What are the contraindications for prednisone (corticosteroid) in patients with a history of Gore-Tex (expanded polytetrafluorethylene) rhinoplasty with ear (war) cartilage?

Contraindications for Prednisone in Patients with Gore-Tex Rhinoplasty and Ear Cartilage

Prednisone is not contraindicated in patients with Gore-Tex rhinoplasty and ear cartilage grafts; however, active infection, nasal septal perforation, and conditions requiring prolonged high-dose systemic corticosteroids warrant extreme caution or avoidance.

Absolute Contraindications

Active Infection

• Nasal septal perforation is considered a contraindication for Gore-Tex implantation and increases infection risk significantly 1
• Active infection at the implant site requires implant removal before initiating systemic corticosteroids, as Gore-Tex infection rates are 5.4% in revision cases and 1.2% in primary cases 1
• Infected Gore-Tex implants must be removed, and systemic corticosteroids should be avoided until infection is completely resolved 1, 2

Pre-existing Nasal Septal Perforation

• Nasal septal perforation present at the time of Gore-Tex implantation is associated with significantly higher infection rates requiring implant removal 1
• This anatomic defect compromises tissue integrity and increases risk of implant exposure and infection 1

Relative Contraindications and High-Risk Conditions

Uncontrolled Diabetes Mellitus

• Steroid-induced diabetes mellitus occurred in patients receiving prolonged postoperative corticosteroids (50mg daily for 6 weeks followed by 6-week taper) 3
• Patients with pre-existing diabetes or glucose intolerance should have careful monitoring if systemic corticosteroids are necessary 3

Conditions Requiring Prolonged High-Dose Corticosteroids

• All 12 patients receiving prolonged oral prednisolone (50mg daily × 6 weeks plus additional 6-week taper) experienced weight gain, and 5 developed Cushingoid features 3
• Single administration of parenteral corticosteroids is discouraged, and recurrent administration is contraindicated due to greater potential for long-term side effects 4
• Short courses (5-7 days) are preferred when systemic corticosteroids are necessary 4

Recent Gore-Tex Implantation (Early Postoperative Period)

• Gore-Tex implants undergo tissue ingrowth over time, with neighboring tissues growing into central portions after extended periods, enhancing adhesion 5
• Early postoperative use of high-dose systemic corticosteroids may theoretically impair wound healing and tissue integration, though this is not explicitly documented in the provided evidence 5

Clinical Decision Algorithm

Step 1: Assess for Absolute Contraindications

• Examine for active infection (erythema, purulent drainage, fever, implant exposure) 1
• Document presence or absence of nasal septal perforation 1
• If either present: Do not initiate prednisone; address underlying condition first

Step 2: Evaluate Metabolic Risk Factors

• Check baseline glucose in all patients, particularly those with diabetes risk factors 3
• Assess for Cushing's syndrome risk factors (obesity, hypertension, osteoporosis) 3

Step 3: Determine Corticosteroid Necessity and Duration

• For severe allergic rhinitis or nasal polyps: Use short courses (5-7 days) only when symptoms are intractable 4
• Avoid prolonged courses (>2 weeks) unless absolutely necessary for underlying disease 3, 4
• Consider intranasal corticosteroids as safer alternative with minimal systemic effects 6

Step 4: Monitor for Complications

• Gore-Tex implants can develop calcification, foreign body reactions, and structural changes over time 5
• Systemic corticosteroids may mask early signs of infection 1, 2
• Follow patients closely for implant-related complications during and after corticosteroid therapy 5, 7

Important Caveats and Pitfalls

Gore-Tex-Specific Considerations

• Overall complication rate for Gore-Tex rhinoplasty is 3.8%, with 13.5% requiring revision in long-term follow-up 2
• Complications include irregularity, infection, deviation, and apparent implant silhouette 2
• Infection requiring removal occurs more frequently in revision cases (5.4%) compared to primary cases (1.2%) 1

Corticosteroid-Related Risks

• Potential for adrenal suppression should be considered in any patient receiving oral corticosteroids 4
• Oral corticosteroids should not be administered as therapy for chronic rhinitis except in rare cases 4
• Intranasal corticosteroids are superior to systemic therapy for controlling nasal symptoms with significantly lower systemic side effects 6, 4

Alternative Approaches

• Intranasal corticosteroids (mometasone furoate, fluticasone furoate, budesonide) have similar safety profiles with minimal systemic effects 6
• Topical corticosteroids are beneficial, safe, and well-tolerated in rhinoplasty patients 3
• Consider leukotriene receptor antagonists or second-generation antihistamines as alternatives to systemic corticosteroids 4