Types of Corticosteroids

Corticosteroids Overview

Corticosteroid are type of drugs that can effectively reduce inflammation. These include cortisone, hydrocortisone and prednisone.

They are useful in treating rashes, inflammatory bowel disease (IBD), asthma and other conditions. In addition, these are also used to treat rheumatology diseases, like rheumatoid arthritis (RA), lupus or vasculitis (inflammation of the blood vessels). But corticosteroids also carry a risk of range of side effects that may limit their use.

Corticosteroids are different than the performance-enhancing drugs that some athletes and bodybuilders use. Those are anabolic steroids.

Corticosteroids are man-made drugs that closely resemble cortisol, a hormone that your adrenal glands produce naturally. Corticosteroids are often referred to by the shortened term “steroids.” Corticosteroids are different from the male hormone-related steroid compounds that some athletes abuse.

How Corticosteroids Work?

Steroids work by decreasing inflammation and reducing the activity of the immune system. Inflammation is a process in which the body’s white blood cells and chemicals can protect against infection and foreign substances such as bacteria and viruses.

In certain diseases, however, the body’s defense system (immune system) doesn’t function properly. This might cause inflammation to work against the body’s tissues and cause damage. Signs of inflammation include:

• Pain
• Redness
• Swelling
• Warmth

Steroids reduce the production of chemicals that cause inflammation. This helps keep tissue damage as low as possible. Steroids also reduce the activity of the immune system by affecting the way white blood cells work.

Corticosteroids mimic the effects of hormones, such as cortisol. A doctor will prescribe corticosteroids to either increase the action of these hormones above a normal level or return it to a normal level.

A patient with Addison’s disease, for example, can benefit from this treatment as their body will not produce enough cortisol.

The increase in hormonal activity suppresses the immune system, which is responsible for activating inflammation in the body. By suppressing immune system activity, corticosteroids can reduce inflammation.

This can also help control conditions in which the immune system mistakenly attacks its own tissues.

Uses of Corticosteroids

Corticosteroids have several different effects on the body, which means that they can treat a range of medical conditions. They can reduce inflammation, suppress overactive immune system responses, and help with hormonal imbalances.

Corticosteroids are fast-acting in the body, which makes them useful for treating sudden, severe symptoms. For example, they can effectively manage allergic responses.

These drugs can also suppress the immune system, which makes them helpful for treating autoimmune diseases.

Some conditions that corticosteroids can help treat include:

• Addison’s disease
• Asthma
• Allergies
• Chronic obstructive pulmonary disease (COPD)
• Eczema
• Hives
• Inflammatory Bowel Disease (IBD), such as Chron’s disease and ulcerative colitis
• Lupus
• Multiple sclerosis (MS)
• Psoriasis
• Rheumatoid Arthritis (RA)

Types of Corticosteroids Drugs

Corticosteroids have a long history of use in the United States. Most are now available in generic forms, including the following:

• Hydrocortisone
• Betamethasone
• Cortisone
• Dexamethasone 
• Methylprednisolone 
• Prednisolone
• Prednisone

Corticosteroids can come in the form of:

• Capsules
• Eye drops
• Injections
• Lotions, creams, ointments, or gels
• Nasal or mouth sprays
• Tablets

A doctor will prescribe different forms of corticosteroids, depending on the problem. For example, they may prescribe a cream, lotion, ointment, or gel to treat skin conditions.

Corticosteroids vs Anabolic Steroids

Side Effects of Corticosteroids

Corticosteroids carry a risk of side effects. Some side effects can cause serious health problems. When you know what side effects are possible, you can take steps to control their impact.

Side Effects of Corticosteroids Taken by Mouth

Corticosteroids that are taken by mouth affect your entire body. For this reason, they are the most likely type of corticosteroid to cause side effects. Side effects depend on the dose of medication you receive and may include the following:

• A buildup of fluid, causing swelling in your lower legs
• High blood pressure (Hypertension)
• Problems with mood swings, memory, behavior, and other psychological effects, such as confusion or delirium
• Upset stomach
• Weight gain in the belly, face and back of the neck

When taking corticosteroids by mouth for a longer term, you may experience the following:

• A round face, which is sometimes called moon face
• Bone fractures and thinning bones, called osteoporosis
• Fatigue, loss of appetite, nausea and muscle weakness
• High blood sugar, which can trigger or worsen diabetes
• Increased risk of infections, especially with common bacterial, viral and fungal microorganisms
• Problems with the eyes, such as glaucoma or cataracts
• Thin skin, bruising and slower wound healing

Side Effects of Inhaled Corticosteroids

When using a corticosteroid that you breathe in, some of the drug may deposit in your mouth and throat instead of making it to your lungs. This can cause:

• Fungal infection in the mouth, known as oral thrush.
• Hoarseness.

You may be able to avoid mouth and throat irritation if you gargle and rinse your mouth with water after each puff on your corticosteroid inhaler. Be sure not to swallow the rinse water. Some researchers think that inhaled corticosteroid drugs may slow growth rates in children who use them for asthma.

Side Effects of Topical Corticosteroids

Topical corticosteroids can lead to thin skin, skin lesions and acne.

Side Effects of Injected Corticosteroids

Injected corticosteroids can cause temporary side effects near the site of the shot. These side effects include skin thinning, loss of color in the skin and intense pain. This pain is known as post-injection flare. Other symptoms may include facial flushing, insomnia and high blood sugar. Doctors usually limit corticosteroid injections to three or four a year, depending on each patient’s situation.

Minimizing Side Effects of Corticosteroids

While there are risks and complications associated with corticosteroids, there are also ways to reduce or address side effects.

Here are some tips to consider:

• Attend regular health checkups
• Always take your medication as directed
• Find an exercise routine that works for you
• Maintain a healthy diet
• Talk to your doctor about low or intermittent dosing

High blood sugar (hyperglycemia) is a symptom of some corticosteroids. High blood sugar can cause fatigue, thirst, and frequent urination among other symptoms. Corticosteroids can also interfere with many other bodily processes, from your bones to your blood pressure.

Taking lower dosages over shorter periods will reduce the risk of side effects from corticosteroids. Doctors will always try to prescribe the lowest dosage that will still provide effective treatment.

Following are Some tips to reduce the risk of problems when taking corticosteroids:

• Avoiding interactions by making sure that the doctor is aware of all other medications and supplements
• Being careful to prevent infections where possible, such as by getting a flu vaccine and keeping open wounds clean and protected
• Having regular eye exams
• Keeping the bones healthy through proper exercise, a healthful diet, and, for older adults, calcium and vitamin D supplements
• Taking precautions to avoid becoming pregnant, if possible
• Avoiding sudden changes in dosage to reduce the risk of complications, such as withdrawal symptoms
• Applying a retinoid cream at the same time as corticosteroid creams, gels, or lotions to reduce the risk of thin skin
• Taking doses according to the doctor’s prescription
• Watching out for signs of water retention, such as swollen ankles

Recommended Foods

• High-protein foods keep muscle tissues healthy. Meat, seafood, eggs, legumes, and tofu can help keep muscles strong.
• High-calcium foods help prevent osteoporosis, which weakens bones. Prioritize milk, yogurt, cheese, nuts and seeds, and dark, leafy greens.
• High-potassium foods help replenish lost potassium in the bloodstream. This includes bananas, avocados, potatoes, spinach, whole grain bread, and dark chocolate.

Foods to Avoid

• Fried foods raise cholesterol and triglycerides (lipids): Avoid products that are high in fat and cholesterol, including heavy creams and fatty cuts of meat.
• High-sodium foods can raise blood pressure and cause fluid retention. This includes cured meats, snacks like chips, and certain sauces.
• High-sodium foods can raise blood pressure and cause fluid retention. This includes cured meats, snacks like chips, and certain sauces.

Interactions

Certain medical conditions may affect the use of a corticosteroid medication. Tell your doctor if you have any preexisting health conditions.

It’s particularly important to tell them if you have:

• A disease of the heart, liver, thyroid, or kidney
• Any kind of infection (viral, bacterial, fungal)
• Diabetes
• Gastrointestinal problems
• Glaucoma
• Herpes simplex infection o fthe eye
• Have had a recent surgery or serious injury
• HIV AIDS
• High Blood Pressure
• Tuberculosis

Corticosteroids can also alter the effects of other medications. However, the likelihood of interactions happening with steroid sprays or injections is low. Patients need to be careful what they eat when taking corticosteroids. Certain steroids shouldn’t be taken with food, as interactions may occur.

Tobacco and alcohol can also cause interactions with certain medications, including corticosteroids. If you regularly drink or smoke, talk to your doctor about the effect this may have on your treatment.

Summary

Corticosteroids are powerful anti-inflammatory medications that mimic our naturally occurring hormone cortisol. These drugs come in oral, topical, and injectable forms, and have benefits for a wide variety of health conditions.

Local corticosteroids can treat asthma and skin allergies. Systemic corticosteroids can help lower inflammation for those with lupus, inflammatory bowel disease, or in patients recovering from an organ transplant. Some health conditions require long-term treatment with corticosteroids, while others only need a very short course.

Corticosteroids can come with serious side effects, including high blood pressure, weight gain, and increased risk of infections. This risk increases if you use them long term.

Patients must discuss with their doctor about the pros and cons of corticosteroids. Communicate any preexisting conditions you have, and any medications you take, to your healthcare team in order to minimize risk of side effects.

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