GLUCOCORTICOID drugs such as prednisone are life-saving medications in many inflammatory conditions, including those involving the skin. They cause few adverse effects when used over periods of days to weeks, but longer-term use (several months or longer) produces adverse changes in many tissues. These risks include truncal obesity, thinning of the skin, easy bruising, hypertension, diabetes, adrenal gland suppression, increased susceptibility to infection, cataracts, and osteoporosis. These complications most commonly occur when glucocorticoids are administered systemically in supraphysiological doses (equivalent to >5 mg/d of prednisone), although extensive topical administration can result in sufficient systemic absorption of the glucocorticoid to also produce the same adverse effects. Because of the large number of adverse effects and their potential seriousness, glucocorticoids should always be administered in the lowest possible dose for the shortest time necessary, and be substituted with other therapeutic agents where these exist.
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