Corticosteroids are drugs that have an effect similar to that of the body’s own hormones. Their mechanism of action is similar to that of natural adrenal steroid hormones. The areas of application of corticosteroids are varied due to their high efficiency. Because they are analogs of biologically active substances of the body, there are so many side effects of corticosteroids.
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The large number of different side effects, which are listed below or found in the instructions to corticosteroids, may make decide not to use steroids. However, you should not be afraid of hormonal drugs – many people use steroids and do not experience any side effects. This applies to both topical and systemic steroids. Usually, if you follow all the warnings and recommendations of the attending doctor, you can avoid or minimize the side effects of treatment. Besides, do not forget that the risk of side effects is dose-dependent, that is, it becomes higher with increasing dose or duration of continuous reception. Therefore, if a low dose of systemic corticosteroids was prescribed, the risk of side effects for you is very small. The patient and the doctor must be aware of the list of possible side effects in order to timely identify and address their initial manifestations.
The type and severity of side effects depend on the dosage form of corticosteroid. Therefore, we can identify common and specific side effects of steroids. Common side effects are more common with systemic treatment with corticosteroids, and less common with topical application of the drugs. Specific side effects occur when using certain medicines.
Specific side effects of corticosteroids
Inhaled corticosteroids: most often lead to dryness of the mucous membranes, vascular fragility at the site of action, and increased risk of nosebleed.
Creams and ointments with corticosteroids: prolonged use may lead to secondary skin infections (due to local decrease in the immune defense of the skin), hypertrichosis, darkening of the skin, or hypopigmentation, and atrophic skin changes. In the case of individual intolerance to corticosteroids, there is swelling, redness and itching in the area of application.
Injectable corticosteroids: occasional necrosis or atrophy of the tissue at the injection site is possible.
Oral corticosteroids (oral use): since oral steroids pass through the digestive tract and are in the intestine absorbed into the bloodstream and delivered with the blood to all organs and tissues. Therefore, this dosage form of corticosteroids has the most pronounced side effects. The most specific effect is increased risk of ulcers of the stomach and intestines.
Common side effects of corticosteroids
Let us separately consider the possible side effects for different systems and processes in the body.
Endocrine system: Corticosteroids cause a rise in blood glucose levels and possible development of steroid diabetes, or provoke the emergence of diabetes in people predisposed to it. There is a risk of Cushing’s syndrome, adrenal suppression, and delayed sexual development in children.
Metabolism: Steroids affect the metabolism and distribution of fatty deposits in the subcutaneous tissue. As a result, there may be weight gain, especially due to deposition of fat in the upper half of the body. Moon face is the second consequence of redistribution of fat under the influence of corticosteroids. Rounding of the face due to increased fatty deposits along the contour occurs under prolonged treatment with steroids. In most cases, this side effect is reversible: the weight and shape of the face comes back to normal shortly after cessation of treatment. Because systemic application of corticosteroids can alter the balance of ions in the blood, there may be retention of fluid in tissues, leading to edema and additional weight gain.
Cardiovascular system: Heart rhythm disturbance, bradycardia, increased blood pressure, development of thrombosis and strengthening of blood clotting are all rare. Patients with myocardial infarction (acute or subacute) may experience increased heart muscle lesion focus and slowdown in the formation of scar. Treatment with high doses of corticosteroids for over a year increases the risk of developing atherosclerosis.
Nervous system: insomnia, mood changes. There is particularly high risk of occurrence of these effects at a daily dose of steroids of more than 30 mg. In some people, this manifests into a feeling of euphoria, which replaces depression without objective reasons. Others experience strong irritability and anxiety. Insomnia often occurs when corticosteroids are taken in the afternoon and at night.
Digestive system: There may be nausea, vomiting, ulcers and bleeding in the stomach and intestines, increased and decreased appetite, pancreatitis.
Musculoskeletal system: prolonged treatment with corticosteroids may cause a delay in bone growth in children, while in adults, lead to osteoporosis. Therefore, before prescribing a treatment with steroids, many experts assign special tests to check the state of the bone tissue. Treatment with high doses of steroids increases the risk of fracture – bones become fragile. This side effect can be prevented by taking supplements with calcium and vitamin D, getting rid of bad habits (smoking, alcohol abuse), maintaining a healthy weight. In the case where the risk of osteoporosis is high, the doctor prescribes drugs to prevent this problem.
Sensory system: there is a possibility of developing glaucoma or cataracts, and infectious eye lesions during treatment with steroid drugs. If you already have glaucoma or lenticular opacity, and steroids were prescribed for you, be sure to inform your ophthalmologist.
Effect on the skin: the skin may become more prone to damage under the influence of prolonged use of corticosteroids. The skin itself and the walls of the blood vessels become fragile. As a result, large bruises and ruptures may form from very light bruises and injuries. Besides, there may be delayed wound healing, acne, and development of purulent and fungal skin lesions.
Immunity: treatment with steroids for more than two weeks can reduce immunity. As a result, the body becomes more susceptible to infectious diseases and the impact of components of live vaccines. Therefore, vaccination is contraindicated during treatment.
Allergic reactions: rash, itching, swelling of the skin and throat, anaphylactic shock.
Withdrawal syndrome of corticosteroids: especially strongly manifests in the case of abrupt cessation of treatment after more than two weeks of continuous use of corticosteroids. Symptoms: pain and aching in joints and muscles, limb numbness, feeling of tiredness, fever. These symptoms can be confused with manifestations of the main disease, and therefore you should never cancel steroids abruptly. Moreover, this can cause a decrease in adrenal function. A gradual cancellation of steroid intake enables the adrenal cortex to restore its function.
Most side effects disappear after treatment has been completed.