What is the dermatologic preoperative evaluation and management of glucocorticoids?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Answer

Glucocorticoids profoundly inhibit normal wound healing in several ways. Fibroblast proliferation is decreased, and the amount of granulation tissue is reduced. Inflammation is diminished. Protein and collagen production is decreased. Epidermal proliferation is reduced, and the host defense mechanisms are altered. Of all the systemic corticosteroids, cortisone acetate is the least harmful in this regard. A single dose of a corticosteroid and doses less than the equivalent of 10 mg/d of prednisolone are thought to have little effect on wound healing. In patients on large doses of corticosteroids, switching the corticosteroid to cortisone acetate and administering supplemental vitamin A are recommended. Vitamin A, in doses of 25,000 IU/d, has been shown to reverse many of the adverse effects of corticosteroids, except for restoration of wound contraction.


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