Corticosteroids - A Man-Made Version of Hormone

What are Corticosteroids?

Corticosteroids are forms of steroids that are used as an anti-inflammatory drugs to treat a range of health problems. These steroids help prevent tissue damage and reduce the immune system's activity. They are produced by the outer portion of the adrenal cortex and have immunosuppressive, anti-inflammatory, and vasoconstrictive effects.

The naturally occurring corticosteroids are of two types:

• Glucocorticosteroids - These corticosteroids suppress inflammation and immunity and assist in the breakdown of fats, carbohydrates, and proteins. Examples of glucocorticosteroids are Cortisone, Prednisolone, and Ethamethasoneb.

• Mineralcorticosteroids - These corticosteroids regulate the balance of salt and water in the body. Fludrocortisone Is an example of a systemic corticosteroid.

• Synthetic Corticosteroids - These are generally used in people with compromised adrenal glands that are unable to produce an adequate amount of corticosteroids

What Are the Different Types of Corticosteroids?

Corticosteroids can be given systemically or locally.

• Systemic Steroids - These steroids move through the blood to parts of the body and can be delivered orally, intramuscularly, or intravenously. They are used to treat conditions such as lupus and multiple sclerosis. Injections like Methylprednisolone can be given into joints, muscles, or blood vessels.

• Localized Steroids - These steroids target a specific part of the body and can be taken by mouth or applied through the skin.

• Creams and Ointments - Hydrocortisone skin cream helps to relieve redness, swelling, itching, or other discomfort.

• Eye Drops and Ear Drops - Ear drops are used to relieve pain, redness, itching, and swelling caused by certain ear problems. The eye drops can be used to prevent permanent damage to the eyes and provide relief from redness, irritability, and other discomforts.

• Inhalers for Nasal Sprays - Beclomethasone and Fluticasone are used to treat symptoms of conditions like asthma or hives. Regular use of inhalers can decrease the number and severity of asthma attacks.

• Tablets - Prednisolone may be used for allergies, blood disorders, or infection.

What Are Corticosteroids Used For?

Corticosteroids treat various health conditions, including asthma, hay fever, hives, eczema, chronic obstructive diseases, gout, lupus, inflammatory bowel disease, and multiple sclerosis. The drug is commonly used to treat autoimmune diseases like autoimmune hepatitis.

The use of corticosteroids decreases inflammatory conditions involving the nose and eyes. It reduces the activity of the immune system by affecting the white blood cells. Corticosteroid injections are given to relieve the inflamed joint in rheumatoid arthritis. Corticosteroids help to reduce the chances of organ rejection in patients who have had an organ transplant recently. Fludrocortisone therapy is used to treat Addison’s disease (a chronic disorder that occurs when the adrenal glands do not produce enough cortisol and aldosterone hormones).

How Do Corticosteroids Work?

Steroids reduce the production of chemicals that cause inflammation and reduce the activity of the immune system. Topical corticosteroids modify the functions of epidermal and dermal cells and leukocytes participating in inflammatory diseases. They pass through the cell membranes and react with the receptor proteins in the cytoplasm to form a steroid-receptor complex.

What Are the Possible Side Effects of Corticosteroids?

The side effects may occur with topical, inhaled, and injected steroids. The most common side effects are from oral steroids.

Side Effects From Oral Steroids:

• Skin and muscle atrophy.

• Increased risk of infection.

• High blood pressure.

• Mood or behavioral changes.

• Osteoporosis.

• Glaucoma.

• High blood sugar levels.

Long-Term Use May Be Associated With:

• Weight gain.

• Facial swelling or puffiness.

• Depression.

• Nausea and vomiting.

Side Effects From Inhaled Corticosteroids:

• Cough.

• Difficulty speaking.

• Oral thrush.

Side Effects From Topical Corticosteroids:

• Acne.

• Rosacea.

• Atrophy.

• Stretch marks.

• Perioral dermatitis.

• Delayed healing.

Side Effects From Injected Corticosteroids:

• Temporary soreness.

• Loss of skin color at the injection site.

What Precautions Need to Be Taken While Taking Corticosteroids?

Long-term use of corticosteroids can cause serious health risks and should be given with caution in the following conditions:

• Pregnant and Breastfeeding - Corticosteroids may increase the risk of hypertension, edema, and gestational diabetes when given in high doses. The drug passes through the breast milk and may cause growth problems in nursing babies.

• Children - Steroid therapy in children may cause stunted growth and increase the severity of infections like measles and chickenpox. Corticosteroids are contraindicated in neonates and infants with low birth weight.

• Diabetes - Corticosteroids may affect blood sugar levels and should be administered with caution in people with diabetes.

• Infection - Long-term steroids suppress the protective role of your immune system and increase the risk of infection.

• Gastric Ulcers - Corticosteroids may increase the risk of developing ulcers or gastrointestinal bleeding, especially when taken along with non-inflammatory drugs.

• Osteoporosis - Steroid therapy can cause thinning of the bones of osteoporosis and increased risk of bone fractures.

• Obesity - Steroids affect the metabolism of fat and can lead to weight gain and should be taken with caution in obese people.

• Blood Pressure - Corticosteroids promote fluid retention and may worsen high blood pressure. Hence, it is important to monitor blood pressure in hypertensives.

• Glaucoma - Steroid therapy can cause cataracts or increase pressure in the eye and should be administered cautiously.

• Heart Disease - High doses of corticosteroids may increase the risk of heart disease and atherosclerosis and should be given with caution.

• Liver Disease - Long-term use of corticosteroids can cause hepatic enlargement and worsen preexisting liver disease.

• Kidney Failure - Anabolic-androgenic steroids can aggravate acute kidney injury, chronic kidney disease, and glomerular toxicity.

What Are the Interactions of Corticosteroids?

Certain medicines may affect the effectiveness of corticosteroids.

Interaction With Medicines:

• Anticoagulants like Warfarin.

• Amiodarone.

• Antifungals such as Fluconazole, Itraconazole, Ketoconazole, and Voriconazole.

• Aprepitant.

• Aspirin.

• Carbamazepine.

• Cimetidine.

• Clarithromycin.

• Cyclosporine.

• Diltiazem.

• Dexamethasone.

• Diuretics.

• Efavirenz.

• Sertraline.

• Verapamil.

• Rifampicin.

• Phenytoin.

• St. John’s wort.

Interaction With Food:

• Sweets and food that is high in sugar like candy, soda, cookies, or icecreams.

• High-sodium foods like chips, sauces, and cured meats.

• Avoid grapefruit juice while taking corticosteroids.

Interactions With the Diseases:

• Gastrointestinal Perforation and Peptic Ulcer Disease - Therapy with corticosteroids should be avoided in patients with nonspecific ulcerative colitis, and a history of peptic ulcers as it may cause hemorrhage or gastrointestinal perforation.

• Infections - Secondary infections are more likely to develop when corticosteroids are used in people with active infections.

• Vaccination - The administration of live or live-attenuated vaccines is not recommended in patients receiving immunosuppressive doses of corticosteroids.

• Tuberculin Test - Use of corticosteroids may reactivate tuberculosis when given to patients with latent tuberculosis.

• Cirrhosis - Patients with cirrhosis should be monitored closely for excessive cortisol effects when given steroids.

• Psychoses - Psychotic patients can have aggravated symptoms of emotional instability when given corticosteroids.

• Diabetes - Corticosteroids raise blood sugar levels and suppress the secretion of insulin and should be administered cautiously in patients with diabetes mellitus.

• Hypothyroidism - Patients with hypothyroidism should be monitored for excessive cortisol effects when given steroids.

• Myasthenia Gravis - Corticosteroids must be administered with caution and at low doses when given for the treatment of myasthenia gravis. High doses of steroids can cause toxic myopathy.

Conclusion:

Corticosteroids are powerful anti-inflammatory medications and have benefits for a wide variety of health conditions. Prolonged corticosteroids can lead to serious side effects, including high blood pressure, weight gain, and increased risk of infection.