedule. Finally, says Scarlata, be aware that steroids’ hormonal regulation of hunger cues may make you feel hungry even when you’re not. For this reason, you should try to eat regularly-timed meals, she says. “If you let yourself get over-hungry, you’ll feel less in control and more likely to overeat.”

Additional reporting by Jordan M. Davidson.

Steroids (dexamethasone, prednisolone, methylprednisolone and hydrocortisone) | Cancer information

Steroids are naturally made by our bodies in small amounts. They help to control many functions including the immune system, reducing inflammation and blood pressure.

Man-made steroids can also be a treatment for many different conditions and diseases. The information on this page is about steroids used in cancer treatment.

The type of steroids you might have as part of your cancer treatment are usually a type called corticosteroids. These are man-made versions of the hormones produced by the adrenal glands just above the kidneys.

Steroids used in cancer treatment include:

• prednisolone
• methylprednisolone
• dexamethasone
• hydrocortisone

What steroids do

Steroids help control many body functions including:

• how your body uses food to produce energy (metabolism)
• keeping the balance of salt and water in your body
• regulating blood pressure
• reducing allergies and inflammation
• controlling mood and behaviour

Why are steroids used in cancer treatment?

There are a number of reasons you might have steroids as part of your cancer treatment.

They can:

• treat the cancer itself
• reduce inflammation
• reduce your body’s immune response, for example after a bone marrow transplant
• help reduce sickness when having chemotherapy
• improve your appetite

You might have them:

• when you are first diagnosed
• before and after surgery
• before and after radiotherapy
• before, during and after chemotherapy treatment
• for an advanced cancer

How you have steroids

The most common ways of taking steroids during cancer treatment are as:

• tablets or liquid (take them after a meal or with milk as they can irritate your stomach)
• an injection into a vein (intravenous)

Make sure you take your steroids according to the instructions your doctor or pharmacist gives you. Take the right dose, not more or less. And don’t stop taking them without talking to your specialist first.

When you have steroids

The dose and length of steroid treatment is different depending on why you’re having steroids. 

You might need to take them:

• every other day
• once a day
• several times a day

You should have a steroid card to carry with you all the time if you take steroids for more than 3 weeks. Your doctor or pharmacist might also suggest you wear a medical alert bracelet. This is in case you need treatment in an emergency. It tells the healthcare team you are taking steroids.

Always let your dentist know you’re taking steroids.

Stopping steroid treatment

Take your steroids exactly as your health professional has told you.

When you take steroid tablets, the higher amounts in your bloodstream stop your body from making its own supply. Stopping them suddenly can cause serious symptoms such as:

• pale, cold, clammy skin
• sweating
• fast, shallow breathing
• dizziness
• feeling or being sick
• diarrhoea

Never just stop taking your tablets. Cut them down gradually with help and guidance from your doctor or pharmacist.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven’t listed all the side effects. You may get some of them, but it is very unlikely that you will have all of them. You might have some of the side effects at the same time.

How often and how severe the side effects are can vary from person to person. We’re unable to give an idea of the frequency of these side effects because it depends on:

• what other treatment you are having – for example, your side effects could be worse if you are also having other drugs or radiotherapy
• the aim of the steroid treatment (for example to treat your cancer or to help with symptoms)
• if you’re taking steroids short or longer term
• the dose of steroids

When to contact your team

Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects
• your side effects aren’t getting any better
• your side effects are getting worse

Early treatment can help manage side effects better.

You might have one or more of these side effects. They include:

Increased risk of infection

Steroids can hide or change the signs and symptoms of some infections. They might also make it harder for your body to deal with an infection. This means infections are more difficult to diagnose at an early stage.

Symptoms of an infection include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection.

Mood changes

You might feel more anxious and emotional than usual when you take steroids. You may also feel tired and sad for a while after you stop taking them.

Up to 6 out of 100 people (6%) experience serious mental health problems when they take steroids. This includes depression. Let your doctor know if you notice any changes in your emotional or psychological wellbeing. Let your doctor know if you or any family members have ever had depression or manic depression (bipolar disorder).

Rarely, steroids can cause a reaction called steroid induced psychosis. People can become excited, confused and imagine things that aren’t real. This can be frightening, but it goes away when you stop taking the steroids.

Changes in blood sugar levels

You might have regular blood and urine tests to check this. Some people develop diabetes. You might need to have blood sugar lowering treatment. But your sugar levels usually go back to normal shortly after you stop taking steroids.

If you have diabetes already, you might need to check your blood sugar levels more often than usual.

Increased appetite and weight gain

Steroids can increase your appetite. Feeling hungrier can make it difficult to keep your weight down. Your appetite will go back to normal when you stop steroids – but some people need to diet to lose the extra weight.

Talk to your nurse or your dietitian about how to safely control your weight.

Fluid build up

A build up of fluid may cause swelling in your arms, hands, ankles, legs, face and other parts of the body. Contact your doctor if this happens to you.

Difficulty sleeping

It can help to change a few things about when and where you sleep. Try to go to bed and get up at the same time each day and spend some time relaxing before you go to bed. Some light exercise each day may also help.

Try and take your steroids in the morning or around lunchtime.

Indigestion or heartburn

Take your tablets after a meal or with milk as they can irritate your stomach.

Steroids can cause ulcers in the stomach or top part of the small bowel (duodenum).

Tell your doctor or nurse if you have:

• a gnawing or burning pain in your tummy (abdomen)
• indigestion
• heartburn

Changes to your face and appearance (Cushing’s syndrome)

You might develop:

• a swollen or puffy face
• stretch marks
• acne
• increased facial hair

You might put on weight around your tummy (abdomen).

This can be quite upsetting. Talk to your doctor or nurse about any of these side effects.

High blood pressure

Tell your doctor or nurse if you have headaches, nose bleeds, blurred or double vision or shortness of breath. Your nurse will check your blood pressure regularly.

Eye problems

You might have eye problems including:

• clouding of the lens of the eye (cataracts)
• glaucoma (damage to an eyesight nerve)
• eye infections
• problems with your vision, such as blurred vision due to increased pressure on the eyesight nerve

Let your doctor or nurse know if you have any problems with your eyes.

Skin changes

Skin changes might include:

• rashes
• skin thinning
• bruising

Wounds might take longer to heal than usual.

Weaker bones

You might have weaker bones due to bone loss (osteoporosis).

Dizziness and loss of balance (vertigo)

You might feel dizzy and you may feel as though the room is spinning. This is vertigo. Let your doctor or nurse know if this happens.

Increased numbers of white blood cells

Steroids can increase the number of white blood cells in your blood. Your doctor might see this on a full blood count test.

Hair changes

You might have more body hair than usual. Your head hair may thin. This is usually not noticeable by other people but can be upsetting.

Heart problems

Steroids can cause severe heart problems if you have had a recent heart attack.

Muscle wasting

Your legs may feel weaker and walking or climbing stairs may be more difficult. You may have aching muscles for a short while after stopping treatment.

Allergic reaction

You might have an allergic reaction to steroids, causing a skin rash, itching, swelling of the lips, face or throat, breathing difficulties, fever and chills. Tell your nurse or doctor immediately if at any time you feel odd or strange.

Headaches

Tell your doctor or nurse if you keep getting headaches. They can give you painkillers to help.

Growth problems in children

Steroids might cause growth problems in babies, children and teenagers. Your child’s doctor will look at the benefits and risks of prescribing high doses of steroids for your child

Low levels of potassium in your blood

Let your doctor or nurse know if you have cramping in your arm or leg muscles, tingling or numbness, palpitations (feeling your heart beat irregularly), or if you feel faint.

A low level of potassium in the blood is called hypokalaemia. You might have blood tests during cancer treatment to check for this. 

Burning or tingling around your bottom

You might have a burning or tingling sensation around your bottom during a steroid injection into a vein (intravenous). It usually goes once the injection finishes. Your nurse will give the injection slowly to try and prevent this.

Epilepsy becoming worse

If you have epilepsy this could become worse when taking steroids.

Blood clots

Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn’t common.

Symptoms of a blood clot include:

•    pain, redness and swelling around the area where the clot is and may feel warm to touch
•    breathlessness
•    pain in your chest or upper back – dial 999 if you have chest pain
•    coughing up blood

Tell your doctor immediately or go to A&E if you have any symptoms of a blood clot.

Inflammation of the pancreas

This drug can cause inflammation of the pancreas (pancreatitis). Tell your doctor straight away if you have sudden and severe pain in your tummy (abdomen).

Changes to your periods

Women might have irregular periods, or they stop altogether (amenorrhoea).

Liver changes

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Chicken pox and shingles

Keep away from people who have chicken pox or shingles whilst taking steroids if you have never had these illnesses. They could make you very ill.

If you do come into contact with someone who has them, tell your doctor or nurse straight away.

Other medicines, food and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. Talk to your doctor or nurse about effective contraception before starting your cancer treatment.

Breastfeeding

There is evidence that steroid drugs may come through into your breast milk. Talk about breastfeeding with your doctor. You can make a decision together based on the benefits to you and the possible risks to your baby.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You might be able to have other vaccinations if you have had:

• small doses of steroids for a short period of time (less than 2 weeks)
• local steroid treatment, such as eye drops or creams

Avoid close contact with people who’ve recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

iWantGreatCare lets patients leave feedback on their experience of taking a particular drug. The feedback is from individual patients. It is not information, or specialist medical advice, from Cancer Research UK.

Prednisone: Pediatric Medication | Memorial Sloan Kettering Cancer Center

This information from Lexicomp^® explains what you need to know about this medication, including what it’s used for, how to take it, its side effects, and when to call your healthcare provider.

Brand Names: US

Deltasone [DSC]; predniSONE Intensol; Rayos

Brand Names: Canada

APO-PredniSONE; TEVA-PredniSONE; Winpred

What is this drug used for?

• It is used for many health problems like allergy signs, asthma, adrenal gland problems, blood problems, skin rashes, or swelling problems. This is not a list of all health problems that this drug may be used for. Talk with the doctor.

What do I need to tell the doctor BEFORE my child takes this drug?

• If your child is allergic to this drug; any part of this drug; or any other drugs, foods, or substances. Tell the doctor about the allergy and what signs your child had.
• If your child has a herpes infection of the eye.
• If your child has any of these health problems: Malaria infection in the brain or a fungal infection.
• If your child has recently spent time in the tropics and has unexplained diarrhea.
• If your child has nerve problems in the eye.

This is not a list of all drugs or health problems that interact with this drug.

Tell the doctor and pharmacist about all of your child’s drugs (prescription or OTC, natural products, vitamins) and health problems. You must check to make sure that it is safe to give this drug with all of your child’s other drugs and health problems. Do not start, stop, or change the dose of any drug your child takes without checking with the doctor.

What are some things I need to know or do while my child takes this drug?

• Tell all of your child’s health care providers that your child is taking this drug. This includes your child’s doctors, nurses, pharmacists, and dentists.
• Have your child’s blood work, body weight, and other lab tests checked as you have been told if your child takes this drug for a long time. Your child may also need to have eye pressure and bone density checked.
• This drug may affect allergy skin tests. Be sure the doctor and lab workers know your child takes this drug.
• Tell the doctor if your child has missed a dose or recently stopped this drug and feels very tired, weak, or shaky, or has a fast heartbeat, confusion, sweating, or dizziness.
• Your child may have more chance of getting an infection. Some infections have been deadly. Have your child wash hands often. Have your child stay away from people with infections, colds, or flu.
• Chickenpox and measles can be very bad or even deadly in some people taking steroid drugs like this drug. Avoid having your child near anyone with chickenpox or measles if your child has not had these health problems before. If your child has been exposed to chickenpox or measles, talk with the doctor.
• If your child has or may have threadworms, talk with your child’s doctor.
• This drug lowers how much natural steroid your child’s body makes. Tell your child’s doctor if your child has fever, infection, surgery, or injury. The body’s normal response to these stresses may be affected. Your child may need extra doses of steroid.
• High blood pressure has happened with this drug. Have your child’s blood pressure checked as you have been told by the doctor.
• Long-term use may raise the chance of cataracts, glaucoma, or weak bones (osteoporosis). Talk with your child’s doctor.
• Talk with the doctor before your child gets any vaccines. Use of some vaccines with this drug may either raise the chance of very bad infection or make the vaccine not work as well.
• If your child has high blood sugar (diabetes), you will need to watch your child’s blood sugar closely.
• Alcohol may interact with this drug. Be sure your child does not drink alcohol.
• You may need to lower how much salt is in your child’s diet and give your child extra potassium. Talk with your child’s doctor.
• This drug may affect growth in children and teens in some cases. They may need regular growth checks. Talk with the doctor.

If your child is pregnant or breast-feeding a baby:

• This drug may cause harm to the unborn baby if your child takes it during pregnancy.
• Talk with the doctor if your child is pregnant, becomes pregnant, or is breast-feeding a baby. You will need to talk about the benefits and risks to your child and the baby.
• If your child used this drug when she was pregnant, tell the baby’s doctor.

What are some side effects that I need to call my child’s doctor about right away?

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your child’s doctor or get medical help right away if your child has any of the following signs or symptoms that may be related to a very bad side effect:

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.
• Signs of infection like fever, chills, very bad sore throat, ear or sinus pain, cough, more sputum or change in color of sputum, pain with passing urine, mouth sores, or wound that will not heal.
• Signs of high blood sugar like confusion, feeling sleepy, more thirst, more hungry, passing urine more often, flushing, fast breathing, or breath that smells like fruit.
• Signs of low potassium levels like muscle pain or weakness, muscle cramps, or a heartbeat that does not feel normal.
• Signs of a pancreas problem (pancreatitis) like very bad stomach pain, very bad back pain, or very bad upset stomach or throwing up.
• Signs of high or low blood pressure like very bad headache or dizziness, passing out, or change in eyesight.
• Signs of a weak adrenal gland like a very bad upset stomach or throwing up, very bad dizziness or passing out, muscle weakness, feeling very tired, mood changes, not hungry, or weight loss.
• Signs of Cushing’s disease like weight gain in the upper back or belly, moon face, very bad headache, or slow healing.
• Shortness of breath, a big weight gain, or swelling in the arms or legs.
• Skin changes (pimples, stretch marks, slow healing, hair growth).
• Fast, slow, or abnormal heartbeat.
• Chest pain or pressure.
• Swelling, warmth, numbness, change of color, or pain in a leg or arm.
• Bone or joint pain.
• Feeling very tired or weak.
• Change in eyesight.
• Feeling confused, not able to focus, or change in behavior.
• Mood changes.
• Memory problems or loss.
• Hallucinations (seeing or hearing things that are not there).
• Seizures.
• A burning, numbness, or tingling feeling that is not normal.
• Very bad belly pain.
• Any unexplained bruising or bleeding.
• Black, tarry, or bloody stools.
• Throwing up blood or throw up that looks like coffee grounds.

If your child has menstrual periods:

• Period (menstrual) changes.

What are some other side effects of this drug?

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your child’s doctor or get medical help if any of these side effects or any other side effects bother your child or do not go away:

• Upset stomach or throwing up.
• Trouble sleeping.
• Restlessness.
• Sweating a lot.
• Dizziness or headache.

These are not all of the side effects that may occur. If you have questions about side effects, call your child’s doctor. Call your child’s doctor for medical advice about side effects.

You may report side effects to your national health agency.

How is this drug best given?

Give this drug as ordered by your child’s doctor. Read all information given to you. Follow all instructions closely.

All products:

• Give this drug with food or milk.
• Give in the morning if giving once a day.
• Keep giving this drug to your child as you have been told by your child’s doctor or other health care provider, even if your child feels well.
• Do not stop giving this drug to your child all of a sudden without calling the doctor. Your child may have a greater risk of side effects. If your child needs to stop this drug, you will want to slowly stop it as told by the doctor.

Delayed-release tablets:

• Have your child swallow whole. Do not let your child chew, break, or crush.

Liquid (solution):

• Measure liquid doses carefully. Use the measuring device that comes with this drug. If there is none, ask the pharmacist for a device to measure this drug.

Liquid (concentrate):

• Only use the measuring device that comes with this liquid drug.

What do I do if my child misses a dose?

• Give a missed dose as soon as you think about it.
• If it is close to the time for your child’s next dose, skip the missed dose and go back to your child’s normal time.
• Do not give 2 doses at the same time or extra doses.

How do I store and/or throw out this drug?

All products:

• Store at room temperature in a dry place. Do not store in a bathroom.
• Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
• Throw away unused or expired drugs. Do not flush down a toilet or pour down a drain unless you are told to do so. Check with your pharmacist if you have questions about the best way to throw out drugs. There may be drug take-back programs in your area.

Liquid (concentrate):

• Throw away any part not used after 3 months.

General drug facts

• If your child’s symptoms or health problems do not get better or if they become worse, call your child’s doctor.
• Do not share your child’s drug with others and do not give anyone else’s drug to your child.
• Some drugs may have another patient information leaflet. If you have any questions about this drug, please talk with your child’s doctor, nurse, pharmacist, or other health care provider.
• If you think there has been an overdose, call your poison control center or get medical care right away. Be ready to tell or show what was taken, how much, and when it happened.

Consumer Information Use and Disclaimer

This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from the healthcare provider. You must talk with the healthcare provider for complete information about the risks and benefits of using this medicine. The use of this information is governed by the Lexicomp End User License Agreement, available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

Last Reviewed Date

2021-08-03

Copyright

© 2021 UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.

90,000 Prednisolone – what you need to know while taking this drug

Most often in non-medical circles it is called a steroid or glucocorticoid, many think that this is a very dangerous drug and are very reluctant to agree to treatment with this drug.

But for certain diseases, it is prednisolone that is considered a mandatory and necessary drug of the first choice in the treatment of a disease (for example, nephrotic syndrome about which you can read here).

It’s not about the drug itself and what diseases it should be prescribed for, but our information block about what doctors usually forget when prescribing prednisolone. Usually, children come for a consultation while taking prednisone in combination with asparkam. Believe me, hypokalemia (a decrease in the level of potassium in the blood) in connection with which is prescribed aspark is not the most frequent complication when prescribing prednisolone.

In our practice, almost 90% of patients receiving this drug are observed with a diagnosis of nephrotic syndrome.

Prednisolone is prescribed for a long time (the full course of therapy until the drug is discontinued can last 6-12 months), it is necessary to prescribe additional drugs to prevent the side effects of prednisolone. It is:

1. In order to protect the mucous membrane of the upper gastrointestinal tract (esophagus, stomach, duodenum), against the background of prednisolone there may be indigestion, nausea, vomiting and more serious complications such as a steroid ulcer. However, all this can be avoided by taking the so-called – gastroprotective drugs (i.e.e. Protection of the stomach in literal translation). These are antacids (eg Maalox, fosfalugel, etc.), H + pump blockers (eg Omeprazole), drugs that improve the motility of the gastrointestinal tract. All doses of drugs are selected individually according to age and body weight.
2. Bone protection. Long-term use of steroids can cause a decrease in bone mass, so-called steroid osteoporosis (bone loss) can develop, which ultimately leads to bone fractures.But this condition can also be prevented, it is necessary to take calcium and Vitamin D preparations. The dose of drugs is also selected individually.

What else you need to pay attention to:

1. Compulsory blood pressure monitoring
2. Observation of an ophthalmologist: control of vision, the state of intraocular pressure and the lens of the eye.
3. Check your blood glucose level if you take prednisolone for very long periods of time.
4. Mental health status. Children very often become capricious, sometimes even aggressive. This condition goes away on its own after discontinuation of the drug.
5. Watch your weight and diet. On the background of taking prednisolone, appetite is greatly increased. However, as a parent, you can control your child’s nutrition by limiting the intake of easily digestible carbohydrates.
6. In order to monitor and evaluate the effectiveness of gastroprotective therapy, the mucous membrane of the upper gastrointestinal tract is assessed by means of EGDS (gastroscopy).

This information has been prepared by an employee of the department (pediatrician) for informational purposes. It is imperative to consult your doctor.

If you have any questions about this topic or have any suggestions, we are happy to answer questions and accept your suggestions.

Noncardiogenic pulmonary edema

Noncardiogenic pulmonary edema (NOL) is the accumulation of edematous fluid in the interstitial tissue of the lung and alveoli, not associated with heart disease.

NOL is rare, mainly in dogs, sometimes in cats. A higher incidence of NOL in puppies under 1 year old is associated with asphyxia, traumatic brain injury, electroshock, laryngeal paralysis; in old animals, NOL occurs due to obstructive and tumor processes in the larynx. Dogs of brachycephalic breeds are prone to airway obstruction.

The impetus for the development of edema may be hypoproteinemia (low protein content in the blood) and massive transfusion of crystal solutions during infusion therapy.

The main trigger is an increase in vascular permeability in the lungs, which leads to the release of fluid into the interstitial space and alveoli.

The release of the liquid part of the blood causes an inflammatory reaction, the accumulation of neutrophils and macrophages in the interstitial space and alveoli, and in severe cases leads to respiratory distress syndrome. The severity of clinical manifestations is different: from slight difficulty in breathing to severe shortness of breath.In severe edema, disseminated intravascular coagulation (DIC) may develop with damage to the cardiovascular, urinary (acute renal failure) systems.

Diagnostics

Clinical manifestations are different and depend on the reasons that led to the development of NOL, as well as the severity of pulmonary edema. When collecting anamnesis, the main cause (road accident, electrical injury), the types and volume of measures taken, are identified. Dyspnea is often determined – an increase in the frequency of breathing, breathing with an open mouth, anxiety, unwillingness to lie, pallor or cyanosis of the mucous membranes.

Auscultation at an early stage of NOL reveals hard breathing, abundant small – and medium bubbling rales. In the later stages of severe NOL, wheezing is heard from a distance, and frothy (usually pink) sputum appears, sometimes with large blisters. During intubation, a lot of bloody fluid may come out of the endotracheal tube. With auscultation of the heart, tachycardia is most often determined, in some patients arrhythmia.

Differential Diagnostics

It is performed with cardiogenic pulmonary edema, bacterial, viral and fungal infections of the lungs, lung cancer, pulmonary hemorrhage and pulmonary embolism.

Research Methods

In a general blood test, leukocytosis is detected. Sometimes, as a result of the death of neutrophils and an increased consumption of platelets in the lungs, leukopenia and thrombocytopenia develop. A biochemical blood test is usually within normal limits, although hypoalbuminemia and mild hyperglycemia are sometimes detected as a result of protein loss in the lungs.

A chest x-ray is essential. At an early stage and with a mild course of NOL, an increase in the interstitial pattern of the lungs is determined.With moderate and severe NOL, infiltration appears in the lung tissue, indicating the involvement of the alveoli in the pathological process. In most patients, asymmetric infiltration is observed in the dorsocaudal parts of the lungs, mainly on the right. When determining arterial blood gases, mild or severe hypoxia is detected, with excessive hyperventilation, hypercapnia.

When studying a coagulogram, an increase in prothrombin and partial thromboplastin time is determined as a result of increased consumption of blood coagulation factors and disseminated intravascular coagulation.The severity of hypoxia is determined by oximetry data.

Treatment

Patients with pulmonary edema need rest, which contributes to lower oxygen requirements.

There is no specific treatment to restore the damaged endothelium in the pulmonary capillaries. Treatment is carried out in several directions, the elimination of airway obstruction quickly leads to an improvement in the patient’s condition. Rational appointment of diuretics and cardiovascular drugs.Naturally, these activities are carried out against the background of oxygen therapy. For most patients, it is sufficient to maintain the oxygen concentration at 40-50%. In severe cases, 80-100% oxygen in the inhaled mixture may be required.

Infusion therapy is necessary for patients with the phenomenon of dehydration and in a state of shock, as well as emergency medical care. For replacement purposes, balanced electrolyte solutions are usually transfused. In case of hypoproteinemia, transfusion of plasma or synthetic colloids is indicated, it allows to increase the oncotic pressure and thus reduce the release of the liquid part of the blood into the interstitial space of the lung.

Diuretics (furosemide) are used in patients with OOL, but they are usually not effective because the edema is caused by changes in capillary permeability rather than an increase in hydrostatic pressure. Furosemide is administered as a bolus at a dose of 0.5-2 mg / kg IV, IM, or as a long-term infusion of 0.1-1 mg / kg / h. For shock and severe NOL, dexamethasone is recommended at 2-4 mg / kg once, for moderate NOL, 0.1-0.2 mg / kg IV. In shock, you can enter prednisone 5-11 mg / kg IV once. Most patients recover within 24-72 hours and do not need specific treatment, with the exception of oxygen inhalation and fluid therapy.In severe cases, distress develops, which leads to death.

Author: Moyzhash Marina Anatolyevna

Memorial Sloan Kettering Cancer Center

This document, provided by Lexicomp ^® , contains all the information you need to know about the drug, including the indications, route of administration, side effects and when you should contact your healthcare provider.

Trade names: USA

Deltasone [DSC]; predniSONE Intensol; Rayos

Trade names: Canada

APO-PredniSONE; TEVA-PredniSONE; Winpred

What is this drug used for?

• Used to treat a variety of health problems including allergy symptoms, bronchial asthma, adrenal gland disorders, blood disorders, skin rashes and edema.This is not a complete list of health problems this drug is used to treat. Consult your doctor.

What do I need to tell my doctor BEFORE taking this drug?

• If you are allergic to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergy and how it manifested itself.
• For herpes eye infections.
• If you have any of the following health problems: fungal or malarial infection that affects the brain.
• If recently you have been to the tropics and you have diarrhea of ​​unknown etiology.
• In case of damage to the optic nerve.

This list of drugs and diseases that may be adversely associated with this drug is not exhaustive.

Tell your doctor and pharmacist about all the medicines you take (both prescription and over-the-counter, natural products and vitamins) and your health problems.You need to make sure that this drug is safe for your medical conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s approval.

What do I need to know or do while taking this drug?

• Tell all healthcare providers that you are taking this drug.These are doctors, nurses, pharmacists and dentists.
• Perform blood tests as directed by your doctor. Please consult your doctor.
• This drug may affect the results of allergic skin tests. Your doctor or laboratory worker should be told that you are taking this drug.
• You may be at increased risk of developing an infection. Wash your hands often. Try not to come into contact with carriers of the infection, incl.with people with colds or flu. Some infections can be very serious and sometimes deadly.
• If any signs of infection appear, such as fever, chills, flu-like symptoms, very severe sore throat, ear or sinus pain, cough, increased or discolored sputum production, pain when urinating, ulceration in the mouth or non-healing wounds, see a doctor immediately.
• People who take steroid drugs like this drug can have very bad and sometimes fatal chickenpox or rubella.If you have never had chickenpox or rubella, avoid contact with people who have these diseases. If you come into contact with someone with chickenpox or rubella, consult your doctor.
• If you have or may have hookworms, consult your doctor.
• This drug suppresses the body’s production of steroid hormones. Tell your doctor if you have a fever, infection, surgery, or injury. The body’s normal response to such stressful situations can change.You may need to increase your steroid dose.
• The use of this type of drugs has been associated with high blood pressure. Monitor your blood pressure as directed by your doctor.
• Prolonged use increases the likelihood of developing cataracts or glaucoma. Consult your doctor.
• Check eye pressure regularly when taking this medicine for a long time. Consult your doctor.
• Long-term use of this drug may cause fragility of bones (osteoporosis).If you have an increased risk of increased bone fragility or have questions, talk to your doctor.
• Get a bone density test as directed by your doctor. Consult your doctor.
• Consult a physician prior to any vaccination. Using some vaccines with this drug may increase the chance of infection or make the vaccine less effective.
• If you have high blood sugar (diabetes), your blood sugar should be checked regularly.Talk to your doctor if you develop signs of high blood sugar, such as confusion, drowsiness, increased thirst and hunger, increased urination, facial flushing, rapid breathing, and fruity breath.
• Consult a physician before drinking alcohol.
• If you are 65 years of age or older, use this drug with caution. You may have more side effects.
• In some cases, the drug may affect the growth rate in children and adolescents.They may need to check their growth rate regularly. Consult your doctor.
• When used during pregnancy, the drug may have a harmful effect on the fetus.
• Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. The benefits and risks for you and your child will need to be discussed.
• If you used this drug while pregnant, tell your child’s doctor.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, some people with this drug can cause serious and sometimes deadly side effects. Call your doctor or get medical help right away if you have any of the following signs or symptoms, which may be associated with serious side effects:

• Signs of an allergic reaction such as rash, hives, itching, reddened and swollen skin with blistering or scaling, possibly associated with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue, or throat.
• Signs of low potassium, such as muscle pain or weakness, muscle cramps, or a feeling of an irregular heartbeat.
• Signs of a problem with the pancreas (pancreatitis) such as severe abdominal pain, severe back pain, severe stomach upset and vomiting.
• Signs of high or low blood pressure, such as very severe headache or dizziness, fainting, or vision changes.
• Signs of adrenal dysfunction such as severe nausea and vomiting, severe dizziness or loss of consciousness, muscle weakness, feeling very tired, mood changes, lack of appetite, or weight loss.
• Signs of Cushing’s disease such as weight gain in the upper back or abdomen, moon face, severe headache, or slow healing.
• Feeling extremely tired or weak, irritated, trembling, heart palpitations, darkening, sweating, or dizziness if you missed a drug or recently stopped taking it.
• Shortness of breath, sudden weight gain, or swelling of the arms or legs.
• Changes in the skin (acne, stretch marks, slow healing, hair growth).
• Rapid, slow heartbeat, or irregular heartbeat.
• Pain or pressure in the chest.
• Inflammation, warmth, numbness, discoloration, or pain in a leg or arm.
• Menstrual irregularities.
• Pain in bones or joints.
• Feeling extremely tired or weak.
• Change in vision.
• Feeling confused, unable to concentrate, or changes in behavior.
• Mood swings.
• Violation or loss of memory.
• Hallucinations (a person sees or hears something that is not in reality).
• Convulsions.
• Unusual burning, numbness, or tingling sensations.
• Severe abdominal pain.
• Any unexplained bruising or bleeding.
• Black, tarry, or bloody stools.
• Vomiting of blood or vomit in the form of coffee grounds.

What are some other side effects of this drug?

Any medicine can have side effects.However, many people have little or no side effects. Call your doctor or get medical help if these or any other side effects bother you or do not go away:

• Nausea or vomiting.
• Sleep disorders.
• Anxiety.
• Excessive sweating.
• Dizziness or headache.

This list of potential side effects is not exhaustive. If you have any questions about side effects, please contact your doctor.Talk to your doctor about side effects.

You can report side effects to the National Health Office.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your healthcare practitioner. Read all the information provided to you.Follow all instructions strictly.

All forms of issue:

• Take this drug with food or milk.
• Take in the morning if you are taking this drug once a day.
• Continue taking this drug as directed by your doctor or other healthcare professional, even if you feel well.
• Do not stop taking this drug abruptly without talking to your doctor.This can increase the risk of side effects. If necessary, this drug should be stopped gradually as directed by your doctor.
• You may need to reduce your salt intake and take additional potassium. Consult your doctor.

Sustained-release tablets:

• Swallow whole. Do not chew, break, or crush.

Liquid (solution):

• Measure liquid doses with care.Use the dispenser that comes with the medicine. If a dispenser is not included in the package, ask your pharmacist for a dosing product for this drug.

Solution (concentrate):

• Use only the measuring container supplied with the liquid preparation.

What should I do if a dose of a drug is missed?

• Take the missed dose as soon as you can.
• If it is time for your next dose, do not take the missed dose and then return to your normal dose schedule.
• Do not take 2 doses at the same time or an additional dose.

How do I store and / or discard this drug?

All forms of issue:

• Store at room temperature in a dry place. Do not store in the bathroom.
• Store all medicines in a safe place. Keep all medicines out of the reach of children and pets.
• Dispose of unused or expired drugs.Do not empty into toilet or drain unless directed to do so. If you have any questions about the disposal of your medicinal products, consult your pharmacist. Your area may have drug recycling programs.

Solution (concentrate):

• Throw away all unused portions after 3 months.

General information on medicinal products

• If your health does not improve or even worsens, see your doctor.
• You should not give your medicine to anyone and take other people’s medicines.
• Some medicines may have different patient information sheets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• Some medicines may have different patient information sheets. Check with your pharmacist. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other healthcare professional.
• If you think an overdose has occurred, call a Poison Control Center immediately or seek medical attention. Be prepared to tell or show which drug you took, how much and when it happened.

Consumer use of information and limitation of liability

This information should not be used to make decisions about taking this or any other drug. Only the attending physician has the necessary knowledge and experience to make decisions about which drugs are suitable for a particular patient.This information does not guarantee that the drug is safe, effective, or approved for the treatment of any disease or specific patient. Here are only brief general information about this drug. It does NOT contain all available information on the possible use of the drug with instructions for use, warnings, precautions, information about interactions, side effects and risks that may be associated with this drug. This information should not be construed as a treatment guide and does not replace information provided to you by your healthcare professional.Check with your doctor for complete information on the possible risks and benefits of taking this drug. Use of this information is governed by the Lexicomp End User License Agreement available at https://www.wolterskluwer.com/en/solutions/lexicomp/about/eula.

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© UpToDate, Inc. and its affiliates and / or licensors, 2021. All rights reserved.

Pretibial myxedema as a dermatological sign of thyroid pathology

Pretibial myxedema (PM, miksedema praetibiale from lat. p rae – anterior, anterior, tibia – tibia) – thyroid dermopathy, a rare disease manifested in changes in the skin of a thyroid nature [1, 2]. According to some authors [3, 4], it is based on dysteriosis – a dysfunction of the thyroid gland, both upward and downward. However, most authors [5, 6] believe that diffuse or local myxedema develops in hypothyroidism, while pretibial myxedema develops against the background of hyperthyroidism.In this case, PM is a cutaneous manifestation of diffuse toxic goiter (DTG) along with the phenomena of thyrotoxicosis, thyroid hypertrophy, ophthalmopathy (exophthalmos) and acropachia (a symptom of drumsticks). Each of these components can develop independently of each other or be absent altogether. PM refers to mucinosis – a heterogeneous group of diseases characterized by mucin deposition in the dermis. The mechanism of PM development is not fully understood, but research data indicate that thyroid hormones affect the synthesis and catabolism of mucopolysaccharides and collagen by skin fibroblasts [7].The autoimmune pathogenesis of PM has been suggested [8]. It is believed that in hyperthyroidism, cytokines or growth factors appearing in the blood stimulate the proliferation of fibroblasts, which in turn produce glycosaminoglycans accumulating in the skin. It occurs in 1-10% of patients with DTG [9]. The disease develops mainly in women over 40-50 years of age [10]. For the first time P.M. described RicMer (1927), Keining (1928) [11].

Histological examination reveals mucin infiltrates separating collagen fibers and the accumulation of acidic mucopolysaccharides that retain water and salt [12].

PM manifests itself locally and is characterized by the formation of dense nodules and plaques, often developing on the front surfaces of the limbs, especially the lower ones, and has a symmetrical character [13]. The severity of the skin process is different, dermatosis is often not diagnosed or is regarded as another pathology: chronic eczema, lymphostasis, lichen amyloid and others.

We present a clinical case of PM from our practice.

Patient Z ., 76 years old, was sent to the Department of Dermatovenereology of Volgograd Medical University with complaints of severe edema, cracks in the lower extremities, burning sensation, pain, inability to put on any shoes. Preliminary diagnosis: skin amyloidosis.

From the anamnesis it is known that the woman considers herself ill for about 2 years: there were complaints of a gradual thickening of the skin of the legs and feet, painful cracks. Repeatedly consulted a dermatovenerologist, a surgeon at the place of residence.Various diagnoses were exposed: chronic eczema, lymphostasis. General anti-inflammatory therapy (desensitizing agents, angioprotectors, glucocorticosteroids) and local treatment (topical glucocorticosteroids, emollients) were prescribed, with no effect.

Objectively: the skin of the legs and feet is compacted, does not fold into a fold, painless on palpation, no fossa remains when pressed. The color of the focus is pale pink without clear boundaries. There is a diffuse lichenification of the skin of the legs and feet.Against the background of the lesion, there are pronounced deep transverse folds and cracks with an increase in the volume of the limbs (Fig. 1).

Rice. 1. Patient Z., before treatment.

Histological examination of the skin (No. 557 dated 05/14/15): in the epidermis – severe hyperkeratosis, moderate atrophy of the epidermis with smoothing of the dermal papillae, vasodilation of the upper dermis with minor perivascular lymphoid infiltration. Collagen bundles are partially disfigured, bluish mucin deposits between the fibers (Fig.2).

Rice. 2. Histological examination of a biopsy specimen of the skin of the anterior surface of the leg. Staining with hematoxylin and eosin (magnification K10 × 18 × 10 / 0.25 160).

The patient was examined: in the study of general, biochemical blood and urine tests, no pathology was revealed. Thyroid hormones: free T ₄ – 26.0 pmol / l (the norm is 9-22.0 pmol / l), thyroid-stimulating hormone (TSH) is less than 0.0025 mU / l (the norm is 0.4-4.0 mU / L), antibodies to TSH receptors more than 40 U / L.

Ultrasound revealed diffuse changes in the thyroid gland, tissue hypervascularization.

Examination by an ophthalmologist: a computed tomography of the orbits revealed a picture of neuroendocrine exophthalmos.

On the basis of laboratory studies, clinical and histological picture, a preliminary diagnosis was made – pretibial myxedema. The patient is referred for a consultation with an endocrinologist.

Endocrinologist’s conclusion: diffuse-toxic goiter I st. (WHO), a form of moderate severity, drug-induced euthyroidism. Autoimmune ophthalmopathy II degree, active phase, severe form.

Treatment was performed: tyrosol 5 mg per day, metipred 500 mg per 200 ml of physiological solution No. 6, then prednisolone 60 mg per day, followed by a decrease. At the same time, occlusive dressings with emollient anti-inflammatory drugs were prescribed: 2% salicylic ointment, methyluracil ointment for cracks.

On re-examination after 2 months of treatment, skin infiltration was significantly reduced, the patient was able to wear shoes (Fig.