Recommended Dosing Regimen
Based on evidence-based studies showing greater treatment-related morbidity and mortality with higher doses, particularly cumulative doses exceeding 8 g, the EUGOGO recommends that the cumulative dose of intravenous steroids should not exceed 8 grams in one course of therapy. For patients with inflammation only, g per day once weekly with a cumulative dose of g over 12 weeks is preferred. For patients with severe eye disease and constant diplopia, a higher dose of g with a cumulative dose of gm over 12 weeks may be required, Dr. Kahaly said.
The most common side effect of topical corticosteroid use is skin atrophy. All topical steroids can induce atrophy, but higher potency steroids, occlusion, thinner skin, and older patient age increase the risk. The face, the backs of the hands, and intertriginous areas are particularly susceptible. Resolution often occurs after discontinuing use of these agents, but it may take months. Concurrent use of topical tretinoin (Retin-A) % may reduce the incidence of atrophy from chronic steroid applications. 30 Other side effects from topical steroids include permanent dermal atrophy, telangiectasia, and striae.