Oral Treatment With Corticosteroids

This leaflet has been written to help you understand more about oral treatment with corticosteroids. It tells you what it is, what it is used for, what its effects are, and where you can find out more about it. 

Oral treatment with corticosteroids is also known as ‘oral cortisone therapy’ or ‘systemic steroid therapy.’ The word ‘oral’ means that the steroids are taken by mouth, usually in tablet or liquid form. Corticosteroids (also known as steroids) are chemicals (hormones) that occur naturally in the body. They have numerous roles in the body, which include decreasing inflammation and suppressing the body’s immune system. 

Corticosteroid medicines are man-made but are similar to these natural hormones. Corticosteroids are produced in the cortex (outer layer) of the adrenal glands (hence the ‘cortico-’ part of the name). The corticosteroids used most often in medical treatment, prednisolone and dexamethasone, are not the same as those produced in the body. It is convenient to refer to them just as ‘corticosteroids’ or ‘steroids,’ but you should be aware that they are different from the type of steroids (anabolic steroids) used for bodybuilding.

Corticosteroids treat many skin disorders. They reduce inflammation and can help to clear a rash, or at least help to control it. They are commonly used for various blistering skin conditions, ‘autoimmune’ diseases such as lupus, inflammatory conditions of skin blood vessels (vasculitis), other skin problems such as sarcoidosis, etc. short-term treatment for severe eczema or lichen planus. 

Before starting oral corticosteroids, your doctor will balance the potential benefits of treatment to your skin condition against the risk of side effects. The dose of a corticosteroid will be adjusted to reduce the risk of side effects. At first, a high dose may be needed to bring your skin condition under control; the dose will then be reduced slowly and, when appropriate, stopped.

If you have been taking the tablets for more than three weeks, it is crucial NOT to stop the medication suddenly. Your body may have stopped making its own corticosteroids, becoming dependent on the tablets for its daily requirement. 

They must be phased out gradually under the instructions of your doctor. If you develop a new illness (e.g., a chest infection) within a week of finishing a short course of corticosteroid tablets (3 weeks or less), you may need to restart treatment temporarily. This treatment helps your body cope with the extra physical stress caused by the illness and should be guided by your doctor.

When taken for extended periods (more than 2-3 months), corticosteroids can cause a range of side effects; the higher the dose and the longer the course, the greater the chances of side effects. They will be discussed with you, and you will be monitored for them while receiving treatment.

Possible side effects include the following :  

• Fluid retention, e.g., swollen ankles
• Increased appetite and weight gain.
• High blood pressure (hypertension).
• Raised blood sugar or worsening of pre-existing diabetes.
• Indigestion, or worsening of a peptic ulcer.

Inform your doctor if you∙ develop abdominal pain.  Changes in mood, sleep disturbance, and insomnia – inform your doctor if this occurs, or if you have had previous problems with your mental health.  Increased risk of infection.

You should inform your doctor if you have had tuberculosis in the past. If you have not had chickenpox in the past, then you should seek medical advice if you come into close contact with someone who has an active chickenpox infection while you are taking corticosteroids.  Thinning or softening of the bones (osteoporosis).

Skin – impaired healing of cuts, risk of stretch marks, skin thinning,∙ bruising, increased growth of facial hair, acne. 

Muscle and tendon weakness.∙  Joint pain, particularly in the hip, maybe due to damage to an area of bone.

This is a very rare side-effect known as ‘avascular necrosis.’ 

Cataracts, glaucoma, and other eye conditions. You should inform your doctor if you develop any change in your vision. 

The risks of these side effects must be balanced against the benefits of treatment for your skin condition.

These side effects are implausible to occur if you are taking the treatment for a short period only.  If they do occur, most of these side effects, such as high blood pressure, can be treated.  In some instances, it is best to use preventative treatment to reduce the chance of side-effects such as osteoporosis.

A healthy diet and regular exercise will help to protect the bones. Also, tablets are known as bisphosphonates, together with calcium and vitamin D, which may be recommended by your doctor if the corticosteroid treatment lasts for more than three weeks. 

The primary way to avoid side effects is by using the lowest effective dose. In some of the conditions treated with corticosteroids, a ‘steroid-sparing effect’ can be achieved by adding other tablets that affect the immune system such as azathioprine, methotrexate, dapsone, mycophenolate mofetil, cyclophosphamide, or ciclosporin.

The potential benefits and drawbacks of adding an immunosuppressive steroid-sparing medication to long-term corticosteroid treatment will be discussed with you by your doctor. 

Oral corticosteroids and vaccinations ‘Live’ vaccines are not recommended while taking oral corticosteroids.These include:  polio (oral drops only, the injections are safe)∙  mumps∙  measles∙  German measles (rubella)∙  oral typhoid∙  BCG∙  varicella-zoster (chickenpox)∙  yellow fever∙

Oral corticosteroids are only recommended in pregnancy if the potential benefits outweigh the risks. High doses or long-term use may affect the unborn baby’s growth. You can usually take oral corticosteroids while you are breastfeeding. However, small amounts can pass into breast milk. If you are taking a high dose of corticosteroid, the baby may need to be monitored for side effects.

If you are on long-term corticosteroid treatment, you should carry a steroid card or wear a medical alert bracelet or necklace. If you become unconscious (for example, after a road traffic accident) and needed to go to the hospital, the emergency team would be made aware that your treatment would need to continue, and the dose might even have to be increased temporarily. 

Remember that for courses longer than three weeks, it is dangerous to stop the corticosteroid tablets suddenly (see above), and you should never do this without discussion with your doctor or pharmacist.  If you have diabetes, you may need to check your blood sugar (glucose) more frequently, as corticosteroid tablets may affect the levels of sugar in your blood. 

Your doctor will be able to advise you about this.  If you buy any medicines or herbal remedies, check with your pharmacist that they are suitable for you to take with corticosteroids. Some anti-inflammatory painkillers (such as ibuprofen) can increase the risk of side-effects and may not be appropriate. 

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking corticosteroids.  Have an annual preventive vaccination against influenza (‘flu’) at your GPs surgery.  If you have any worries or concerns, please do not hesitate to ask your doctor.