Do you use, or have you recently used, oral or systemic corticosteroids, such as prednisone or dexamethasone? This medication can affect your wound healing and immune defence, and is therefore important to report before an eyelid surgery.
Which medication does this concern?
- Prednisone and prednisolone, often used for inflammation, auto-immune conditions, asthma or COPD attacks
- Dexamethasone, among others for inflammation and as part of certain treatments
- Hydrocortisone, among others for Addison’s disease (adrenal cortex insufficiency)
- Triamcinolone injections, for example for joint complaints
Why is this relevant?
Corticosteroids have an anti-inflammatory and immune-suppressing effect. This can slow down wound healing and increase the risk of infections. Chronic use of corticosteroids is a known risk factor for the opening up of a wound (wound dehiscence) [1].
In addition, long-term use of corticosteroids can suppress your own adrenal function. Under stress, such as a surgical procedure, the body may then be unable to produce sufficient extra cortisol, which can in rare cases lead to complaints. This is the reason why a temporary extra (‘stress’) dose of corticosteroids is sometimes advised around a procedure [2].
Discuss it in a personal consultation with plastic surgeon David Jairath, at our clinic for eyelid surgery in Haarlem. A first consultation can usually take place within a week.
Points of attention
- Always report current or recent use of prednisone, dexamethasone or comparable medication, including short courses
- With long-term use (think weeks to months), consultation with the prescribing doctor about a possible adjustment around the procedure is important [2]
- Increased risk of delayed wound healing and infections [1]
Our protocol at Kliniek het Bolwerk
1. Extensive medical history
We ask about current and recent use of corticosteroids, the dosage, duration and the reason for use.
2. Consultation with the treating doctor with long-term use
With long-term use of corticosteroids, we consult, if necessary, with your treating doctor about the medication around the procedure [2].
3. Extra attention to wound healing
In the planning and follow-up check, we take account of a possibly increased risk of delayed healing or infection [1].
4. Clear aftercare instructions
We give clear instructions about wound care and when to get in touch in the case of signs of slow healing or infection.
Important: always report (recent) use of corticosteroids such as prednisone, even with a short course. With long-term use, we coordinate, if necessary, with your treating doctor.
When do we advise against the procedure (for the time being)?
- In the case of high doses of corticosteroids without consultation with the treating doctor [1,2]
- In the case of signs of reduced immune defences or an active infection
- If the treating doctor advises against the procedure at this time
Our advice
Are you using, or have you recently used, prednisone or another corticosteroid? Report this during the intake consultation at Kliniek het Bolwerk, even if it concerned a short course.
Literature references
The publications below form the medical-scientific basis of this article:
- Wound dehiscence. Wikipedia (medical overview) https://en.wikipedia.org/wiki/Wound_dehiscence
- Perioperative “stress dose” of corticosteroid: Pharmacological and clinical perspective. Journal of Anaesthesiology Clinical Pharmacology (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598572
