Corticosteroids: Types, side effects and how they work

What are corticosteroids?

Corticosteroids are a class of steroid hormones that are naturally produced in the adrenal glands, which are located on top of the kidneys. They are involved in regulating various physiological processes in the body, including metabolism, immune response, inflammation, and stress.

Corticosteroids can also be synthesized and used as medications to mimic the effects of natural corticosteroids. These synthetic versions are commonly referred to as corticosteroids or simply steroids. They have potent anti-inflammatory and immunosuppressive properties and are used to treat a wide range of medical conditions, including:

● Inflammatory conditions:

 Corticosteroids are commonly prescribed to reduce inflammation in conditions such as asthma, rheumatoid arthritis, inflammatory bowel disease (e.g., Crohn's disease, ulcerative colitis), and allergic reactions.

● Autoimmune disorders: 

They are used to suppress the immune system in autoimmune disorders like lupus, multiple sclerosis, and vasculitis, where the immune system mistakenly attacks the body's own tissues.

● Allergic reactions: 

Corticosteroids can be used to manage severe allergic reactions, including anaphylaxis, as they help reduce inflammation and swelling.

● Skin conditions: 

Topical corticosteroids are often prescribed for various skin conditions like eczema, psoriasis, and dermatitis to alleviate itching, redness, and inflammation.

● Organ transplantation: 

After an organ transplant, corticosteroids are used to prevent organ rejection by suppressing the immune system's response.

Corticosteroids can be administered orally, topically (creams or ointments), intravenously, or through inhalation, depending on the specific condition being treated. It is important to note that long-term and high-dose use of corticosteroids may have significant side effects, such as weight gain, osteoporosis, increased risk of infections, and adrenal suppression. Therefore, the use of corticosteroids is typically carefully monitored by healthcare professionals.

What are some types of steroids?

Steroids can be classified into several different types based on their specific structures and functions. Here are some of the main types of steroids:

■ Corticosteroids: 

These steroids are involved in the regulation of various physiological processes, including metabolism, immune response, inflammation, and stress. They can be further divided into glucocorticoids (e.g., cortisol) that regulate glucose metabolism and immune responses, and mineralocorticoids (e.g., aldosterone) that regulate electrolyte and fluid balance.

■ Anabolic steroids:

 These are synthetic variations of the male sex hormone testosterone. Anabolic steroids promote muscle growth and enhance physical performance. They are often used illegally by athletes and bodybuilders to improve muscle mass, strength, and endurance. However, their non-medical use can lead to numerous health risks and is considered doping in sports.

■ Progestogens: 

These steroids are involved in the regulation of the female reproductive system and play a role in maintaining pregnancy. They include progesterone and synthetic progestins, which are used in hormonal contraception (such as birth control pills) and hormone replacement therapy.

■ Estrogens:

 These steroids are primarily responsible for the development and maintenance of female secondary sexual characteristics. The main estrogen hormone is estradiol, which plays a crucial role in the menstrual cycle and reproductive system. Estrogens are also used in hormone replacement therapy for menopausal women.

■ Glucocorticoids: 

Glucocorticoids are a type of corticosteroid that regulate glucose metabolism, suppress inflammation, and modulate the immune system. They are widely used in medicine to treat inflammatory conditions, autoimmune disorders, allergies, and other conditions.

It's important to note that while corticosteroids (such as glucocorticoids) are commonly used in medical settings, anabolic steroids are strictly regulated due to their potential for abuse and adverse effects. The non-medical use of anabolic steroids is illegal in many countries.

How are steroids given?

Steroids can be administered through various routes depending on the specific medication, the condition being treated, and the desired therapeutic effect. Here are some common methods of steroid administration:

● Oral: 

Many steroid medications are available in tablet or capsule form and are taken orally. This route is convenient and allows for systemic distribution of the medication throughout the body. Examples include prednisone and dexamethasone.

● Topical: 

Steroids can be applied directly to the skin in the form of creams, ointments, gels, or lotions. This route is commonly used for treating skin conditions such as eczema, psoriasis, and dermatitis. Topical application delivers the medication locally to the affected area and minimizes systemic absorption. Examples include hydrocortisone cream and betamethasone lotion.

● Inhalation: 

Some steroids are formulated as inhalers or nebulizer solutions to be directly inhaled into the lungs. This method is primarily used to manage respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD). Inhaled steroids help reduce inflammation in the airways. Examples include beclomethasone, fluticasone, and budesonide.

● Injected into joints: 

Steroids can be injected directly into joints affected by inflammation, such as the knee, shoulder, or hip. This method delivers the medication directly to the site of inflammation, providing local relief. Intra-articular steroid injections are commonly used for conditions like arthritis and tendinitis.

● Injected into muscles or veins: 

In certain situations, steroids may be administered via intramuscular or intravenous injection. Intramuscular injections involve injecting the medication into a muscle, typically the gluteal or deltoid muscles. Intravenous injections are delivered directly into a vein. These routes allow for rapid absorption and distribution of the medication throughout the body. Intravenous steroids are often used in acute situations requiring immediate anti-inflammatory or immunosuppressive effects.

The specific route of administration, dosage, and frequency of steroid use are determined by the prescribing healthcare professional based on the patient's condition, response to treatment, and potential side effects. It's important to follow the prescribed instructions and consult with a healthcare provider for proper use and administration of steroids.

How do steroids work?

Steroids, particularly corticosteroids, work by interacting with specific receptors in the body to produce their effects. Here's a general overview of how steroids work:

■ Anti-inflammatory and immunosuppressive effects:

 Corticosteroids have potent anti-inflammatory properties. They inhibit the production of inflammatory molecules, such as prostaglandins and cytokines, and suppress the activity of immune cells involved in the inflammatory response. By doing so, they help reduce swelling, redness, and pain associated with inflammation. Additionally, corticosteroids can suppress the immune system, preventing it from overreacting and attacking the body's own tissues in autoimmune disorders.

■ Regulation of gene expression: 

Steroids, including corticosteroids, can enter cells and bind to specific receptors in the nucleus. This receptor-steroid complex then binds to DNA and regulates the expression of certain genes. By modulating gene expression, steroids can influence various physiological processes, including metabolism, immune response, and cellular signaling.

■ Stabilization of cell membranes: 

Corticosteroids help stabilize cell membranes, reducing their permeability and preventing the release of inflammatory substances from cells. This action contributes to their anti-inflammatory effects.

■ Suppression of the hypothalamic-pituitary-adrenal (HPA) axis: 

Prolonged use of exogenous (synthetic) corticosteroids can suppress the HPA axis, which is responsible for regulating the body's natural production of corticosteroids. This suppression can lead to adrenal insufficiency, where the body becomes reliant on exogenous corticosteroids. Therefore, when using corticosteroids, it's important to gradually reduce the dosage and not abruptly discontinue them to allow the HPA axis to recover.

It's essential to note that different types of steroids, such as anabolic steroids, have distinct mechanisms of action. Anabolic steroids bind to androgen receptors in cells, promoting protein synthesis and enhancing muscle growth and physical performance. However, their non-medical use can have serious health risks and is associated with various adverse effects.

The specific mechanisms and effects of steroids can vary depending on the type, dosage, route of administration, and individual response. It's crucial to use steroids under medical supervision and follow the prescribed instructions to minimize potential risks and maximize benefits.

When are steroids given?

Steroids are given in various situations and medical conditions where their anti-inflammatory, immunosuppressive, or other therapeutic effects are beneficial. Here are some common scenarios and conditions in which steroids may be prescribed:

● Inflammatory conditions:

 Steroids are frequently used to manage acute or chronic inflammatory conditions, such as:

• Asthma: 

Corticosteroids, usually inhaled, are commonly prescribed to control airway inflammation and reduce asthma symptoms.

• Rheumatoid arthritis:

 Steroids can be prescribed to reduce joint inflammation and pain during acute flare-ups.

• Inflammatory bowel disease: 

Corticosteroids may be used to treat flare-ups of Crohn's disease or ulcerative colitis.

• Allergic reactions: 

Steroids are administered to manage severe allergic reactions, including anaphylaxis, by reducing inflammation and suppressing the immune response.

● Autoimmune disorders: 

Steroids are employed in various autoimmune conditions to suppress the immune system and reduce inflammation caused by an overactive immune response. 

Examples include:

• Systemic lupus erythematosus (SLE):

 Steroids are often used to manage inflammation and symptoms associated with lupus.

• Multiple sclerosis (MS): 

Corticosteroids can be used to reduce inflammation during MS relapses and speed up recovery.

• Vasculitis: 

Steroids may be prescribed to control inflammation in blood vessels affected by vasculitis.

● Organ transplantation: 

After organ transplantation, corticosteroids are often administered to suppress the immune system and prevent organ rejection. These medications are typically used in combination with other immunosuppressive drugs.

● Skin conditions: 

Topical steroids, in the form of creams or ointments, are frequently prescribed for various skin conditions with inflammation, itching, or allergic reactions. Examples include eczema, psoriasis, contact dermatitis, and allergic dermatitis.

● Hormone replacement therapy: 

Steroids, such as estrogen or progestogens, may be prescribed as hormone replacement therapy for menopausal women or to manage certain hormonal imbalances.

It's important to note that the use of steroids is carefully evaluated by healthcare professionals, taking into account the specific condition, its severity, and the potential risks and benefits of steroid therapy. Steroids are typically used for a limited duration and at the lowest effective dose to minimize side effects. The specific dosage, duration, and route of administration will depend on the individual patient and the condition being treated.

How are steroids beneficial?

Steroids, when used appropriately and under medical supervision, can provide several therapeutic benefits in various medical conditions. Here are some ways in which steroids can be beneficial:

■ Anti-inflammatory effects: 

Steroids, particularly corticosteroids, have potent anti-inflammatory properties. They help reduce inflammation by suppressing the production of inflammatory substances and inhibiting immune cell activity. This makes them effective in managing conditions characterized by inflammation, such as asthma, rheumatoid arthritis, inflammatory bowel disease, and allergic reactions.

■ Immunosuppressive effects: 

Steroids can suppress the immune system, which can be beneficial in certain situations. They are used to prevent organ rejection after transplantation, manage autoimmune disorders, and control overactive immune responses. By suppressing the immune system, steroids help reduce inflammation and prevent the immune system from attacking the body's own tissues.

■ Symptom relief: 

Steroids can provide relief from symptoms associated with various conditions. For example, in asthma, they help alleviate airway inflammation and improve breathing. In skin conditions like eczema and psoriasis, topical steroids can reduce itching, redness, and inflammation. Steroids can also help manage pain, swelling, and stiffness in inflammatory joint conditions such as rheumatoid arthritis.

■ Control of acute flare-ups: 

Steroids are commonly used to manage acute flare-ups or exacerbations of certain conditions. For instance, in multiple sclerosis, corticosteroids are used to reduce inflammation and speed up recovery during relapses. In inflammatory bowel disease, they can help control severe symptoms during flare-ups.

■ Hormonal balance: 

Steroids, such as estrogen and progestogens, are used in hormone replacement therapy to manage symptoms associated with hormonal imbalances, such as those experienced during menopause. They can alleviate symptoms like hot flashes, vaginal dryness, and mood swings.

It's important to note that while steroids offer benefits in many situations, they should be used judiciously and under medical supervision. Their use requires careful consideration of potential risks, side effects, and the individual patient's specific needs. The goal is to balance the benefits of steroid therapy with the potential risks and minimize any adverse effects.

How will my doctor decide if steroids are the right treatment?

The decision to prescribe steroids as a treatment option is made by a healthcare professional, typically a doctor, based on several factors. Here's an overview of the considerations that doctors take into account when determining if steroids are the right treatment for a particular condition:

● Medical condition and diagnosis:

 The doctor will assess the patient's medical condition and make a diagnosis based on symptoms, medical history, physical examination, and any relevant diagnostic tests. Steroids may be considered if the condition involves inflammation, an overactive immune response, or other indications for which steroids are known to be effective.

● Severity of the condition: 

The severity of the condition plays a role in determining the appropriate treatment. Steroids are often reserved for moderate to severe cases or when other treatments have been ineffective or inappropriate. The doctor will assess the severity of the condition and consider if steroids are necessary.

● Potential benefits:

 The doctor will weigh the potential benefits of steroid treatment against the risks and side effects. They will consider whether the use of steroids is likely to alleviate symptoms, control inflammation, prevent organ rejection, or achieve other desired therapeutic goals.

● Potential risks and side effects: 

Doctors carefully consider the potential risks and side effects associated with steroid therapy. Steroids, especially when used long-term or at high doses, can have various side effects such as weight gain, osteoporosis, increased risk of infections, adrenal suppression, and mood changes. The doctor will evaluate these risks and determine if the benefits outweigh the potential adverse effects.

● Individual patient factors:

 Doctors also take into account the patient's individual factors, including age, overall health, medical history, and any specific contraindications or precautions related to the use of steroids. Certain medical conditions or medications may interact with steroids or increase the risk of complications. The doctor will consider these factors to ensure the safe and appropriate use of steroids for the specific patient.

● Treatment goals and alternatives: 

The doctor will discuss the treatment goals with the patient and consider other available treatment options. They may explore non-steroidal treatments or alternative therapies that could be effective and have fewer potential risks.

The decision to use steroids is a complex one that requires an individualized approach. It is important for patients to have open and honest discussions with their healthcare provider, ask questions, and understand the potential benefits and risks associated with steroid treatment.

What are the possible side effects of steroids?

Steroids, particularly when used long-term or at high doses, can have various side effects. The specific side effects experienced can vary depending on the type of steroid, dosage, duration of use, individual patient factors, and the route of administration. Here are some potential side effects of steroids:

■ Adrenal suppression:

 Prolonged use of exogenous (synthetic) corticosteroids can suppress the natural production of corticosteroids by the adrenal glands. This can lead to adrenal insufficiency, where the adrenal glands are unable to produce sufficient cortisol on their own. When discontinuing steroid use, it's important to gradually taper the dosage to allow the adrenal glands to recover and resume normal function.

■ Weight gain: 

Steroids can cause fluid retention and increased appetite, leading to weight gain. This is particularly common with long-term use or higher doses of steroids.

■ Osteoporosis: 

Prolonged use of steroids can weaken the bones and increase the risk of osteoporosis. Steroids can interfere with the normal process of bone remodeling, leading to bone loss and increased susceptibility to fractures.

■ Increased risk of infections: 

Steroids suppress the immune system, making individuals more susceptible to infections. This can include both common infections, such as respiratory tract infections and urinary tract infections, as well as more severe infections.

■ Glucose intolerance and diabetes: 

Steroids can interfere with glucose metabolism, leading to elevated blood sugar levels. Prolonged use of steroids can result in glucose intolerance or even the development of steroid-induced diabetes, particularly in individuals who are already at risk.

■ Mood changes and psychiatric effects: 

Steroids can cause mood swings, irritability, agitation, and in some cases, even psychiatric symptoms such as depression or psychosis. These effects are more likely with higher doses or long-term use.

■ Skin changes: 

Steroids can cause thinning of the skin, easy bruising, and delayed wound healing. They may also lead to the development of stretch marks and increased vulnerability to skin infections.

■ Eye problems: 

Prolonged use of steroids, particularly when applied topically around the eyes or in high doses, can increase the risk of cataracts and glaucoma.

Hormonal imbalances: Steroids can disrupt the normal hormonal balance in the body. In women, this can lead to menstrual irregularities or changes. In men, it can cause decreased testosterone production and testicular shrinkage.

It's important to note that not all individuals will experience these side effects, and the severity and likelihood of side effects can vary. The risks and benefits of steroid therapy should be carefully considered by healthcare professionals, and patients should be monitored closely for any potential side effects. It's crucial to follow the prescribed dosage and duration and discuss any concerns or side effects with a healthcare provider.

Does everyone have side effects?

Not everyone who uses steroids will experience side effects. The likelihood and severity of side effects can vary depending on several factors, including:

● Dosage: 

Higher doses of steroids are more likely to cause side effects than lower doses. The duration of steroid use also plays a role, as long-term use carries a higher risk of side effects compared to short-term use.

● Duration of use: 

Short-term use of steroids, such as a brief course to manage an acute condition, is less likely to cause significant side effects. However, prolonged use, especially for several months or years, increases the risk of side effects.

● Type of steroid:

 Different steroids have varying potency and side effect profiles. Some steroids are more likely to cause specific side effects than others. For example, topical steroids used on the skin are less likely to cause systemic side effects compared to oral or injectable steroids.

● Individual response: 

Each person's body may react differently to steroids. Some individuals may be more susceptible to side effects, while others may have a lower risk. Factors such as age, overall health, underlying medical conditions, and genetic predisposition can influence how an individual responds to steroids.

● Concomitant medications and medical conditions:

 The presence of certain medical conditions or the use of other medications alongside steroids can interact and increase the risk of side effects. For example, certain medications or conditions may interact with steroids and increase the risk of gastrointestinal issues or affect the metabolism of steroids.

It's important to note that even at low doses and short durations, some individuals may still experience side effects. Conversely, some individuals may tolerate higher doses for longer periods without significant side effects. The occurrence and severity of side effects can be unpredictable and vary from person to person.

To minimize the risk of side effects, it's essential to use steroids under medical supervision, follow the prescribed dosage and duration, and regularly communicate with your healthcare provider. They can monitor your response to treatment, adjust the dosage if needed, and address any concerns or side effects that arise.

How can the side effects of steroids be minimized?

To minimize the potential side effects associated with steroid use, here are some strategies that can be employed:

■ Medical supervision: 

It is important to use steroids under the guidance and supervision of a healthcare professional. They can prescribe the appropriate dosage and duration based on your specific condition and monitor your response to treatment.

■ Lowest effective dose: 

The goal is to use the lowest effective dose of steroids that provides the desired therapeutic benefit. This helps minimize the potential for side effects. High doses or long-term use should be avoided whenever possible.

■ Short-term use:

 Steroids are sometimes prescribed for short periods to manage acute conditions or flare-ups. Short-term use reduces the risk of certain side effects associated with prolonged use.

■ Gradual tapering: 

If you have been using steroids for an extended period, it is important not to stop them abruptly. Gradual tapering of the dosage allows the body's natural cortisol production to recover and helps prevent adrenal insufficiency.

■ Alternate-day dosing: 

In certain cases, your healthcare provider may recommend an alternate-day dosing regimen. This involves taking the steroid on one day and skipping the next, which can help minimize side effects while still providing therapeutic benefits.

■ Topical administration: 

When treating localized conditions, such as skin conditions, using topical steroids can minimize systemic absorption and reduce the risk of systemic side effects compared to oral or injectable forms.

■ Regular monitoring:

 Regular monitoring of your health, including blood tests and physical examinations, can help detect and manage any potential side effects. Your healthcare provider can adjust the treatment plan if necessary.

■ Lifestyle modifications: 

Adopting a healthy lifestyle can help mitigate the impact of some side effects. This includes maintaining a balanced diet, engaging in regular exercise, getting adequate sleep, and minimizing stress.

■ Calcium and vitamin D supplementation:

 If you are on long-term steroid therapy, your healthcare provider may recommend calcium and vitamin D supplementation to help mitigate the risk of osteoporosis and bone loss.

■ Open communication:

 It is crucial to maintain open communication with your healthcare provider. Discuss any concerns or side effects you experience promptly. They can provide guidance, adjust the treatment plan, or explore alternative options if necessary.

Remember, the specific strategies to minimize side effects may vary depending on the type of steroid, your medical condition, and individual factors. It is important to follow your healthcare provider's recommendations and seek their guidance for personalized advice.