Corticosteroids, also called glucocorticoids and steroids, are common anti-inflammatory medications, which help fight swelling and pain throughout the body.
Corticosteroids are not the same steroids sometimes abused by athletes to enhance their performance or bulk up their muscles.
Corticosteroids act like the naturally occurring hormone cortisol that the body produces to fight inflammation.
Corticosteroids work in two ways; they stop inflammation and suppress the body’s immune response.
Since they do both, corticosteroids provide rapid relief for pain, swelling, and stiffness.
Corticosteroids come in several forms. Which particular type is prescribed will depend on where a person has pain, what health conditions they have, and the best way to administer the medication.
The delivery forms for corticosteroids include:
- Oral—Tablets, capsules, or liquid may be prescribed to people with certain types of arthritis, lupus, and other diseases that cause chronic pain, have flare-ups, or inflammation, swelling, and pain.
- Topical—Creams, lotions, or ointments may be made with corticosteroids. They are used to handle skin issues like eczema, psoriasis, and psoriatic arthritis (PsA).
- Ophthalmic—Usually in drops, this form of corticosteroids is used to treat eye inflammation and pain.
- Aerosol—Corticosteroids are often administered via metered-dose inhalers or nebulizers for asthma and chronic obstructive pulmonary disease (COPD)
- Injectable—Corticosteroids can be injected intramuscularly for longer-lasting relief; intra-articularly (into a joint) in combination with a local anesthetic to treat arthritis pain and injury (relief can last several months); and intravenously (IV) to help treat a severe disease or for patients in the hospital.
Corticosteroids are used to treat many chronic conditions that involve inflammation and pain.
A few of these conditions include:
- chronic obstructive pulmonary disease (COPD)
- Crohn’s disease
- inflammatory bowel disease (IBD)
- ulcerative colitis
- multiple sclerosis (MS)
Corticosteroids are also used to treat acute conditions such as severe COVID-19, acute asthma, and adrenal crises.
While corticosteroids are an effective treatment for these diseases and more, there may be significant side effects and risks for some people.
There are medications and other treatments that help offset the side effects; however, the side effects may be severe for some people, leading them to use other treatment options.
The risks and side effects from corticosteroids may include:
- Weight gain—The most noted side effect of taking corticosteroids is a characteristic swelling and fullness around the cheeks and face.
There’s even a name for it, “moon face.” People often gain weight while taking corticosteroids because corticosteroids alter the way the body metabolizes fat.
One can do few things to help reduce weight gain while on corticosteroids, such as eating fewer calories, increasing exercise, and lowering salt intake.
However, it can take several months and up to a year after they stop taking corticosteroids to return to their typical weight for some people.
- Changes in mood or emotions—Corticosteroids can affect how people taking them feel. Individuals may experience mood swings or feelings like anxiety, anger, agitation, aggression, excessive energy, and depression.
It’s important that people taking corticosteroids practice self-care and engage in meditating, deep breathing, yoga, and exercise that may help stabilize mood and increase feelings of well-being.
Be sure to report feelings of depression or thoughts of self-harm to a healthcare provider or mental health professional.
It can also help people take corticosteroids to let others know about the medication and affect their mood.
- Renal insufficiency—This is a potentially serious side effect and risk of taking corticosteroids. Taking them for as little as two weeks can affect the adrenal glands.
These glands are found on top of the kidneys and regulate essential functions of metabolism like maintaining weight, the immune system, blood pressure, etc.
Stress can make this risk worse. For individuals who have taken corticosteroids, they must let their healthcare providers know if they have taken them anytime in the past year before having any medical procedure or dental work.
Individuals who have taken corticosteroids may need additional medication before surgery or treatment.
This risk can be potentially life-threatening in the event of serious illness, significant injury, or major surgery especially.
- Elevated blood sugar—Many individuals who take corticosteroids may have a sudden elevation in blood sugar. This side effect can occur within a few hours of taking the first dose of corticosteroids.
For many people, blood sugar levels return to normal once they stop taking corticosteroids. However, this can be a significant risk of taking corticosteroids because some people can develop type 2 diabetes.
Doctors and other healthcare providers will monitor individuals taking corticosteroids and check for elevated blood sugar levels.
They will consider other treatment options if corticosteroids are causing elevated blood sugar levels.
- High blood pressure—Taking corticosteroids can retain excess fluids, altering other biochemical functions like how the body uses sodium, electrolytes, and water.
While taking corticosteroids, it’s important to watch salt intake and choose lower sodium food options.
Health-care providers generally monitor blood pressure in individuals taking corticosteroids.
For individuals taking corticosteroids, it’s important to note things like swollen ankles or feet and other signs of water retention and to discuss them with healthcare providers.
- Cataracts and glaucoma—Corticosteroid use can permanently affect the eyes, causing both cataracts (clouding of the lens) and glaucoma (elevated pressure within the eye).
Both these conditions can permanently affect vision, and glaucoma can lead to blindness.
It’s important to have an eye exam before taking corticosteroids, during corticosteroid therapy, and afterward to ensure prompt treatment of any eye conditions since these changes may be permanent.
- Infections—Because corticosteroids can reduce the immune response, people taking them may be at greater risk for infection, and normally mild illnesses can be more serious than usual or may become serious very quickly.
People taking corticosteroids may need to avoid large crowds and people with known illnesses.
Standard infection control measures like hand washing and wearing a mask may help as well.
Individuals on corticosteroids should contact their healthcare provider immediately if they have signs of infection like body aches, fever, chills, painful urination, sore throat, or cough.
- Skin problems—Corticosteroids, especially oral and topical versions, can reduce the amount of collagen the body produces.
Collagen is important for the skin to heal and remain taught and firm.
For individuals taking corticosteroids, wounds may take longer to heal, and skin may be thinner and more prone to bruising, bleeding, and stretch marks, which may be permanent.
While taking corticosteroids, individuals should be cautious to protect the skin and avoid injury. Some doctors suggesting using retinoid cream while on corticosteroids to help protect the skin.
- Bone loss and bone death—Taking any corticosteroid can lead to bone conditions like osteoporosis (bone loss) and osteonecrosis (bone death).
Bones stay healthy through a continuous process of breaking down and building up bone. Corticosteroids interrupt this process, and it can begin soon after beginning treatment with corticosteroids.
This is a serious risk and side effect which can lead to fractures and permanent bone loss.
To help avoid this risk, individuals taking corticosteroids can consider load-bearing exercises like lifting weights and other exercises such as running, jogging, and walking, which use the body’s own weight as resistance.
Doctors also recommend getting between 1000 and 1200 mg of calcium and between 600 and 800 IU of vitamin D each day.
Other ways to help protect bones include maintaining a healthy weight, eating a well-balanced diet, limiting alcohol, and avoiding or stopping using tobacco products.
To address these side effects and risks, doctors will often prescribe a lower dose of corticosteroids for a brief span of time and then gradually increase the dosage until a therapeutic level is reached.
They may also decide corticosteroids are not the best option for patients at higher risk of developing these complications.
Corticosteroids are prescribed as a treatment for various medical conditions, from allergies and eczema to Crohn’s disease and multiple sclerosis.
They can be highly effective, but they can also come with minor side effects and major risk factors.
It’s important to keep in touch with a healthcare provider while taking corticosteroids and to report any new or unusual symptoms.
Prompt treatment can help prevent a side effect from becoming a permanent health condition.
“Corticosteroids.” Arthritis Foundation. https://arthritis.org/drug-guide/corticosteroids/corticosteroids (accessed March 1, 2021).
“Corticosteroids.” Cleveland Clinic. January 20, 2020. https://my.clevelandclinic.org/health/drugs/4812-corticosteroids (accessed March 1, 2021).
“Corticosteroids Definition.” American Academy of Allergy, Asthma & Immunology (AAAAI). https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/inhaled-corticosteroids (accessed March 1, 2021).
“Prednisone and other corticosteroids.” Mayo Clinic. December 16, 2020. https://www.mayoclinic.org/steroids/art-20045692 (accessed March 1, 2021).
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