Faculty Bibliography

Sarcoidosis is a chronic, multisystem, inflammatory disorder of unknown etiology that is characterized by noncaseating granulomas that impair normal organ functioning. Sarcoidosis predominantly affects the lungs, but the skin is often cited as the second most frequently involved organ. Cutaneous manifestations of sarcoidosis are highly variable and ongoing research seeks to better understand the relationship between clinical morphology and disease prognosis. Skin findings in patients with sarcoidosis can be "specific," in which sarcoidal granulomas infiltrate the skin, or they can represent a "nonspecific" reactive inflammatory process, as is seen in calcinosis cutis and erythema nodosum. Cutaneous sarcoidosis can be the initial presenting sign or develop later in the course of the disease. In some patients, the skin will be the most involved and impactful organ system and will drive therapy. In other cases, the skin will be an incidental or minor finding, but may be easily accessible for biopsy to confirm the diagnosis. There are many potential therapies for sarcoidosis, though no one therapy is universally effective.

The final article in this 4-part continuing medical education series reviews the ocular, cardiovascular, muscular, and psychiatric side effects of glucocorticoids and discusses side effects unique to pediatric patients.

Part 3 of this 4-part continuing medical education series reviews several important infectious complications of corticosteroid use, including a focus on pneumocystis pneumonia (PCP) prophylaxis, tuberculosis, viral hepatitis, and other infections, followed by a discussion of vaccination recommendations in immunosuppressed patients.

Part 2 of this 4-part continuing medical education series continues with a discussion of the prevention and management of gastrointestinal side effects associated with corticosteroid use, including peptic ulcer disease, gastrointestinal bleeding, and pancreatitis, followed by a review of corticosteroid-related endocrinologic side effects, such as diabetes, adrenal suppression, and Cushing syndrome.

Systemic glucocorticoids are an essential therapy for a range of conditions, but their multiple side effects can produce significant morbidity for patients. The objective of this review is to discuss these side effects while addressing 3 questions: 1) What dose and duration of glucocorticoid therapy should prompt concern for individual side effects?; 2) How should clinicians counsel patients about these complications?; and 3) How can these problems be prevented or managed? To accomplish these objectives, we have created a series of tables and algorithms based on a review of relevant data to guide counseling, prophylaxis, and management of 11 glucocorticoid side effects. The first article in this 4-part continuing medical education series begins with a review of glucocorticoid pharmacology followed by a discussion of bone health (ie, osteoporosis and osteonecrosis).