Systemic corticosteroids and wound healing in HOF

Corticosteroids are among the most widely used drugs in medicine, and many people who come to an orofacial harmonization (HOF) practice take them, took them or take them from time to time without thinking it matters: for asthma, autoimmune disease, allergy, inflammatory bowel disease, pain. The medical history is where this information shows up, and it is where it can change the plan.

This page covers systemic corticosteroid use (oral or injectable) in relation to healing and the risk of complications in injectable procedures. The goal is to support the right question and a prudent approach, without advising on drug adjustments: that is the treating physician's decision.

Why do corticosteroids matter in HOF?

Corticosteroids have anti-inflammatory and immunosuppressive effects, and when used for a long time they can influence the skin and the body's response to injury. In general terms, and without getting into detailed pharmacology, the points that matter to the HOF professional are:

• Slower healing: the inflammatory repair response may be blunted.
• Thinner, more fragile skin, with a tendency to develop ecchymosis and bruises more easily.
• Vulnerability to infection: early signs may be milder, which can delay recognition.
• Underlying disease: often the concern is the condition that led to corticosteroid use, such as autoimmune diseases (see autoimmune diseases and fillers).

The intensity of these effects depends on the dose, the duration and the route. A short, old course is very different from long-standing continuous use.

What should you ask in the medical history?

The question "do you take any medication?" often fails to capture corticosteroids, which the patient may not recognize as such. Ask directly and use the most common examples.

Record the answers in the patient record and in the HOF medical history. If the patient cannot give the name, ask them to bring the prescription or the medication list to the next visit.

How do the route and duration change the risk?

Not every corticosteroid weighs the same in the decision. The table below helps organize the reasoning without replacing medical assessment.

How does this change the procedure plan?

The reasoning is one of prudence and individualization. In practice, the common options are:

1. Talk to the treating physician, asking for an assessment of the patient's condition and timing.
2. Postpone the procedure, when there is decompensated disease, high-dose use or a significant recent course.
3. Adapt the plan, with a more conservative approach, fewer areas and closer follow-up.
4. Contraindicate the procedure, when the risk outweighs the benefit, documenting the decision and the instructions given.

In every case, communicate clearly with the patient. Without promising results, explain that the skin may bruise more, that recovery may be slower, and that signs of infection or disproportionate pain must be reported right away. For the conversation, see communicating risk to the patient and saying no to a patient with a contraindication.

What should you watch for afterward?

People on corticosteroids may have milder signs of infection, so it is worth reinforcing the instructions and bringing the follow-up forward. Tell the patient to contact the practice if there is progressively increasing pain, warmth, redness, hardness, discharge, fever or malaise. See also facial cellulitis after a procedure, abscess after filler and scarring and filler.

For bruising, the general guidance is in anti-inflammatories and bruising in HOF and post-procedure instructions. A patient on corticosteroids, however, should not receive the generic advice to "take an anti-inflammatory if it hurts" without an assessment, because the interactions and risks change.

What about documentation?

Record in the patient record the drug, the duration of use, the conversation with the treating physician (when there is one), the decision made and the instructions given. The informed consent form should state specifically that use of the drug may increase certain risks. Standardized clinical photography before and after helps track progress. See also general contraindications in HOF and corticosteroids and aesthetic procedures, for the question patients usually ask.

Harmy supports the visual conversation about the plan through an illustrative projection made from a frontal photo. For patients with health conditions that change the risk, the projection never replaces clinical assessment or the decision to postpone or contraindicate the procedure.

What should you tell the treating physician?

When the case calls for a conversation with the physician who follows the patient, the message should be short, objective and should not ask them to "clear" something generic. State which procedure is being considered, in which area, on roughly which date, that it is an elective injectable procedure and what questions you have about healing and infection in that clinical picture. Ask openly whether there is a restriction, a special precaution or a better time.

Ask for the answer in writing, attach it to the patient record and make clear that adjusting any medication is their decision. This record protects the patient, the physician and the HOF professional, and turns a loose question into a shared decision. For the referral workflow, see patient referral in HOF and multiprofessional team in HOF.