Corticosteroids are synthetic drugs that closely resemble cortisol, a hormone which the body produces naturally. They work by reducing inflammation and the activity of the immune system. They are used to treat a variety of inflammatory diseases and conditions.
Steroids reduce the production of inflammatory chemicals to help minimise tissue damage. They also reduce the activity of the immune system by affecting the function of white blood cells.
Examples of corticosteroid medications include cortisone, prednisolone and methylprednisolone. However, they should not be confused with anabolic steroids, which are a different group of drugs used by some athletes – especially bodybuilders - to build bigger muscles. Steroids can be given orally or by injection. Depending on the site of the inflammation, they can be injected into a vein or muscle, directly into a joint or bursa (the lubricating sac between certain tendons and the bones beneath them) or around tendons and other soft tissue areas.
In general, oral steroids such as prednisolone, are not used in the treatment of psoriasis. In low doses, steroid tablets may occasionally provide relief from pain and stiffness for people with psoriatic arthritis. Temporary use of higher doses of steroids may also help a person recover from a severe flare-up of the condition.
The occurrence of side effects depends on the dose, type of steroid and duration of treatment. Side effects are much more common with oral medications since they travel around the whole body in the blood stream after being digested through the stomach. Some side effects are more serious than others. Common side effects of steroids include:
- Skin conditions similar to acne
- Blurred vision
- Cataracts or glaucoma
- An increased tendency for the skin to bruise
- High blood pressure
- Increased appetite & weight gain
- Increased growth of body hair
- Lower resistance to infection
- Muscle weakness
- Nervousness, restlessness
- Stomach irritation
- Sudden mood swings
- Swollen, puffy face
- Water retention, swelling
- Worsening of diabetes
Steroid injections are not used in the skin manifestations of psoriasis but may be recommended to reduce joint inflammation and pain from psoriatic arthritis, tendonitis or bursitis. These injections can be targeted at specific points in the joints or tendons to achieve maximum benefit and are usually combined with anti-inflammatory painkiller medications and physiotherapy. If effective, these injections may be repeated every 3-6 months. As long as steroid injections are used infrequently, side effects are very uncommon. In rare instances, the following may occur:
- Allergic reactions
- Bleeding into the joint
- Rupture of a tendon
- Skin discoloration
- Weakening of bone, ligaments and tendons (from excessively frequent, repeated injections into the same area)
To minimize the side effects of steroids, doctors follow these guidelines:
- They prescribe steroids only when necessary.
- They restrict the use of oral steroids to a minimum.
- They use injected steroids only for the management of psoriatic arthritis.
- They monitor the patient closely to detect the development of serious side effects.
- They use the minimum dose necessary to gain control of the disease.
- They will reduce the dose gradually as long as the disease remains under control.
- They will monitor blood pressure often and treat if necessary.
- They may prescribe calcium supplements to help maintain bone density.
Steroids, as with other medications, are not recommended for everyone. In general, people with the following conditions should not take steroids:
- Uncontrolled diabetes
- Uncontrolled high blood pressure or congestive heart failure
- Peptic ulcer
The decision to prescribe steroids is always made on an individual basis. Your doctor will consider your age, your overall health and other medications you are taking. Your doctor also will make sure you understand the potential benefits and risks of steroids before you start taking them.
Current available Corticosteroids