Most common uses of Corticosteroids

Corticosteroids are a very popular and effective type of medication, essentially close copies of cortisol, a hormone that our adrenal glands produces naturally. As most drugs, they have their good sides and their bad sides. For example, they can cause several serious side effects, and have been abused for many years by top athletes all around the globe. On the other hand corticosteroid medications have a great potential in the treatment of a variety of conditions, from rashes to lupus to asthma.

The corticosteroid family of medications is large, but the most commonly used ones are:
 
•         Prednisolone (Prelone®)
•         Cortisone (Cortone®)
•         Dexamethasone (Decadron Betamethasone (Celestone®))
•         Budesonide (Entocort® EC)
•         Hydrocortisone (Cortef®)
•         Methylprednisolone (Medrol®)
•         Prednisone (Deltasone®)
•         Triamcinolone (Kenacort®, Kenalog®)
 

Mechanism of corticosteroid action

Steroids mimic the effects of cortisone and hydrocortisone, two hormones that our body produces naturally in our adrenal glands.

These hormones help control three important aspects of our health:

•         Stress of illness and injury
•         Immune function
•         Inflammation

So by taking corticosteroids, we in fact duplicate the effects of our body's natural steroids.

The medications are most commonly used in situations where our body’s inflammation response is too strong. Steroids can reduce the symptoms of inflammatory conditions such as arthritis and asthma. When inflammation threatens to damage critical body organs, steroids can save a patient’s life. Also, these medications can significantly reduce kidney inflammation which could lead to kidney failure. In cases of rheumatoid arthritis, corticosteroids can provide significant relief from pain and stiffness in joints!
The corticosteroid’s mechanism of action is still not fully understood; experts suggest that they might deactivate a protein associated with inflammation. 
 

Most common indications for corticosteroids usage

Corticosteroid medications are extremely useful in treatment of variety of conditions in which the body’s defense system malfunctions and causes tissue damage, such as:

• Systemic vasculitis - a serious disorder characterized by generalized inflammation of blood vessels.
• Myositis - an autoimmune disorder in which our immune system attacks our muscles
• Rheumatoid arthritis – This condition is present mostly in older people and characterized by chronic and painful inflammatory arthritis occurring in joints all around the body
• Systemic lupus erythematosus – An autoimmune disorder causing our immune system to target several body systems, especially the skin.
• Sjögren’s syndrome - a serious disorder characterized by dryness of the eyes and mouth.

Steroids are also used in the treatment of many other conditions such as:

•         temporal arteritis
•         dermatitis
•         allergic reactions
•         asthma
•         hepatitis
•         inflammatory bowel disease (ulcerative colitis and Crohn's disease)
•         sarcoidosis
•         for glucocorticoid replacement in Addison's disease
•         treatment of different skin conditions
•         eye diseases (uveitis)
•         prevention of nausea
 
All corticosteroids have their own specific side effects, of which the most common are: hypertension (high blood pressure), hypokalemia (abnormally low potassium levels in the blood), hypernatremia (high sodium levels in the blood), permanent eye damage (central serous retinopathy), and many others. 
 

How are corticosteroids administrated?

There are hundreds of different corticosteroid medications today, and each one of them has its own characteristic administration rules, dosage, etc.  However, depending on their type of administration, we can divide all corticosteroids into these groups:

•         Oral corticosteroids
These come in the form of tablets, capsules or syrups, usually meant to help treat the inflammation and pain associated with chronic conditions such as arthritis and lupus.
•         Inhalational corticosteroids
These come as intranasal sprays which usually help control inflammation associated with allergy and asthma.
•         Topical corticosteroid medications
These come in the form of creams, ointments and roll-ons that can help relieve symptoms mostly from skin conditions associated with a strong immune response.
•         Injectable corticosteroids
These highly effective corticosteroids are usually used to treat such signs and symptoms as the pain and inflammation of tendinitis, severe musculoskeletal pain, or serious rashes.

Corticosteroid drugs can also be used as ingredients contained in various eye products, inhalers, nasal drops and sprays, topical creams, ointments, etc.
 

Possible side effects of steroids

Like all other medications, corticosteroids can cause several possible side effects, some of which can even be life-threatening! Every type of corticosteroids have its own characteristic side effects, depending mostly on their method of administration.

Side effects of oral corticosteroids

Oral medications affect our entire body instead of a particular area, which is why the side effects caused are usually more serious. Some of the most common side effects caused by oral corticosteroids are:

•         Mood swings
•         Elevated pressure in the eyes (glaucoma)
•         Slow wound healing
•         Cataracts
•         High blood sugar
•         Increased risk of infections
•         Increased blood pressure
•         Fluid retention, causing edema on legs
•         Weight gain
•         Menstrual irregularities
•         Suppressed normal adrenal gland hormone production
•         Thin skin
•         Loss of calcium in bones

 

Side effects of inhaled corticosteroids

Like all other medications which target specific points on our body, these medications may deposit in our mouth and throat instead of making it to our lungs. Studies have proven that this can cause coughing, hoarseness, dry mouth and sore throat. If this happens after the inhalation, you should gargle and rinse with water to reduce the chance of experiencing the side effects of this kind!

Side effects of topical and injected corticosteroids

A prolonged usage of topical corticosteroids can cause severe skin lesions, thickness of the skin and acne. Similarly, injected corticosteroids can cause side effects near the site of the injection. Most common side effects include pain, infection, shrinking of soft tissue and loss of color in the skin.
As a rule, these side effects grow in severity if treatment is continued for an extended period of time. This is because, with prolonged use, the drug inhibits the communication between the pituitary gland and the adrenals. 

How can the side effects of steroids be minimized?

• First, use steroids only when necessary.
• If possible, local steroids should be used in the treatment of local problems.
• Only the minimal dose required should be used to gain control of the disease.
• Reduce the dose gradually as long as the disease remains under control.
• Monitor your own blood pressure during the usage of corticosteroids
• Use calcium supplements to prevent osteoporosis and maintain normal bone density.