Guide To The Side Effects Of Steroids

Steroids, also known as corticosteroids, are medications that reduce inflammation and suppress the immune system. Physicians may prescribe these drugs as part of a treatment plan for conditions such as allergies, asthma, rheumatoid arthritis, chronic obstructive pulmonary disease, and inflammatory bowel diseases. Depending on the condition to be treated, steroids may be prescribed as topical creams or oral tablets, and they might also be given as injections. Patients taking oral corticosteroids will normally need to take these in the morning, and taking them with food is suggested. To reduce the risk of potential side effects, doctors normally prescribe corticosteroids for no more than two to three weeks. Corticosteroids need to be prescribed and used with caution if a patient has a history of epilepsy, liver problems, high blood pressure, cardiovascular disease, cataracts, or diabetes.

Patients should always check with their healthcare team about any worrying side effects that occur while they are using a corticosteroid. The most common side effects that could develop with longer-term corticosteroid use are discussed below.

Weight Gain

Corticosteroid use alters the body's metabolism and how body fat is stored. Patients taking these drugs experience an increase in appetite, and weight gain is very common. Generally, most of the weight gained while taking corticosteroids is gained around the abdomen, and individuals might also notice puffiness around the face. Anecdotal evidence suggests some patients might have unusual food cravings for foods they don't normally like, and frequent episodes of nighttime eating have been reported. Doctors recommend patients follow a heart-healthy diet and engage in regular exercise while taking corticosteroids, and having only healthy foods in the house could help reduce weight gain associated with cravings and nighttime eating. Any weight gain experienced with this medicine is usually temporary, and most patients find that their waist size and weight return to normal within six to twelve months after discontinuing the medication.

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Insomnia

When used for a month or longer, oral corticosteroids may cause insomnia. In particular, patients may notice they have trouble falling asleep, and this is often worse if the medication is taken in the evening. To reduce the chance of developing insomnia, patients should ask their physician about the possibility of taking their entire daily dose in the morning. In addition, it can help to establish a regular bedtime and relaxing pre-sleep routine. Patients should ensure their bedroom is cool and dark, and they should turn off mobile phones and televisions at least one to three hours before bedtime. Taking a warm bath and engaging in relaxing activities such as reading a book, listening to nature sounds, or meditating during the thirty minutes before bedtime could improve sleep quality and reduce the amount of time it takes to fall asleep. Patients may find it helpful to track their sleep using a fitness tracker, and keeping a sleep journal could also be beneficial. If necessary, doctors can prescribe medications that make sleeping easier for patients who need to take corticosteroids.

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Mood Swings

Although mood swings can happen to any patient who uses a corticosteroid, patients prescribed a daily corticosteroid dose of thirty milligrams or more are at an increased risk of experiencing this side effect. Mood swings caused by corticosteroids typically begin within a few weeks of starting the medication, and the symptoms vary from person to person. For example, some patients report feeling euphoric, and others feel very depressed. It is also common for individuals to alternate between depression and periods of feeling very happy. Confusion, anxiety, irritability, delusions, and suicidal thoughts have been reported in patients who take this drug. Patients should let their family members and friends know they are using corticosteroids, and they should also mention mood changes are a potential side effect of the treatment. With this knowledge, family and friends can help the patient identify when the mood and behavioral changes are occurring, and they can take action as necessary. Patients experiencing troublesome mood changes may want to speak with their healthcare team about adding medications that could help with mood stabilization.

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Thinning Skin

Both oral and topical corticosteroids can cause thinning skin, especially when used for a prolonged period. Thinning skin is naturally more fragile, and patients could experience bruising after minor bumps that would not normally cause any skin changes. It may take longer than usual for cuts and scrapes to heal, and some individuals have developed stretch marks. During treatment with corticosteroids, patients will need to carefully monitor their skin for any changes, and it is important to take steps to protect thinner skin from damage. Any cuts and scrapes should be promptly cleaned, and antibiotic cream should be applied to prevent infection. Wounds need to be covered with a bandage. Wearing long sleeves or heavier fabrics could help reduce the potential for bruising. Individuals who notice stretchmarks might want to speak with a dermatologist about ways to minimize and treat these.

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Bone Loss

Bone loss and osteoporosis are most likely to occur in individuals placed on oral corticosteroids for an extended period. After six months of treatment with corticosteroids, patients could lose as much as ten to twenty percent of their bone density. Doctors will typically request that the patient has a bone density scan before beginning high-dose corticosteroid treatment. The scans should be repeated at least once a year, and the results can be compared to prior scans to determine how much bone is being lost. To strengthen bones and prevent bone loss, patients taking corticosteroids are generally asked to take calcium and vitamin D supplements, and prescription medications such as raloxifene, calcitonin, and risedronate may be appropriate for improving bone health. Patients are encouraged to do weight-bearing exercises such as walking, dancing, and running to stabilize their bone mass. Patients concerned about their bone density may want to ask their doctor about newer injectable medications that can strengthen bones.

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Allergic Reactions

Patients who take steroids could experience allergic reactions associated with this medication. Although relatively rare, symptoms of a systemic allergic reaction to oral or injected steroids could include rapid heart rate, facial swelling, confusion, fever, and a skin rash with blisters. These are symptoms of an immediate systemic allergic reaction, and they typically start within thirty to sixty minutes of taking the steroid. This type of reaction is potentially life-threatening, and patients should be taken to an emergency room.

A less severe type of systemic reaction could develop up to two days after steroid administration, and this is known as a non-immediate systemic reaction. Patients with this type of reaction typically have hives, and a widespread rash could also occur. Patients who use topical steroids could also have an allergic reaction that involves a mild rash. These types of reactions occur in around six percent of individuals who use topical steroids. To diagnose allergic reactions, physicians often order a patch test, a RAST test, and a drug challenge. These tests can help doctors determine which drugs may be safe for the patient. Patients who have severe systemic reactions will be given supportive care in the emergency room to aid breathing and reduce heart rate, and individuals with other types of reactions will typically be closely monitored at regular follow-up appointments.

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Skin Discoloration

Steroids may cause several types of skin discoloration. Patients who use topical steroids might notice the formation of red skin lesions or rashes, and these could be itchy. After an injection of corticosteroids, some individuals may have facial flushing and a loss of color in the skin; these symptoms are part of what is known as a post-injection flare. Topical, oral, and injected corticosteroids may cause thinning of the skin, and the risk of this side effect increases if the drugs are used over a long period. Thinner skin could make any existing skin issue more noticeable, and veins might appear more prominent. To reduce the risk of skin discoloration and thinning skin, doctors limit the use of steroid injections to three to four injections per year for each patient. Topical steroids are used whenever possible since these are less likely to cause side effects, and doctors use the lowest potency of steroid that is appropriate for the patient's needs. Patients should monitor their skin closely while taking steroids, and any skin changes such as discoloration or rashes should be reported to the prescribing physician.

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Easy Bruising

Easy bruising is most common with long-term use of oral corticosteroids. Patients might notice they have bruises after bumping themselves on a counter or table, and they may not even remember what caused the bruises to appear. Bruises occur when there is bleeding underneath the skin, and they need to be monitored closely. Patients might want to photograph their bruises to keep track of how long it takes for them to heal, and any large or painful bruises should be examined by a doctor. To reduce easy bruising, precautions should be taken when doing household chores, and patients will need to be especially careful when using any sharp objects or tools for yard work. Patients should talk to their doctor about whether they need to avoid or modify any of their physical fitness activities. In some cases, it may be advisable to avoid contact sports, as the hits and potential falls could lead to significant bruising.

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Blurred Vision

Blurred vision could develop in patients who take oral steroids. In the short term, patients might have elevated eye pressure, a condition known as glaucoma. This condition can cause hazy and blurry vision in the later stages, and patients might also see colored circles when looking at bright lights. If left untreated, this condition can lead to blindness. Medications can be given to reduce eye pressure, and surgery may be needed to remove accumulated fluid. This can be done with conventional methods or laser-assisted devices. Patients who take oral steroids long-term are at risk of developing cataracts. These occur when the lens of the eye becomes cloudy, and this can trigger blurred vision, double vision, sensitivity to light, and eye pain. Surgery is the only way to remove cataracts, and this involves replacing the cloudy lens with an artificial one. Patients on corticosteroids should see an eye doctor at least once a year for a complete eye examination, and individuals with certain underlying conditions may need to have an examination more frequently. Patients who notice any changes in their vision should see an eye doctor urgently.

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Acne

Topical steroid use could trigger or worsen acne for some individuals. Acne caused by steroids typically develops on the chest, and it might also appear on the patient's back, arms, neck, or face. Red, painful lumps known as nodules could form, and patients might notice cyst-like swellings called pseudocysts. Pustules (white or yellow spots) may be present as well. If patients scratch or pick at acne, the skin at the site of recently healed spots could darken, and scars may form. The treatment for acne caused by corticosteroids usually includes topical treatments. In addition, oral antibiotics such as tetracycline and doxycycline are given to patients with severe acne from steroids and to those who have acne scars from the steroids. It may take four to eight weeks of antibiotic use for the skin to heal, and some patients need to continue taking antibiotics for three to six months.