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Systemic corticosteroids play an integral role in the management of many inflammatory and immunologic conditions, but these agents are also associated with serious risks. Osteoporosis, adrenal suppression, hyperglycemia, dyslipidemia, cardiovascular disease, Cushing's syndrome, psychiatric disturbances and immunosuppression are among the more serious side effects noted with systemic corticosteroid therapy , particularly when used at high doses for prolonged periods. This comprehensive article reviews these adverse events and provides practical recommendations for their prevention and management based on both current literature and the clinical experience of the authors.
Hypersensitivity vasculitis primarily affects postcapillary venules and arterioles of the skin. This disorder usually presents as palpable purpura, although lesions may occasionally be urticarial or ulcerative ( Figure 2 ) . Skin biopsy usually shows leukocytoclastic angiitis. Although hypersensitivity vasculitis is occasionally idiopathic, there are multiple known etiologies, including medications, infections, malignancy and primary connective tissue diseases. If hypersensitivity vasculitis is suspected, diagnostic evaluation should focus on identifying an underlying cause and on looking for other organ involvement and large-vessel involvement, which may require more aggressive treatment.