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Corticosteroids:

Corticosteroids or glucocorticoids, often just called "steroids", where once thought to be almost miraculous. In 1948, at the Mayo Clinic in Rochester, Minnesota a group of arthritis patients were given daily injections of a corticosteroid. The results were so striking and the improvement so dramatic that it was thought that the "cure" for arthritis had been discovered. However, as the use of corticosteroids expanded over the years, side effects emerged and it was realized that high doses given over prolonged periods of time turned steroids into "scare-oids". Patients were warned of the potential problems, the use of corticosteroids became more conservative, and some patients were so frightened of them they even declined treatment.
Corticosteroids are powerful drugs that can have valuable effect if administered within proper guidelines.

 

Corticosteroids: What Are They?

 

Corticosteroids are drugs closely related to cortisol, a hormone which is naturally produced in the adrenal cortex (the outer layer of the adrenal gland) during th etress response.

 

Corticosteroids: The Role Of Cortisol

Cortisol plays an important part in controlling salt and water balance in the body, and regulating carbohydrate, fat, and protein metabolism. When the body becomes stressed, the pituitary gland at the base of the brain releases ACTH, adrenocorticotropic hormone, which stimulates adrenals to produce cortisol. The extra cortisol allows the body to cope with the stress such as infection, trauma, surgery, or emotional problems. When the stressful situation ends, adrenal hormone production returns to normal.


The adrenal glands usually produce about 20 milligrams of cortisol per day, mostly in the morning, but can produce five times that much when needed.

Corticosteroids: How Do They Work?

Corticosteroids act on the immune system by blocking the production of substances that trigger allergic and inflammatory actions, such as prostaglandins. However, they also impede the function of white blood cells which destroy foreign bodies and help keep the immune system functioning properly. The interference with white blood cell function yields a side effect of increased susceptibility to infection.

 

Steroid Injections

 

Local injections--Injections of steroids directly into hairless patches on the scalp and sometimes the brow and beard areas are effective in increasing hair growth in most people. It usually takes about 4 weeks for new hair growth to become visible if it is going to be effective.

Injections deliver small amounts of cortisone to affected areas, avoiding the more serious side effects encountered with long-term oral use. The main side effects of injections are transient pain, mild swelling, and sometimes changes in pigmentation, as well as small indentations in the skin that go away when injections are stopped.

Because injections can be painful and have to be repeaded, they may not be the preferred treatment for children.

Large areas cannot be treated, however, because the discomfort and the amount of medicine become too great and can result in side effects similar to those of the oral regimen.


Oral corticosteroids--Corticosteroids taken by mouth are a mainstay of treatment for many autoimmune diseases and may be used in more extensive alopecia areata. However due to their side effect they tend not to be administered longer term.

 

Side effect - see medlineplus for full details

 

Side Effects of This Medicine

Corticosteroids may lower your resistance to infections. Also, any infection you get may be harder to treat. Always check with your doctor as soon as possible if you notice any signs of a possible infection, such as sore throat, fever, sneezing, or coughing.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. When this medicine is used for short periods of time, side effects usually are rare. However, check with your doctor as soon as possible if any of the following side effects occur:

  • Less common
    • Decreased or blurred vision;  frequent urination;  increased thirst 
  • Rare
    • Blindness (sudden, when injected in the head or neck area);  burning, numbness, pain, or tingling at or near place of injection ;  confusion;  excitement ;  false sense of well-being;  hallucinations (seeing, hearing, or feeling things that are not there);  mental depression;  mistaken feelings of self-importance or being mistreated;  mood swings (sudden and wide);  redness, swelling, or other sign of allergy or infection at place of injection;  restlessness ;  skin rash or hives 

Additional side effects may occur if you take this medicine for a long time. Check with your doctor if any of the following side effects occur:

  • Abdominal or stomach pain or burning (continuing);  acne;  bloody or black, tarry stools ;  changes in vision;  eye pain;  filling or rounding out of the face;  headache;  irregular heartbeat;  menstrual problems;  muscle cramps or pain;  muscle weakness;  nausea;  pain in arms, back, hips, legs, ribs, or shoulders;  pitting, scarring, or depression of skin at place of injection;  reddish purple lines on arms, face, groin, legs, or trunk;  redness of eyes;  sensitivity of eyes to light;  stunting of growth (in children);  swelling of feet or lower legs;  tearing of eyes;  thin, shiny skin;  trouble in sleeping;  unusual bruising;  unusual increase in hair growth;  unusual tiredness or weakness;  vomiting;  weight gain (rapid);  wounds that will not heal 

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

  • More common
    • Increased appetite;  indigestion;  loss of appetite (for triamcinolone only);  nervousness or restlessness 
  • Less common or rare
    • Darkening or lightening of skin color;  dizziness or lightheadedness;  flushing of face or cheeks;  hiccups;  increased joint pain (after injection into a joint);  increased sweating;  nosebleeds (after injection into the nose) ;  sensation of spinning 

After you stop using this medicine, your body may need time to adjust. The length of time this takes depends on the amount of medicine you were using and how long you used it. If you have taken large doses of this medicine for a long time, your body may need one year to adjust. During this time, check with your doctor immediately if any of the following side effects occur:

 

  • Abdominal, stomach, or back pain;  dizziness ;  fainting;  fever;  loss of appetite (continuing);  muscle or joint pain;  nausea;  reappearance of disease symptoms;  shortness of breath ;  unexplained headaches (frequent or continuing) ;  unusual tiredness or weakness;  vomiting;  weight loss (rapid)

 

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.

 

Corticosteroid : Full brand names click here for medline:

    Topical

  • Alclometasone

    • Cream (U.S.)

    • Ointment (U.S.)

  • Clocortolone

    • Cream (U.S.)

  • Desonide

    • Cream (U.S. and Canada)

    • Lotion (U.S.)

    • Ointment (U.S. and Canada)

  • Dexamethasone

    • Cream (U.S.)

    • Gel (U.S.)

    • Topical aerosol (U.S.)

  • Flumethasone

    • Cream (Canada)

    • Ointment (Canada)

  • Flurandrenolide

    • Cream 0.0125% (Canada)

    • Ointment 0.0125% (Canada)

  • Hydrocortisone

    • Cream (U.S. and Canada)

    • Lotion (U.S. and Canada)

    • Ointment (U.S. and Canada)

    • Topical solution (U.S. and Canada)

  • Hydrocortisone acetate

    • Cream (U.S. and Canada)

    • Topical aerosol foam (U.S.)

    • Lotion (U.S.)

    • Ointment (U.S. and Canada)


    • Oral

  • Betamethasone

    • Syrup (U.S.)

    • Tablets (U.S.)

    • Effervescent tablets (Canada)

    • Extended-release tablets

  • Budesonide

    • Extended-release capsules (Canada)

  • Cortisone

    • Tablets (U.S. and Canada)

  • Dexamethasone

    • Elixir (U.S.)

    • Oral solution (U.S.)

    • Tablets (U.S. and Canada)

  • Hydrocortisone

    • Oral suspension (U.S.)

    • Tablets (U.S. and Canada)

  • Methylprednisolone

    • Tablets (U.S. and Canada)

  • Prednisolone

    • Oral solution (U.S. and Canada)

    • Syrup (U.S.)

    • Tablets (U.S.)

  • Prednisone

    • Oral solution (U.S.)

    • Syrup (U.S.)

    • Tablets (U.S. and Canada)

  • Triamcinolone

    • Syrup (U.S. and Canada)

    • Tablets (U.S. and Canada)

    Parenteral

  • Betamethasone

    • Injection (U.S. and Canada)

  • Cortisone

    • Injection (U.S. and Canada)

  • Dexamethasone

    • Injection (U.S. and Canada)

  • Hydrocortisone

    • Injection (U.S. and Canada)

  • Methylprednisolone

    • Injection (U.S. and Canada)

  • Prednisolone

    • Injection (U.S.)

  • Triamcinolone

    • Injection (U.S. and Canada)