Introduction
Corticosteroids are a class of steroid hormones that are widely used in clinical practice due to their potent anti-inflammatory, immunosuppressive, and anti-allergic properties. They are synthetic analogues of hormones produced by the adrenal cortex and are commonly prescribed in the management of inflammatory, autoimmune, allergic, and endocrine disorders.
Classification of Corticosteroids
Corticosteroids are broadly classified into:
1. Glucocorticoids
These have predominant anti-inflammatory and immunosuppressive effects.
Examples include:
-Hydrocortisone.
-Prednisolone.
-Dexamethasone.
-Betamethasone.
In clinical practice, glucocorticoids are more commonly used.
2. Mineralocorticoids
These regulate electrolyte and water balance.
Example:
Fludrocortisone
Mechanism of Action
Corticosteroids exert their effects by penetrating the cell membrane and binding to intracellular glucocorticoid receptors. The drug-receptor complex then translocates into the nucleus, where it alters gene transcription.
This results in:
a. Inhibition of pro inflammatory mediators (prostaglandins, leukotrienes, cytokines)
b. Reduced migration of inflammatory cells
c. Suppression of immune response
d. Stabilization of lysosomal membranes
Therapeutic Uses of Corticosteroids
Corticosteroids are indicated in a wide range of clinical conditions:
1. Inflammatory and Autoimmune Disorders
Rheumatoid arthritis
Systemic lupus erythematosus
2. Allergic Conditions
Asthma
Allergic rhinitis
Severe allergic reactions
3. Dermatological Conditions
Eczema
Psoriasis
Contact dermatitis
4. Respiratory Disorders
Acute asthma exacerbations
Chronic obstructive pulmonary disease (COPD)
5. Endocrine Disorders
Adrenal insufficiency (replacement therapy)
6. Oncology and Transplant Medicine
Prevention of organ rejection
Adjunct therapy in some malignancies
Adverse Effects and Safety Concerns
The adverse effects of corticosteroids are dose and duration dependent.
Short term Adverse Effects
Increased blood glucose levels
Fluid retention and hypertension
Mood changes
Gastric irritation
2. Long term Adverse Effects (usually >2–3 weeks of systemic therapy) can result in significant adverse effects:
1. Endocrine Effects
Adrenal suppression
Cushing’s syndrome (moon face, weight gain)
Hyperglycaemia and steroid-induced diabetes
2. Musculoskeletal Effects
Osteoporosis
Muscle wasting
Growth retardation in children
Increased risk of fractures
3. Immune System Effects
Immunosuppression
Increased susceptibility to infections
Poor wound healing
4. Cardiovascular Effects
Hypertension
Fluid retention
Increased risk of cardiovascular disease
5. Gastrointestinal Effects
Peptic ulcer disease
Gastrointestinal bleeding (especially with NSAIDs)
6. Dermatological Effects
Skin thinning
Acne
Striae
Delayed wound healing
7. Neuropsychiatric Effects
Mood swings
Insomnia
Depression or psychosis (rare)
Drug Interactions
•NSAIDs: Increased risk of gastrointestinal bleeding
•Antidiabetic drugs: Reduced glycaemic control
•Vaccines: Reduced immune response to live vaccines
Counseling Points and Monitoring
Steriods should be used only on medical prescriptions.
Long term corticosteroids should not be stopped abruptly to prevent adrenal crisis
Lowest effective dose should be used for the shortest duration
Patients should be monitored for blood pressure, blood glucose, bone health and signs of infection
Topical steroids should be used appropriately to avoid skin thinning
