Quantification of Rebound Edema After Steroid Treatment

Abstract

OBJECTIVE: Return of edema after abrupt discontinuation of steroid treatment has never been studied or quantified. The purpose of this study was to measure the effect of abrupt cessation and tapering doses of steroids on tissue water content (TWC) in a rat skin flap model. DESIGN: A randomized controlled animal trial was designed to study the effects of discontinuation of steroid on skin flap edema. The animals were assigned to a control group (C), a steroid group (S), an abrupt steroid cessation (SC) group, or a tapering steroid (ST) group. MAIN OUTCOME MEASURES: In each group the skin flaps were biopsied at 30 and 36 hours. TWC was determined by a biopsy-drying technique. RESULTS: A significant difference ( P = 0.05) was found between the C and S groups and between the SC and S groups at both 30 and 36 hours, with the C group having the highest TWC. No significant difference was noted between the SC and C groups. The ST group had significantly less edema than the C group and similar TWC to that of the S group. CONCLUSION: Edema rebounded in the skin flaps after abrupt cessation of steroids (SC was not different from C), presumably because of destabilization of inflammatory mediators. The rebound effect was not observed in the ST group. The control of rebound edema by a tapering steroid protocol may be important in skin flap survival and may have implications for the management of airway edema.