What are the potential side effects of systemic corticosteroids in the treatment of pyoderma gangrenosum, and how can I mitigate them?

Potential side effects of systemic corticosteroids used in pyoderma gangrenosum include immunosuppression leading to increased infection risk, hyperglycaemia, hypertension, osteoporosis, mood changes, weight gain, adrenal suppression, and gastrointestinal disturbances such as peptic ulcers ¹. These adverse effects arise due to the systemic nature and potency of corticosteroids, which affect multiple organ systems.

Strategies to mitigate these adverse effects involve using the lowest effective corticosteroid dose for the shortest duration possible, regular monitoring of blood pressure, blood glucose, and bone density, and prophylactic measures such as calcium and vitamin D supplementation to reduce osteoporosis risk ¹. Additionally, gastrointestinal protection with proton pump inhibitors may be considered in patients at risk of peptic ulcers. Gradual tapering of corticosteroids is essential to prevent adrenal insufficiency ¹.

Recent literature on pyoderma gangrenosum, including cases associated with Crohn's disease, highlights the potential benefit of steroid-sparing agents such as biologics (e.g., adalimumab) to reduce corticosteroid exposure and thus minimize side effects (Fousekis et al., 2025). This approach aligns with the principle of minimizing corticosteroid use to mitigate adverse effects while effectively controlling disease activity.