Glucocorticosteroids systemic

Antiproliferative effect

Suppression of fibroblast formation and collagen synthesis (growth inhibition may result in children)

Anti-inflammatory effect

Reduction of local capillary permeability and vasodilation

Reduction of leukocyte adherence to the vascular endothelium

Reduction of leukocyte chemotaxis and migration

Inhibition of phagocytosis capacity of granulocytes and macrophages

Inhibition of granulocyte and macrophage accumulation at the site of inflammation

Inhibition of macrophage bactericidal activity

Inhibition of macrophage response to various lymphokines (e.g. IFN)

Inhibition of IL-1 production by macrophages

Inhibition of arachidonic acid metabolism by macrocortin-mediated phospholipase A2 inhibition

Immunosuppressive effect

Induction of lymphocytopenia and monocytopenia by redistribution

Decrease in CD4/CD8 ratio due to greater decrease in CD4+ than CD8+ cells

Decrease of B cells

Increase of NK cells

Decrease in serum IgG concentration (catabolism, decreased production, reduced primary response)

decreased antigen processing by antigen presenting cells

inhibition of IL-1 action on antigen-activated T cells

Inhibition of IL-2 and IFNγ production by T cells.

Decreased T cell proliferation to mitogens, antigens and alloantigens.

Suppression of delayed-type immune response.

Glucocorticoid

Trade name

Plasma protein binding (%)

HWZ (min.)

Relative glucocorticoid potency1

Cushing's threshold dose (mg/day)

relative mineralocorticoid potency1

Betamethasone

Celestamine, Celestan

67

300-400

30

1

0

Cloprednol

Synthestan

85

110-126

8

3,75

0,6

Cortisol (hydrocortisone)

Ficortril, hydrocortisone

87

78-96

1

30

1

Cortisone

Cortisone CIBA

88

80-95

0,8

40

0,8

Deflazacort

Calcort

65

110-135

3

10

< 0,5

Dexamethasone

Fortecortin

75

201-255

30

1

0

Fluocortolone

Ultralan

89

58-92

5

6

0

6α-methylprednisolone

Urbason

62

141-168

5

6

0

Prednisolone

Predni Hexal, Decortin H, Solu-Decortin H

87

162-240

4

7,5

0,6

Prednisone

Decortin, Prednisone Hexal, Rectodelt

87

162-240

4

7,5

0,6

Budesonide

Entocort

80-90

120-216

9,4

3

0

Triamcinolone

Berlicort, Delphicort, Volon

42

160-300

6

5

0

Diagnosis

Initial daily dose

(mg prednisolone equivalent)

Duration of therapy

(weeks)

Maintenance dose

(mg prednisolone equivalent)

Duration of maintenance therapy

(weeks)

Acute febrile neutrophilic dermatosis

40-80

1-3 days

10-20

Weeks

Alopecia areata totalis

20-40

2-3

5-7

4-26

Arteritis temporalis

120

2-3

10-15

1-2 years

Medicinal exanthema

60-80

few days

-

-

M. Behçet

60

1-2

5-10

Months

Bullous pemphigoid

60-100

1-3

10

Months

Cheilitis granulomatosa

40-60

1-2

Reduction

over weeks

Dermatitis herpetiformis

20

weeks to months (dapsone is better)

< 10

Weeks-Months

Dermatomyositis

80-100

2-4

15

1-2 years

Pressure urticaria

30-40

according to course

5-15

Weeks-Months

Dyshidrosis

40

1-2

5-15

months if necessary

Acute toxic contact dermatitis

40-60

Days

-

-

Allergic contact dermatitis

40-60

1-6

-

-

Seborrhoeic eczema

40-60

1-3 (+ antimycotic)

-

-

Microbial eczema

40-80

2-5 (+ antibiotic)

-

-

Atopic eczema

40

1-2

< 15

Weeks-Months

Eosinophilic fasciitis

60

4-6

10-20

Weeks

Epidermolysis bullosa group

60-120

1-2

5

Weeks

Erosive pustular dermatitis d. Scalp

60-100

1-2

10-15

Weeks

Erythema exsudativum multiforme

60-80-100

1-3

-

-

Erythema nodosum

40-80

1-2

-

-

Erythroderma

80-120

up to 6

5-15

Months

Granuloma anulare

30-40

2

5-15

Weeks

Hemangioma

1.5 mg/kg bw

2

-

-

Herpes gestationis

10-40

until healed

-

-

Herxheimer reaction

40

once

-

-

IgA linear dermatosis

40-60

1-2 months

5-10 (+ dapsone)

Weeks

Impetigo herpetiformis

60-120

according to clinic

-

-

Lichen planus exanthematicus

15-30

3

< 10

weeks

Lupus erythematosus, chronic discoid

60

few weeks

-

-

Lupus erythematosus, subacute cutaneous

60-80

1-2

5-10

months

Lupus erythematosus, systemic

100-200

some weeks

5-15

Months-Years

Mycosis fungoides

40

2

< 10

Months

Panarteritis nodosa

80-120

2

10-20

Months

Parapsoriasis

20-40

2

5-10

Weeks

Pemphigus vulgaris

100-200-400

6-10

< 10

Months-Years

Pityriasis rubra pilaris

20-40

2

5-10

Weeks

Pseudoallergic drug reaction

60-80

few days

-

-

Progressive syst. Scleroderma

40-60

Weeks-Months

5-15

Months

Pustular psoriasis

40-80

4-6

-

-

Pustulosis acuta generalisata

60-100

1-2

-

-

Pyoderma gangraenosum

60-80

until healing

5

weeks

Quincke's edema

100-200

once

-

-

Relapsing polychondritis

80-100

2-3

25

weeks

Sarcoidosis

40-60

8-12

10-20

Weeks

Sézary syndrome

20-40

> 1 year

10-20

Months-Years

Toxic epidermal necrolysis

500

2-5 days (never longer)

-

-

Vasculitis allergica

20-80

according to clinic

10-20

weeks, rarely months

Scarring mucous membrane pemphigoid

40-120

Weeks-Months

< 10

Week-months

Active ingredients

Drug Interactions

ACE inhibitors

Blood formation disorders ↑

Alcohol

Gastrointestinal bleeding

amphotericin B

Hypokalemia, superinfection

Anticholinergics

Intraocular pressure ↑ with long-term therapy

Antidepressants, tricyclic

Psychosis, exacerbation of steroid psychosis

Antihistamines

Intraocular pressure ↑

Coumarins

Coumarin effects ↓, gastrointestinal ulcers.

Diazoxide

Hypokalemia ↑

Cardiac glycosides

Hypokalemia ↑, glycoside toxicity ↑.

Insulin

Insulin action ↓

Laxatives

Hypokalemia ↑

Live virus vaccines

Avoid combination approximately 8 weeks before to 2 weeks after vaccination: increased viral replication, severe reaction possible.

Mesalazine

Gastrointestinal bleeding

Metformin

Metformin effect ↓

NSAIDS

Gastrointestinal ulcers

Pethidine

Reciprocal toxicity ↑ in glaucoma.

Phenobarbital

Glucocorticoid effect ↓ due to increased degradation.

Phenytoin

reciprocal effect ↓, symptom attenuation of phenytoin-induced hepatotoxicity

Primidone

Glucocorticoid effect ↓

Salicylates

Salicylate effect ↓, gastrointestinal bleeding

Saluretics

Hypokalemia ↑

Loop diuretics

Hypokalemia ↑

Sulfonylureas

Sulfonylurea effect ↓

Thiazide diuretics

Hypokalemia ↑

Inactivated vaccines

Avoid combination approx. 8 weeks before to 2 weeks after vaccination, vaccine effect ↓