What are the side effects of 5mg prednisone daily x 10 months for sclerosing panniculitis leg ulcer?
My patient is a 90 year old male with a 2+ year history of a right leg ulcer. Upon biopsy, a diagnosis of sclorising panniculitis was determined. I have prescribed Prednisone 5mg, QD which seems to be effective along with Apligraf application. The wound has improved and I expect to re-apply a second and possibly more Apligraf to further complete the wound closure. Every attempt to reduce or stop the prednisone has created an increase in ulcer size and depth. What is your recommendation?
Hi Dr. Vince,
As you know, oral steroid (prednisone in this case) may shut down the bodies steroid making capacity when taken daily for several weeks. If it is stopped at some point, checking out your patient's capacity to make his own steroid (cortisol) should be considered.
Your patient's family and caregivers should be informed of the need for additional steroid infusion if he requires surgery or sustains any trauma or intense physical stress.
Steroid side effects include the same ones that may occur at higher doses when taken for long periods of time, although the risk at 5mg daily is probably small. This dose of prednisone is comparable to the body's daily production of cortisol from the adrenal glands. It comes down to weighing the risk of low dose systemic steroid exposure against worsening panniculitis.
The oral steroid risks include: sodium and water retention, increased fat deposition in certain areas of the body, easy bruising, increased potential for cataracts, and increased risk of certain types of infections, possible increased blood pressure and blood sugar in susceptible individuals, weight gain, stomach irritation and higher negative calcium balance (unfortunately not a complete list).
The potential risks of these side effects are dose dependent so low doses (as in your patient's case) have lower risk. Furthermore, you can screen for many of the above problems by having adequate follow-up to check blood pressure, blood glucose, weight, white blood cell count, and send him for regular eye exams and bone densitometry (to look for osteoporosis). Calcium supplement and vitamin D may be useful to recommend.
The risk of not being on low dose prednisone may perhaps be of greater concern based on potential risks and complications of panniculitis. Sometimes the quality of life is a major factor in the decision. I have a similar circumstance in patients I treat that have severe chronic urticaria that fail to respond to high doses of antihistamines. I manage some of them with low dose oral steroid over several months at times.
Dr. Vince I tried to use more lay terms and explanations for the benefit of our readers.
I would be happy to discuss this further with you. My website URL may be found in my profile. You can leave a message or phone number on the website.
Sorry about the delay in answering your question Dr. Vince.
Best Wishes,
J. Thompson, MD
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