**16.3. Delayed wound healing**

The effects of GCs on wound healing are multifactorial. GCs prevent the early inflammatory phase, which is essential for wound repair. GCs also affect keratinocytes (epidermal atrophy and delayed reepithelialization), fibroblasts (reduced collagen and ground substance, resulting in dermal atrophy, and striae), and vascular connective tissue support (telangiectasia, purpura, and easy bruising). According to delayed granulation, tissue formation of GCs impairs angiogenesis. Furthermore GCs have impact on wound healing by the regulation of pro-inflammatory cytokines, growth factors, matrix proteins, and matrix proteases [142].

### **16.4. Purpura**

When severe dermal atrophy and loss of intercellular substance occur by GCs, blood vessels lose their surrounding dermal matrix. The fragility of dermal vessels causes purpura. The dorsum of the hands, forearms, sides of the neck, face, and lower legs (sun exposed areas) are the most common affected sites [143].

**18. Monitoring and prevention of side effects**

used in prolonged daily therapy regimens [54].

risk factors taking general preventive measures are important.

\* and Bahadır Alan<sup>2</sup>

\*Address all correspondence to: irmaksayin@yahoo.com

**19. Concluding remarks**

**Author details**

Irmak Sayın Alan<sup>1</sup>

The same total dose of GCs among systemic treatments has different side effects. Splitdose regimens are more toxic than single daily-dose protocols. Both these protocols are more toxic than alternate-day treatment programs. In daily treatment regimens, SGCs with long biologic half-lives (e.g. dexamethasone) have a greater potential for side effects than analogs do with intermediate biologic half-lives (e.g. prednisone). High doses of systemic GCs can be administered for less than a week with partial safety, even though the same dose of drug administered for a more prolonged period will result in presumably, clinically significant side effects. The lowest dose of GCs should be used for the shortest period of time that is needed to achieve the treatment goals. Preexisting comorbid conditions (diabetes mellitus, hypertension, dyslipidemia, heart failure, cataract or glaucoma, peptic ulcer disease, use of nonsteroidal anti-inflammatory drugs, low bone density, or osteoporosis) may increase risk when GCs are required. To provide an optimal therapy, patient education is very important. Patients should be informed about the side effects of GCs. GCs generally stimulate the appetite, causes weight gain, elevated blood pressure, and glucose levels. Therefore, patients should be informed about the importance of diet when therapy is begun. The symptoms and signs of side effects related with GCs, should also be explained to the patients [32, 51–53]. For systemic therapy, the choice of specific GCs depends, partially, on clinical variables like underlying or accompanying diseases. Hydrocortisone is usually used for physiologic replacement and "stress" coverage in patients with HPA suppression. Hydrocortisone has a short biologic half-life and causes sodium and potassium retention. Thus, this agent is not commonly used for systemic immunosuppressive or antiinflammatory treatment. Fluorinated analogs, such as dexamethasone, have a long biologic half-life and little sodium-retaining potency. But long biologic half-life, may be associated with a greater potential for side effects. As a result, this group of SGCs is not commonly

Side Effects of Glucocorticoids

113

http://dx.doi.org/10.5772/intechopen.72019

To reduce the incidence and severity of these side effects (described above); they should be well known. Besides, dose of GCs should be decreased carefully. According to the patients'

1 Okan University, Medical Faculty, Department of Internal Medicine, Istanbul, Turkey

2 Okan University, Medical Faculty, Department of Cardiology, Istanbul, Turkey
