Corticosteroids

Glucocorticoids have potent anti-inflammatory and immunosuppressive effects and are used to treat a variety of diseases, including nephrotic syndrome, rheumatologic diseases, inflammatory bowel disease, asthma, and malignancies. Unfortunately, chronic corticosteroid use is associated with a variety of adverse effects that range from adrenal suppression, hyperglycemia, hyperlipidemia, obesity, growth suppression, and peptic ulcer disease to osteoporosis, aseptic necrosis of bone, myopathy, cataracts, hypertension, and adverse psychological effects. These adverse effects are related to the type, dose, and duration of corticosteroid use as well as to the underlying disease state. Adverse effects are uncommon with inhaled steroids, especially when used at lower doses. This In Brief focuses on the special management needs that arise when patients receiving chronic oral steroids contract varicella or are experiencing physiologic stress (eg, infection or surgery).

Clearly, immunocompromised children have a greater risk of developing complicated varicella. However, it remains unclear whether steroids place an otherwise immunocompetent child at increased risk or if there is an association with the dose or type of steroid preparation. A case-control study by Patel and associates of varicella in immunocompetent children found no association between steroid use within the past 30 days and severe varicella infection (odds ratio of …