What are they used for?
Systemic steroids have strong anti-inflammatory effects so they can be used in many injuries or conditions that cause inflammation.
In high doses, oral and intravenous steroids can supress the immune system so they are useful in diseases that are due to an overactive immune system.
Steroids can be used for the prevention of nausea during chemotherapy, prevention of organ rejection after organ transplantation and replacement of the body’s natural cortisol hormone when this is in low levels.
Steroids can be used short term to gain control of severe diseases including certain skin conditions and, in this setting, may be lifesaving. Steroids can be used longer term to maintain control of severe diseases.
Systemic steroids that are commonly used in Australia include prednisone, prednisolone, methylprednisolone, dexamethasone and hydrocortisone.
Systemic steroids can be used for skin conditions such as:
- Severe eczema
- Severe hand dermatitis
- Lichen planus
- Bullous pemphigoid
- Lupus erythematosus
Systemic steroids may worsen some skin conditions including:
What precautions should you take with systemic steroids?
Systemic steroids are prescribed for more severe skin conditions and close monitoring by a dermatologist or general practitioner is necessary. The dose will often need to be adjusted to achieve good results.
The medication is usually taken in the morning as this follows the body’s natural hormone levels and is less likely to affect sleep patterns.
It is necessary to reduce the dose gradually before stopping treatment with systemic steroids except in cases when a very short course of treatment has been used. Stopping the medication suddenly can lead to worsening of the skin condition. It can also result in a deficiency of natural cortisol as it takes the body some time to take over production of this hormone when systemic steroids have been used for more than three weeks.
Systemic steroids may worsen high blood pressure, diabetes, stomach ulcers and infections. It is important to let your doctor know if you have these conditions. With longer-term use, steroids can worsen or cause osteoporosis. You can protect your bones by undertaking weight-bearing exercise, having an adequate amount of calcium in your diet and, if necessary, a vitamin D supplement. Your doctor can advise you about these measures and may recommend a medication in the bisphosphonate group to help your bones further.
You should let your doctor know if you are pregnant or breastfeeding.
You may need to avoid vaccination with live vaccines while taking systemic steroids.
What monitoring is required?
With longer courses of systemic steroids, it is often necessary to check blood sugar levels and to monitor body weight and blood pressure. It may be necessary to check bone density also.
What to expect when using systemic steroids and potential side effects:
Short courses of treatment are usually not associated with serious side effects.
Common milder side effects include:
- tummy upset
- increased appetite and weight gain
- mood changes
- trouble sleeping.
Rare serious side effects include:
- stomach ulcer
- severe mood changes
- avascular necrosis of the hip
All of these side effects are more likely to occur with higher doses and longer courses of treatment (ie more than 4 weeks).
Other side effects that can be seen with longer courses include:
- effects on the eyes including glaucoma and cataract
- muscle weakness and osteoporosis
- irregular periods
- high blood pressure
- high blood sugar
- skin thinning and easy tearing and bruising of the skin
- growth problems in children.
For a full list of known side effects, please refer to the product information leaflet provided with the medication.
This information has been written by Dr Jenny Byth