Steroid card: A simple practice to avoid catastrophe

Sir,

Steroids are commonly used in the field of dermatology. Long term treatment with steroid is required in many skin conditions including Lepra reactions, systemic sclerosis, immunobullous diseases, and so on. Adrenal suppression is a well-known complication of long-term steroid therapy.

Many private practitioners use steroids injudiciously and discontinue their usage without tapering and with no follow-up. Self medication based on own/others’ experience, unregulated and unsupervised sale of steroids over the counter are some other conditions where steroid tapering is not done. Sudden stopping of long term systemic steroids may lead to adrenal crisis. After stopping the steroids adrenocortical function takes several months to recover.[1] Surgical procedures, injury or infections demand an extra supply of endogenous cortisol, which cannot be met with by an atrophied adrenal cortex.[1] These situations may become fatal unless and until the required doses of cortisone are administered to the patient.[1] Hence several authors recommend the provision of steroid card to the patient.

The steroid card gives information to the health care professionals/ personnel that the individual is/was on systemic steroids.[2] We in our department have been providing steroid cards to the patients who are to take systemic steroids for more than 2 weeks. A prototype of the steroid card we use [Figure 1].

Figure 1.

Steroid card

Each patient on treatment with long term steroids is provided with a steroid card, mentioning his/her name, diagnosis, dose of the drug and duration of intake of the drug.[2] These cards are inspected on each visit and after any change in drug, dose and duration. It is clearly mentioned that in case of any sickness this card be shown to the treating physician, not only during the treatments but also for a period of 6-12 months after the treatment gets over so that in relevant situations steroid dose may be altered.[1]

As dermatologists we use systemic steroids on long term basis for many diseases and patients with acute adrenal crisis never report to us but to the physician/causality. If undiagnosed, mortality is very high in these patients and if diagnosed, life can be saved. The practice of providing a steroid card, a simple tool, to patients on long term systemic steroids may go a long way in preventing the mortality and morbidity associated with withdrawal of steroids or in situation like infections, surgery, etc. which the patient may have to undergo, while on steroids.