Rational use of corticosteroid drugs in oral surgery and aesthetic medicine: a practical clinical guide

Corticosteroids remain among the most widely used pharmacological agents in clinical practice because of their potent anti-inflammatory, anti-edematous, and immunomodulatory effects. In oral surgery and aesthetic medicine, they are employed across a broad spectrum of indications, ranging from the control of postoperative swelling and pain to the management of inflammatory mucosal diseases, delayed inflammatory reactions, and selected procedure-related complications. Their clinical versatility, however, is counterbalanced by a complex pharmacology and by a non-negligible burden of adverse effects, particularly when treatment is prolonged, repeated, or inadequately tailored to the patient’s systemic profile. This review provides a practical and clinically oriented overview of corticosteroid use in oral surgery and aesthetic medicine. The paper first summarizes the physiological role of endogenous cortisol and the pharmacological basis of synthetic corticosteroids, including glucocorticoid and mineralocorticoid activity, genomic and non-genomic mechanisms of action, pharmacokinetics, biological half-life, and dose equivalence among commonly prescribed agents. Particular attention is given to the rationale behind drug selection, route of administration, timing of treatment, and tapering strategies. This article then examines the main safety issues associated with corticosteroid therapy, including endocrine, metabolic, musculoskeletal, cardiovascular, immunological, neuropsychiatric, dermatological, ocular, and gastrointestinal adverse events, as well as clinically relevant drug interactions. Special emphasis is placed on risk stratification and monitoring in patients with diabetes, hypertension, osteoporosis, active infection, or suspected hypothalamic-pituitary-adrenal axis suppression. Finally, the article discusses the most relevant applications of corticosteroids in oral medicine and oral surgery, including recurrent aphthous stomatitis, oral lichen planus, autoimmune bullous diseases, chemotherapy- or radiotherapy-induced mucositis, anaphylaxis support therapy, and perioperative management in oral surgical procedures. In aesthetic medicine, the review addresses delayed inflammatory reactions to fillers, granulomas, biofilm-related complications, post-procedural inflammatory events, ischemic complications, post-peeling inflammation, thread-lift complications, and the adverse consequences of inappropriate topical corticosteroid use on facial skin. A rational use of corticosteroids requires more than familiarity with their anti-inflammatory efficacy. It demands careful indication, appropriate molecule and dose selection, awareness of systemic and local risks, and individualized monitoring. When prescribed within a structured clinical framework, corticosteroids remain valuable tools in both oral surgery and aesthetic medicine; when used indiscriminately, they may expose patients to avoidable and sometimes serious complications.