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Corticosteroid Therapy – Effects, Uses and Side Effects

Corticosteroid therapy is a medical treatment using corticosteroids to reduce inflammation and regulate the immune system in a wide range of conditions.

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Things worth knowing about "Corticosteroid Therapy"

Corticosteroid therapy is a medical treatment using corticosteroids to reduce inflammation and regulate the immune system in a wide range of conditions.

What is Corticosteroid Therapy?

Corticosteroid therapy refers to the therapeutic use of corticosteroids – synthetic derivatives of the natural steroid hormones produced by the adrenal cortex. These substances mimic the effects of endogenous hormones such as cortisol and specifically target inflammatory and immune processes. Corticosteroid therapy is one of the most widely used pharmaceutical treatments in modern medicine.

Mechanism of Action

Corticosteroids bind to specific intracellular receptors known as glucocorticoid receptors and influence gene expression within cells. This inhibits pro-inflammatory mediators such as cytokines, prostaglandins, and leukotrienes. At the same time, the activity of immune cells is suppressed, resulting in potent anti-inflammatory and immunosuppressive effects.

Indications – When is Corticosteroid Therapy Used?

Corticosteroid therapy is used in a wide variety of conditions, including:

Inflammatory diseases: e.g., rheumatoid arthritis, Crohn's disease, ulcerative colitis
Allergic reactions: e.g., severe allergic reactions, anaphylactic shock
Respiratory diseases: e.g., bronchial asthma, COPD exacerbations
Skin conditions: e.g., atopic dermatitis, psoriasis
Autoimmune diseases: e.g., systemic lupus erythematosus, multiple sclerosis (relapses)
Transplant medicine: prevention of organ rejection
Neurological conditions: e.g., cerebral oedema, spinal cord injuries
Oncology: as adjunct therapy in certain cancers

Forms of Administration and Dosage

Corticosteroids can be administered in several ways:

Systemic: orally (tablets) or intravenously (infusion) for severe or generalised conditions
Local/topical: as creams or ointments for skin conditions, nasal sprays for allergies, or inhalers for asthma
Intra-articular: direct injection into a joint for localised inflammation

Dosage depends on the type, severity, and duration of the condition. A fundamental distinction is made between short-term therapy (days to weeks) and long-term therapy (months to years). In long-term use, the lowest effective dose is generally recommended.

Commonly Used Corticosteroids

Among the most frequently prescribed corticosteroids are:

Prednisolone and Prednisone (oral, systemic)
Dexamethasone (systemic, especially for cerebral oedema and in oncology)
Hydrocortisone (equivalent to endogenous cortisol; used in adrenal insufficiency)
Budesonide and Beclomethasone (inhaled for asthma)
Betamethasone and Mometasone (topical for skin disorders)

Side Effects

When used short-term, corticosteroids are generally well tolerated. However, prolonged or high-dose use can lead to numerous side effects, including:

Weight gain and redistribution of body fat (central obesity, moon face)
Osteoporosis (loss of bone density)
Diabetes mellitus (elevated blood sugar, known as steroid-induced diabetes)
High blood pressure
Increased susceptibility to infections due to immunosuppression
Peptic ulcers (especially when combined with NSAIDs)
Skin atrophy (thinning of the skin with topical use)
Cataracts and glaucoma
Psychological changes: mood swings, sleep disturbances, and rarely steroid-induced psychosis
Adrenal insufficiency upon abrupt discontinuation after long-term therapy

Important Notes on Discontinuation

After prolonged corticosteroid therapy, the medication must not be stopped abruptly. The dose must be gradually reduced (known as tapering), as the body's own cortisol production is suppressed during treatment. Sudden discontinuation can trigger a life-threatening adrenal crisis.

Contraindications and Precautions

Corticosteroids should be used with caution or avoided in patients with:

Active infections (e.g., untreated tuberculosis, systemic fungal infections)
Existing peptic ulcers
Poorly controlled diabetes mellitus
Severe osteoporosis
Certain psychiatric conditions

During pregnancy, a careful benefit-risk assessment is required. Topical corticosteroid use in infants and young children should only occur under medical supervision.

References

Buttgereit F. et al. – Standardised nomenclature for glucocorticoid dosages and glucocorticoid treatment regimens. Annals of the Rheumatic Diseases, 2002; 61(8): 718–722.
Strehl C. et al. – Defining conditions where long-term glucocorticoid treatment has an acceptably low level of harm to facilitate implementation of existing recommendations. Annals of the Rheumatic Diseases, 2016; 75(6): 952–957.
National Institutes of Health (NIH) – MedlinePlus: Corticosteroids. Available at: https://medlineplus.gov/corticosteroids.html

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