a quick guide to steroids

A Quick Guide to Steroids

Corticosteroids (i.e., steroids) are synthetic versions of naturally-produced steroid hormones that have been used for decades to treat various inflammatory disorders. Depending on their regulation mechanism, steroids can be broadly classified as glucocorticoids, which regulate metabolism and inflammation, or mineralocorticoids, which regulate sodium and water levels. However, these two classes are not mutually-exclusive, as many compounds, such as hydrocortisone (cortisol), stimulate both glucocorticoid and mineralocorticoid receptors. In addition, steroids also work to suppress the body’s natural immune response, making them useful for treating conditions in which the body attacks its own tissues.

Administration routes

Steroids can be administered either systemically or locally, typically to reduce inflammation in different parts of the body. The choice of administration route depends on the disorder being treated and a specific patient’s needs (e.g., dose and duration). To mitigate the risks of side effects, prescribers should consider non-systemic administration routes when possible and locally apply these agents directly to the sites of inflammation (e.g., topical and inhaled administration routes). Local administration also helps ensure that the highest dose possible reaches the site of inflammation.

Indications

Steroids can be prescribed to treat a wide variety of inflammatory and immune-related conditions, as shown by the indications below. 

Allergies and Pulmonology

  • Inhaled formulations of steroids such as hydrocortisone are indicated to treat asthma.
  • To reduce eye inflammation due to allergies, an ophthalmic solution of dexamethasone can be applied. 

Dermatology

  • Short-term oral administration of low to moderate-potency corticosteroids such as prednisone can be used to treat severe eczema
  • Compounded topical steroids can be used to treat inflammatory papules, pustules, and erythema of rosacea.
  • A topical hydrocortisone cream can be applied to psoriasis patches to help alleviate symptoms and inflammation. 
  • Hair loss can be treated by the topical application of steroids such as fluocinolone and in conjunction with minoxidil, finasteride to help increase the thickness and fullness of hair.
  • Corticosteroids can be injected into a scar and may result in up to a 50% reduction in scar size.

Endocrinology

  • Congenital adrenal hyperplasia can be treated using glucocorticoid replacement therapy using hydrocortisone in children and adults.

Gastroenterology

  • Inflammatory bowel disease can be treated by administering oral steroids such as prednisone or budesonide.

Hematology

  • Prednisolone and dexamethasone tablets may be prescribed to treat leukemia or lymphoma or to decrease the severity of allergic reactions to chemotherapy. 

Rheumatology

  • Rheumatoid arthritis can be managed using the administration of low doses of prednisone, prednisolone, and hydrocortisone. For more severe flare-ups, prescribers should consider a short-term regimen of a higher dose. 

Ophthalmology

  • Ophthalmic compounding of steroids such as difluprednate ophthalmic can be performed to obtain formulations for treating conditions such as uveitis and post-operative ocular inflammation.

Other

  • Symptoms of multiple sclerosis can be managed by a short-term intravenous regimen of methylprednisolone or the oral administration of prednisone. 
  • Steroids can also help suppress the immune system, to help prevent the rejection of a transplanted organ.

Selecting the correct steroid

Before prescribing a steroid, prescribers should perform a potassium hydroxide test to ensure that the disease to be treated is not a fungal infection, which may be aggravated by the use of steroids. Each steroid comes in a variety of potencies and preparations (which is determined by both the steroid itself and its concentration), so it’s important to know which one to prescribe and the duration and frequency of application. Low-potency corticosteroids can be prescribed for children and mild diseases. Due to the risk of skin thinning associated with topical steroids, only low-potency steroids should be used on areas such as the face and groin. Medium- to high-potency corticosteroids can be used for most areas of the body. For treating severe diseases or in areas with thick skin, super-potent steroids can be used. Below, we have prepared a table to help prescribers select the appropriate steroid per indication. 

Note: We recommend using only the minimum duration necessary to treat the specified indication to avoid adverse effects, as noted in the next section. Often, the duration of use can be as short as 2 to 4 weeks or less.

steroid selection guide

Risks and considerations

As with any pharmaceutical, steroids also have risks whose likelihood increases with the dose and duration of therapy. The route of administration has been known to affect the type of adverse effect that patients may experience. Oral steroids may suppress the immune system, which can increase a patient’s risk of secondary infections. Inhaled steroids may induce gingival irritation and have systemic adverse effects, whereas topical formulations may result in skin thinning and color changes. Therefore, prescribers should carefully consider both the dose and duration when prescribing steroids—short-term, intermittent administration is typically recommended. The patient should generally be weaned off steroids by tapering the dose to allow the adrenal glands time to re-adapt after the cessation of corticosteroid therapy to help prevent adrenal insufficiency.

Why choose VLS Pharmacy?

As shown above, steroids may be administered by a variety of routes to meet a patient’s needs to help reduce inflammation associated with a variety of conditions. VLS Pharmacy and New Drug Loft will work with you to create a customized formulation with a dose and administration route tailor-made for your patient. As a 503A pharmacy specializing in sterile and non-sterile compounding, we will support you and your patients by creating safe, individualized, and effective pharmaceutical therapies. 

 

Reach out to our team to learn about best practices and to partner with our experts on custom compounded medications for your patients.  All medications from VLS Pharmacy and New Drug Loft are prepared in a lab that follows safety and quality standards per our status as a 503A pharmacy.

 

References

Auchus RJ. Management of the adult with congenital adrenal hyperplasia. Int J Pediatr Endocrinol. 2010;2010:614107. doi:10.1155/2010/614107

Curtis JR, Westfall AO, Allison J, et al. Population-based assessment of adverse events associated with long-term glucocorticoid use. Arthritis Rheum. 2006;55(3):420-426. doi:10.1002/ART.21984

Ericson-Neilsen W, Kaye AD. Steroids: pharmacology, complications, and practice delivery issues. Ochsner J. 2014;14(2):203-207.

Ference JD, Last AR. Choosing topical corticosteroids. Am Fam Physician. 2009;79(2):135-140.

Hodgens A, Sharman T. Corticosteroids. In: StatPearls. Treasure Island (FL): StatPearls Publishing; May 8, 2022.

Sloka JS, Stefanelli M. The mechanism of action of methylprednisolone in the treatment of multiple sclerosis. Multiple Sclerosis Journal. 2005;11(4):425-432. doi:10.1191/1352458505ms1190oa

Stacey SK, McEleney M. Topical Corticosteroids: Choice and Application. Am Fam Physician. 2021;103(6):337-343.

Whittle E, Falhammar H. Glucocorticoid Regimens in the Treatment of Congenital Adrenal Hyperplasia: A Systematic Review and Meta-Analysis. J Endocr Soc. 2019;3(6):1227-1245. Published 2019 Apr 18. doi:10.1210/js.2019-00136

Younes AK, Younes NK. Recovery of steroid induced adrenal insufficiency. Transl Pediatr. 2017;6(4):269-273. doi:10.21037/tp.2017.10.01

 


 

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