The buffalo hump develops in patients who are on long term prednisone therapy. In hepatology, this is most frequently encountered in patients being treated for autoimmune hepatitis.
Prednisone should be minimized, if not altogether discontinued, within 6-12 months of starting; azathioprine is often initiated as maintenance therapy. Recently, there has been evidence that budesonide (three mg TID) is an effective starting agent for autoimmune hepatitis, and can be used in lieu of prednisone. Rates of remission induction are similar to prednisone, and naturally, the systemic steroid side effects (ie. buffalo hump, moon facies, acne, hypertension, diabetes, metabolic bone disease) are attenuated.