Corticosteroids - Facts, Health Benefits and Side Effects
Useful Chemicals and Medications
Corticosteroids are important and very useful chemicals. Natural corticosteroids are made in the outer layer of the adrenal glands, a region known as the adrenal cortex. We have two adrenal glands, one on top of each kidney. Artificial corticosteroids are produced for use as medications. Like the natural chemicals, they can be very helpful. They can also produce side effects, however, some of which may be serious.
Corticosteroid medications are frequently used as anti-inflammatory drugs. They are also prescribed to suppress the activity of the immune system. This suppression is useful in autoimmune diseases and in organ transplants. In addition, the medications are used to make patients being treated for cancer feel more comfortable. In specific cases, they are used with or without chemotherapy to treat cancer.
Natural Steroids in the Body
A steroid is a molecule made of four connected rings of atoms. Important steroids in humans are cholesterol, vitamin D, estrogen, progesterone, testosterone, cortisol and aldosterone. Cortisol and aldosterone are made by the adrenal cortex and are classified as corticosteroids.
Corticosteroids in the body are either mineralocorticoids or glucocorticoids. An important example in each class is described below.
- Aldosterone is a mineralocorticoid that increases the amount of sodium ions and water in the blood by acting on the kidneys. This action indirectly causes blood pressure to rise.
- Cortisol is a glucocorticoid and has many functions. Some of these functions are to increase the level of glucose in the blood, decrease the activity of the immune system, help in the metabolism of proteins, fats and carbohydrates, reduce inflammation and help the body respond to stress.
Differences Between Corticosteroids and Anabolic Steroids
Artificial corticosteroids that are used as medicines are quite similar in structure to cortisol. They are not the same as anabolic steroids. Anabolic steroids are structurally related to the male sex hormone testosterone and have very different functions from corticosteroids.
Anabolic steroids stimulate the development of muscle mass. They are helpful in maintaining muscle in people with AIDS and are sometimes prescribed for men with hormone problems. They are also used by some athletes to help build muscle. In the concentrations used by athletes, anabolic steroids can cause very serious side effects.
Inhaled Corticosteroid Medications and Asthma
Inhaled corticosteroids are often prescribed for asthma patients. They are used in low doses every day to reduce inflammation in the airways and reduce the chance of an asthma attack. The more inflamed the airways, the more sensitive they are to triggers that can cause asthma. The inhaled medication is known as a preventer or a controller medicine. A different medication known as a rescue medicine is inhaled if an asthma attack occurs.
I use an inhaler containing a corticosteroid myself and find it very effective. If I don't use the inhaler on a regular schedule, my asthma returns. Inhaled corticosteroids cause fewer side effects than the oral forms of the medications.
The most common problem caused by an inhaled corticosteroid is the development of a yeast infection inside the mouth, which is known as thrush. Patients are advised to rinse their mouths out thoroughly after each use of an inhaler to prevent this infection from developing. Inhaler use may also cause mouth or throat irritation or hoarseness.
Three corticosteroids that are commonly inhaled to control asthma are budesonide, fluticasone and beclomethasone. The medications are sold under various brand names. It's important that an asthma patient talks to their doctor about the benefits and disadvantages of each medication in their particular case.
Inhaler Advice from a Doctor
Corticosteroid Medications and Rheumatoid Arthritis
Rheumatoid arthritis is an autoimmune disease. The body’s immune system normally fights disease-causing bacteria and viruses that enter the body. In rheumatoid arthritis, the immune system mistakenly attacks the lining of the sufferer’s joints, causing inflammation, swelling and pain.
Oral or injected corticosteroids reduce or relieve the symptoms of rheumatoid arthritis. Prednisone and prednisolone are common oral corticosteroids given to arthritis patients. There are newer medications available which can actually stop the joint damage in rheumatoid arthritis, however, as described in the video below.
In rheumatoid arthritis, the synovial membrane lining the joint capsule becomes inflamed. In addition, the articular cartilage covering the surface of each bone in the joint is damaged and destroyed. This is followed by damage to the bone itself.
Treating Rheumatoid Arthritis
Corticosteroids and Cancer Treatment
Corticosteroids may play a useful role in cancer treatment. Since they are strongly anti-inflammatory they are prescribed to reduce swelling and pain. They are used with other drugs to reduce nausea and vomiting created by chemotherapy treatment. They may also increase appetite. In a few types of cancer, specific corticosteroids are used with or without chemotherapy drugs to destroy cancer cells. It's important to note that while corticosteroids are an important aspect of treatment in some types of cancer, they may not be helpful in all types.
When my golden retriever had lymphoma, the vet prescribed prednisone for him at one point during his illness. For one glorious week after the medication was started, Sam seemed to feel much better and behaved much more normally. Sadly, after about a week Sam returned to his prior condition. This experience may or may not be related to human biology and is purely anecdotal. It impressed me at the time, though. I wish Sam's improvement had lasted for longer.
Other Uses of the Medications
Corticosteroids are not as widely used to treat osteoarthritis as they are to treat rheumatoid arthritis. They are sometimes injected into the affected joints of people suffering from osteoarthritis, however, and have provided temporary relief from pain.
Corticosteroids are sometimes prescribed in other autoimmune diseases in addition to rheumatoid arthritis, such as lupus and the autoimmune form of Addison's disease. In Addison's disease the adrenal glands stop producing enough cortisol and aldosterone.
Osteoarthritis is often known as a wear and tear disease. The articular cartilage breaks down, removing cushioning from the joint. Although not traditionally considered to be a disease that involves inflammation, the inflammatory process may be involved in the disorder.
Side Effects of Oral Corticosteroids
Doctors prefer to prescribe oral corticosteroids at low doses or for short periods if possible due to the potential side effects. The most common side effects of oral corticosteroid use are appetite increase, weight gain, increased body fat, mood changes and fluid retention. There may also be increased blood pressure and fluid buildup in the eye, producing an eye disorder called glaucoma.
If a person takes oral corticosteroids for a long time, he or she may develop osteoporosis, muscle weakness, cataracts, high blood sugar, skin bruising, slow healing of wounds and acne. There may also be stomach ulcers and an increased incidence of infections (due to suppression of the immune system by the corticosteroid). Children and teenagers may experience slowed growth.
Despite the possible side effects, in many cases taking a corticosteroid medication is very worthwhile. If a person stops taking oral corticosteroids, the medications must be reduced slowly under a doctor’s guidance. Artificial corticosteroids may reduce the production of natural cortisol by the adrenal glands. A gradual reduction in medication dose allows the adrenal glands to slowly recover and helps prevent the patient from experiencing unpleasant withdrawal symptoms.
Allergies, Nose Sprays and Eye Drops
Sometimes corticosteroid nose sprays are prescribed to relieve allergy symptoms such as a stuffy and runny nose, nasal itching and sneezing. The medications may cause side effects, which can include a burning sensation in the nose or occasionally nosebleeds. Some people experience an unpleasant taste or smell after using a corticosteroid nose spray. However, side effects from corticosteroids in nose sprays are less common than those caused by the oral medications.
Corticosteroids are also added to some eye drops to treat eyes that are inflamed, red and itchy due to an allergic reaction. The long term use of these eye drops isn't recommended, however, since they can increase the risk of eye infections, cataracts and glaucoma.
What is Eczema?
Topical corticosteroids are rubbed on the skin, where they help to relieve the itch and redness of inflammatory skin conditions such as eczema. The corticosteroid may be added to a cream, lotion or gel. It's not a cure for the skin condition but does relieve the symptoms. As described by the dermatologist in the video below, though, cortisone (a corticosteroid) is only part of the treatment for true eczema, or atopic dermatitis.
Topical corticosteroids produce fewer side effects than oral corticosteroids, unless the corticosteroid cream is rubbed over large areas of the body or is used for a long time. In these cases, a significant amount of the corticosteroid may be absorbed into the body. The most common side effect of topical steroid use is thinning of the skin.
Non-prescription creams or lotions containing a low dose of a corticosteroid called hydrocortisone can be bought in drug stores. They are used to relieve itchy skin and skin irritations cause by factors such as insect bites, poison ivy and allergic reactions to detergents or cosmetics. More concentrated hydrocortisone creams can be obtained with a prescription.
Treatments for Atopic Dermatitis (Eczema)
Monitoring and Reducing Corticosteroid Use
Corticosteroids are powerful drugs that can be extremely helpful in relieving pain and inflammation. However, they can cause unpleasant or dangerous side effects. The potential side effects may be serious if oral medications are used. For this reason, a doctor's advice should be followed very carefully when a person is taking a corticosteroid. Any unpleasant effects of the treatment should be reported to the doctor.
It's a good idea to follow other steps to help a health problem in order to reduce or eliminate corticosteroid use, if this is possible. For example, if you know that dust mites are responsible for your asthma attacks, it's an excellent plan to keep the dust level low in your home. You may not be able to eliminate the use of a corticosteroid inhaler, but you may well be able to reduce the dose of the medication.
In serious situations where a higher dose of a corticosteroid medication must be taken, the side effects - if they develop - may be less bothersome or less serious than the health problem being treated. A patient's condition should always be monitored, though.
References and Further Reading
© 2011 Linda Crampton
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