Corticosteroids have transformed modern medicine from managing severe allergic reactions to treating chronic inflammatory diseases. Such powerful medications help ease medical conditions such as asthma, autoimmune disorders, and skin diseases. However, they have to be used with caution, as prolonged or high dosing can lead to major side effects.

It is important for both healthcare professionals and patients to understand corticosteroid drugs’ benefits, uses, and possible risks. This guide will explain how these medications function, their role in different treatments, and precautions that must be adhered to.

What are Corticosteroids?

Corticosteroids are a class of steroid hormones that reduce inflammation and also suppress the immune system. Synthetic versions of cortisol are what they are: hormones that are made by the adrenal glands. Corticosteroid drugs are prescribed to treat some medical conditions, such as autoimmune diseases, allergies, asthma, and inflammatory disorders, among others.

Types of Corticosteroids

Corticosteroids can be classified into 2 main types:

1. Glucocorticoids
2. Mineralocorticoids

Comparison of corticosteroids under the subcategories are explained briefly in the table below:

Agent	Type	Drug	Description and Use	Route of Administration
1. Glucocorticoids	(a) Short-acting (8-12 hours)	Hydrocortisone (cortisol)	• Replacement therapy in acute adrenal insufficiency  • Status asthmatics • Anaphylactic shock	Oral, IM, IV., intra-articular and topical
		Cortisol	• Cheap: prodrug • Converted to hydrocortisone after metabolism in the liver	Rarely used nowadays
	(b) Intermediate-acting(12-36 hours)	Prednisolone	• Allergic, inflammatory • Autoimmune disorders • Malignancies • Causes less HPA axis suppression if given once daily in the morning	Oral, IM, intra-articular and topical
		Deflazacort	• Lacks mineralocorticoid activity • Lower risk of growth retardation	Oral
		Methylprednisolone	• Anti-inflammatory •Immunosuppressant effects • High-dose pulse therapy in renal transplant • Pemphigus Vulgaris	IM, IV, retention enema in ulcerative colitis.
		Triamcinolone	Oral, IM, intra-articular, and topical.	Oral, IM, intra-articular and topical.
	(c) Long-acting(36-72 hours)	BetamethasoneDexamethasone	• Highly potent • Anti-inflammatory • Immuno-suppressant effects • No mineralocorticoid activity • Cause severe HPA axis suppression • Used in allergic and inflammatory conditions • Cerebral oedema due to neoplasm, where water retention is undesirable • Promote lung maturation in the fetus	Oral, IV, IM and topical
		Beclomethasone	• Bronchial asthma • Allergic rhinitis Ointment for skin • Mucous membrane lesions • HPA axis suppression is minimal	Inhalation, topical
		Budesonide	Same as beclomethasone but is more potent than beclomethasone	Inhalation, topical
		Fluticasone	• Asthma  • Chronic obstructive pulmonary disease (COPD) • Inflammatory bowel disease • Skin and mucous membrane lesions	Inhalation, oral, topical
2. Mineralocorticoids		Desoxycorticosterone acetate (DOCA)	• Selective mineralocorticoid activity  • Used in Addison’s disease as replacement therapy
		Fludrocortisone	Oral, IV, IM, and topical

Uses of Corticosteroids

Corticosteroids are vital drugs used clinically for various diseases. They are often misused due to their intense symptomatic relief. Non-endocrine conditions may require higher doses. Their primary benefits come from their anti-inflammatory and immunosuppressant effects and their anti-allergic and lymphocytic properties.

Uses in Replacement Therapy

1. Acute Adrenal Insufficiency: It is treated with hydrocortisone and normal saline with 5% glucose to correct fluid and electrolyte imbalance. 

2. Chronic Adrenal Insufficiency: Treated with oral hydrocortisone (two-thirds of the daily dose is given in the morning and one-third in the evening), along with adequate salt and water.

3. Adrenogenital Syndrome and Adrenal Virilism: This syndrome suppresses pituitary adrenocorticotropic hormone (ACTH), reducing adrenal androgens. A highly potent glucocorticoid like dexamethasone is preferred.

Uses in Non-endocrine Diseases

1. Rheumatoid Arthritis: They produce immediate and dramatic symptomatic relief in rheumatoid arthritis but do not halt the progression of the disease. Their anti-inflammatory effects decrease swelling, redness, and pain and improve joint mobility. 

2. Osteoarthritis: They are rarely used in osteoarthritis. Intra-articular injection is recommended for acute episodes involving one or two joints.

3. Rheumatic Fever: Glucocorticoids produce more rapid symptomatic relief than aspirin and are indicated in cases with carditis and congestive cardiac failure (CCF). Prednisolone is given along with aspirin.

4. Gout: They are reserved anti-inflammatory drugs in acute gout that do not respond to NSAIDs.

5. Allergic Diseases: Hay fever, drug reactions, urticaria, and contact dermatitis can be suppressed but have a slow onset of action. Hence, severe reactions such as anaphylaxis and angioneurotic oedema require immediate therapy with adrenaline.

6. Bronchial Asthma: Glucocorticoids have anti-inflammatory and antiallergic effects, reducing mucosal oedema and bronchial hyperreactivity. Chronic asthmatics need steroids, but it is more effective to give inhalational preparations like beclomethasone, budesonide, or fluticasone.

7. Collagen Diseases: Collagen diseases such as polymyositis, polyarteritis nodosa, polymyalgia rheumatica, and dermatomyositis can be controlled with large doses of glucocorticoids. 

8. Renal Disease: Glucocorticoids are the first-line drugs in nephrotic syndrome.

9. Ocular Diseases: They are frequently used to suppress inflammation in the eye and thus prevent damage to vision. They may be administered topically, subconjunctivally, systemically, or through retrobulbar injection. 

Benefits of Corticosteroids

There are several benefits to use corticosteroids, which include:

• Rapid inflammation control.
• Effective relief from allergic reactions.
• Improves lung function in asthma and chronic obstructive pulmonary disease (COPD)
• Prevents autoimmune flare-ups.
• Aids in pain management for inflammatory diseases.
• They prevent organ rejection by suppressing the immune response.
• In cases like Addison’s disease, corticosteroids can replace deficient hormones.

Side Effects of Corticosteroids

A single dose of glucocorticoids is practically harmless; instead, they are life-saving drugs for conditions like anaphylactic shock and acute adrenal insufficiency. The use of glucocorticoids in supraphysiological doses for more than 2-3 weeks causes a number of undesirable effects.

1. Metabolic Effects: Hyperglycaemia or aggravation of pre-existing diabetes.

2. Cushing’s Habitus: Abnormal fat distribution causes peculiar features with moon face, buffalo hump and thin limbs.

3. Gastrointestinal Tract: Peptic ulceration, sometimes with haemorrhage or perforation.

4. Salt and Water Retention: The mineralocorticoid effect may cause oedema, hypertension, and even precipitation of CCF, particularly in patients with primary hyperaldosteronism. Synthetic steroids like dexamethasone and betamethasone can minimise this.

5. Muscle Issues: Steroid treatment can cause hypokalaemia, leading to muscle weakness and fatigability. Long-term steroid therapy leads to steroid myopathy.

6. Bone Fracture: Osteoporosis with pathological fractures of vertebral bodies is common. Ischaemic necrosis of the femoral head can also occur.

7. Growth Retardation in children is more familiar with dexamethasone and betamethasone.

8. Eye Problems: Glaucoma and cataracts may occur on prolonged therapy.

9. Central Nervous System: Behavioural disturbances like nervousness, insomnia, mood changes, and even psychosis may be precipitated.

10. Long-term Therapy: Steroid therapy leads to immunosuppression, which makes the patient vulnerable to opportunistic infections like fungal (candidiasis, cryptococcosis), viral (herpes, viral hepatitis), and bacterial (reactivation of latent tuberculosis) infections. 

Inhalational steroids can cause local irritation and fungal infection of the upper respiratory tract, which can be prevented by using a spacer and rinsing the mouth after inhalation.

11. Hypothalamic-pituitary-adrenal (HPA) Axis Suppression: The most dangerous side effect of long-term steroid therapy is HPA axis suppression. Long-term use of corticosteroids in large doses will decrease ACTH secretion through a negative effect on the hypothalamus and pituitary and gradually cause adrenal cortical atrophy. 

Hence, abrupt stoppage of glucocorticoid therapy following prolonged use leads to:

• Flaring up of the underlying disease being treated.
• Withdrawal symptoms like fever, myalgia, arthralgia, and malaise.
• Acute adrenal insufficiency on exposure to stress which manifests as anorexia, nausea, vomiting, abdominal pain, hypotension, dehydration, hyponatraemia, hyperkalaemia, etc.

Precautions for Corticosteroids

Necessary precautions to be taken during long-term steroid therapy to minimise HPA axis suppression are as follows:

1. Whenever possible, topical use is preferred.
2. Short or intermediate-acting steroids (e.g. hydrocortisone, prednisolone) should be preferred.
3. Use steroids as a single morning dose; if the daily dose is high, administer two-thirds of the dose in the morning and one-third in the evening, mimicking endogenous hormone levels and minimising the chances of HPA axis suppression. 
4. Try alternate-day steroid therapy in chronic conditions like bronchial asthma, nephrotic syndrome, and systemic lupus erythematosus (SLE).
5. Withdrawal of steroids after long-term ( more than 2 weeks) treatment should be slow to allow recovery of normal adrenocortical function. The doses of steroids should be tapered gradually and then stopped. 

Suppose a patient on long-term steroid therapy is exposed to stress-like infections and major surgery. In that case, the dose of steroids administered should be increased to combat stress (as adrenals will fail to increase glucocorticoid secretion on account of HPA axis suppression).

FAQs about Corticosteroids

1. What are corticosteroids used for?

Corticosteroids are medications used to treat inflammation, some autoimmune diseases, asthma, allergies, and certain skin conditions.

2. Are corticosteroids safe for long-term use?

There are many serious side effects from long-term use. Doctors typically recommend the lowest possible dose for the shortest period.

3. Can corticosteroids cause weight gain?

Yes, corticosteroid drugs can cause weight gain for many people because they cause fluid retention and increased appetite.

4. How do corticosteroids affect the immune system?

They decrease inflammation but increase the risk of infection while suppressing the immune system.

5. Are corticosteroids the same as anabolic steroids?

No, anabolic steroids increase muscle growth, but corticosteroids decrease inflammation.

6. Can I stop corticosteroids suddenly?

No, it is not advised to stop abruptly since you can experience withdrawal symptoms. Always taper off under medical guidance.

7. Do corticosteroids affect sleep?

Yes, they can cause insomnia, especially if taken in the afternoon or later.

8. Can corticosteroids be used during pregnancy?

Some may pose risks, but these are only prescribed if necessary. Consult a doctor before use.

Conclusion

Corticosteroid drugs significantly manage inflammatory and autoimmune diseases. Although they have significant benefits, they need to be used carefully to avoid side effects. Knowing how corticosteroids are used and taking precautions will help us take safe and effective treatment.DocTutorials offers in-depth medical courses and study notes for students preparing for medical exams like NEET PG 2025. Join Doctutorials and get expert insights to stay ahead!