Corticosteroids are a group of anti-inflammatory drugs similar to hormones produced by the body. They are used to treat a variety of skin conditions, including eczema, urticaria, keloids, pruritus, lichen sclerosus and psoriasis. Corticosteroids are also particularly effective in treating rashes caused by allergies or inflammatory reactions to poison ivy, metals, cloth or other substances.

Corticosteroids can be taken in several forms, with each of the different forms used to treat different conditions. These forms include:

• Topical treatments. Used to treat inflammation of the skin (e.g., eczema, rash).
  
  
• Oral methods (e.g., pills, liquids). Used to quickly treat allergy and asthma episodes (e.g., allergic reaction, asthma attack). They may also be used to treat some skin conditions.  
  
  
• Intravenous (I.V.) methods. Used to quickly treat allergy and asthma episodes, and usually administered by a physician. They may also be used to treat some skin conditions. 

Most corticosteroids are available only with a physician’s prescription. However, some low potency topical creams are available over-the-counter.

Corticosteroids can have a wide range of serious side effects, including a loss of bone density. Some of these side effects may affect the skin. For example, prolonged use of potent corticosteroids may cause thinning of the skin. This is particularly true in some areas of the body (such as the face) and in some populations (such as children and the elderly).  Many medications can interfere with corticosteroids, and these drugs should be used only after talking with a physician.

Corticosteroids are a type of anti-inflammatory medication that is effective in the treatment and prevention of many health problems, including skin disorders. Though there are several types of corticosteroids, all work on the same principal – reducing or preventing inflammation.

Corticosteroids can be administered through several different methods. These include:

• Topical treatments (lotions, creams, ointments and gels). Medication is applied directly to the skin to treat that skin area.
  
  
• Oral methods (e.g., pills, liquids). Medication is swallowed and absorbed into the bloodstream where it spreads throughout the body.
  
  
• Intravenous (I.V.) methods. Medication is injected under the skin through a needle and syringe. It enters the bloodstream and spreads throughout the body.

Corticosteroids work by mimicking the hormone cortisol, which the adrenal gland naturally produces to protect the body against illness. It is unclear how exactly corticosteroids are able to so effectively reduce inflammation, but studies have shown that the medications lower the amount of chemicals released by some inflammatory cells. This leads to decreased swelling in inflamed areas.

Topical corticosteroids are the type of corticosteroid medication most often prescribed to treat skin conditions. Ointments and creams are among the most effective means of delivering corticosteroids. In some cases, other methods may be used to enhance the effect of these medications. For example, a thin plastic film is sometimes used to cover a topical corticosteroid and enhance the absorption of the medication. This method, called an occlusive dressing, may be used to treat stubborn cases of psoriasis and severe eczema.

Patients should use corticosteroids only to treat specific conditions exactly as recommended by their physician. Corticosteroids are not used to treat all skin conditions. For example, topical corticosteroids should not be used to treat bacterial, viral or fungal skin infections.

Individuals are advised to never stop taking a corticosteroid treatment abruptly as serious side effects can result. A physician can provide a schedule for safely discontinuing the use of corticosteroids.

Corticosteroids are available in different formulations and by different delivery methods. Some of the more commonly used corticosteroids include:

Corticosteroid drugs are prescribed for a variety of skin conditions. They are particularly effective in treating rashes caused by allergies or inflammatory reactions to poison ivy, metals, cloth or other substances. Specific skin conditions that may be effectively treated with corticosteroids include:

• Atopic dermatitis (eczema). Skin condition usually characterized by itching and a red, raised rash. Topical corticosteroid creams are often used to treat the rashes experienced with this condition. In some cases, limited use of oral corticosteroids also may be recommended.
  
  

  

• Contact dermatitis. A localized rash or skin inflammation caused by direct contact with an allergen (substance that triggers an exaggerated immune system response) or irritant. Topical corticosteroid creams are often used to treat the rashes experienced with this condition. If the rash covers a large portion of the skin or is severe, a physician may prescribe corticosteroid pills or injections.
  
  
• Chronic idiopathic urticaria. Condition in which wheals and flare lesions of the skin last at least six weeks. Oral corticosteroids may be used to treat this condition.
  
  
• Keloids. Scar tissue that grows beyond what is needed to heal a wound, forming a benign tumor-like growth. Patients who have a history of keloids may be able to prevent these scars from forming after surgery if corticosteroid solutions are injected into or applied on top of the scar as it forms. This can inhibit keloid formation, reduce pain or cause a forming keloid to shrink.
  
  
• Lichen sclerosus. Skin eruption characterized by flat, angular, pea-sized bumps or white-pink thin, itchy skin. It is especially common around the genital and anal areas. Topical corticosteroid creams can relieve symptoms and slow the course of the disease, particularly if given early in the disease’s progression.
  
  
• Lichen planus. A skin condition characterized by angular, purple bumps (papules) that are inflammatory and itchy. Topical corticosteroids are frequently prescribed to reduce inflammation and suppress immune and allergic reactions. They may also be injected directly into the lesions to ease itching. For severe cases, systemic corticosteroids may be used.
  
  
• Pruritus. A disorder in which an unpleasant sensation causes the patient to scratch excessively, potentially leading to a secondary skin infection. Mild topical corticosteroids may be used to treat this condition.
  
  
• Psoriasis. Common skin disease marked by raised, inflamed lesions that join together to form plaques with distinct borders and are covered with flaky scales. Topical corticosteroids may be used to treat this condition.
  
  
• Shingles. An infection caused by a virus, which leads to a painful rash. This virus, varicella-zoster, also causes chickenpox which can re-activate years later in the form of shingles. Oral corticosteroids are sometimes used to treat shingles that does not resolve on its own or with other treatments. They may be used in conjunction with antivirals to reduce pain as well as post herpetic neuralgia (chronic pain that occurs after one has shingles).
  
  
• Alopecia areata. An autoimmune disease that causes hair loss. Corticosteroids may be administered orally, topically or through local injection.  
  
  
• Pemphigus. An immune system disorder that causes blisters to form on a person’s skin or mucous membranes (the tissue that lines body cavities). Mild cases are usually treated with corticosteroids.
  
  
• Pemphigoid. This autoimmune disorder is similar to pemphigus, but is less severe and produces blisters that are shallower than pemphigus. Oral steroids may be used to treat severe cases.

Corticosteroid drugs also are prescribed to treat numerous other conditions associated with inflammation (e.g., other allergies, asthma, certain forms of arthritis).

Patients should not take corticosteroid drugs if they have been diagnosed with any of the following conditions:

• Chickenpox or measles. Contagious skin diseases that can spread to other parts of the body and cause a severe condition when using corticosteroids.
  
  
• High blood pressure (hypertension). Corticosteroids can exacerbate this condition by causing the body to retain extra water. Individuals with a weak heart (weakened heart muscle) or heart disease should also refrain from using some types of corticosteroids, which can worsen these conditions.
  
  
• High cholesterol. Corticosteroids can increase blood cholesterol levels.
  
  
• Diabetes mellitus (sugar diabetes). Usually from an inadequate secretion of insulin by the pancreas. Some types of corticosteroids affect blood sugar control.
  
  
• Osteoporosis. Condition that occurs when bone mass is not replaced as fast as it is lost. High doses of corticosteroids can cause this condition to worsen in women who are past menopause and not receiving estrogen treatments.
  
  
• Glaucoma. Eye disease characterized by increased pressure inside the eyeball. Corticosteroids can cause the pressure in the eye to further increase.
  
  
• AIDS (Acquired Immunodeficiency Syndrome). Viral disease that weakens the immune system. Corticosteroids can interfere with the treatment of this condition.
  
  
• Kidney disease or kidney stones. Treatment of these conditions (particularly dialysis) can be disrupted by the excess water retention common when using corticosteroids.
  
  
• Liver disease. Corticosteroids may not be eliminated from the body at the usual rate when used with this condition.
  
  
• Psychosis. This mental disorder can be made worse by using corticosteroids.
  
  
• Tuberculosis. Infectious bacterial disease. Corticosteroid use can cause infections to return in individuals with a history of tuberculosis.
  
  
• Cushing's disease. A disease caused by elevated levels of the hormone cortisol.

In addition, any active viral, bacterial or fungal infection is a possible contraindication.

When used safely, topical corticosteroids can be effective in treating various skin disorders. However, high dosage levels of topical corticosteroids can cause serious side effects. Long-term treatment with corticosteroids (more than three months) also increases the risk for side effects. Potential side effects include:

• Adverse effects in the skin and eyes. Long-term exposure to topical corticosteroids can result in thinning of the skin, permanent stretch marks in folds, such as in the armpits and behind the knees, swelling of tiny blood vessels beneath the skin surface (particularly in the face), slow healing of wounds and diminishing skin color (hypopigmentation). Cataracts (condition in which the lens of the eye becomes cloudy) and glaucoma (a disease in which fluid pressure slowly rises in the eye, often resulting in vision loss) may also result.
  
  
• Hypothalamic pituitary adrenal axis suppression. High levels of corticosteroids that are absorbed into the bloodstream can reduce the function of the adrenal glands, which produce the body’s natural steroid hormones. This condition can be life-threatening and lead to conditions such as Cushing’s syndrome, a disease characterized by obesity, weakened bones and muscles and thinning of the skin.
  
  
• Growth suppression. Long-term exposure to topical corticosteroids can result in slowed body growth and development, particularly in children.

Some patients who use topical corticosteroids on their face for long periods of time are at risk for developing a condition called steroid-induced rosacea. Symptoms are similar to those of standard rosacea – redness, pimples and thin, wavy red lines – but appear wherever the corticosteroid cream was applied. In some cases, oral or inhaled corticosteroids can also cause this effect. People with steroid-induced rosacea often have facial skin with a distinctive shine. Medications used to treat standard rosacea may be effective in treating steroid-induced rosacea.

Other common side effects of corticosteroids include:

• Topical corticosteroids:
  
  
• • Skin thinning (atrophy) resulting in an increased chance of bruising
  • Increased skin sensitivity
  • Itching or burning skin
  • Numbness in the fingers
  • Raised red spots on the skin
  • Skin blisters filled with blood
  • Stretch marks
    
    
• Oral and intravenous corticosteroids:
  
  
• • Blurred vision
  • Frequent urination
  • Increased appetite
  • Increased thirst
  • Indigestion
  • Flushing of face or cheeks

Women may also experience menstrual irregularity as the result of corticosteroid use.

Some side effects of corticosteroid drugs are considered more dangerous, though rare. An individual should immediately contact a physician if they experience any of these side-effects:

• Blindness
• Bloody stool
• Delayed growth (in children)
• Eye pain
• Hallucinations
• Irregular heartbeat
• Mental depression
• Unusual confusion or excitement
• Unusual increase in hair growth
• Vomiting

It is important to note that the use of corticosteroids can lower a person’s resistance to bacterial and fungal skin infections. Corticosteroids can also cause existing infections to worsen. Therefore, patients taking corticosteroids should contact their physician if signs or symptoms of infection, such as fever, develop.

Patients should also contact their physician if their condition fails to improve with treatment, or if the condition appears to have worsened.

Patients should consult their physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. Patients who are using topical corticosteroids should be particularly careful to inform their physician about any other topical over-the-counter or prescription medications that they use.

Other medications of particular concern to individuals taking corticosteroid drugs are:

• Aminoglutethimide (used to treat some kinds of tumors). Can reduce the effectiveness of corticosteroids.
  
  
• Amphotericin B by injection (used to treat fungal infections). Can decrease the amount of potassium in the blood.
  
  
• Antacids (counteracts stomach acidity). Can decrease the effectiveness of some corticosteroids.
  
  
• Anticonvulsants (used to treat seizures). Can decrease the effectiveness of some corticosteroids.
  
  
• Antidiabetic agents or insulin (used to treat diabetes). Can increase blood sugar levels when taken with corticosteroids.
  
  
• Barbiturates (group of drugs used as sedatives). Can decrease the effectiveness of some corticosteroids.
  
  
• Cyclosporine (used to prevent transplanted organ rejection). Can cause seizures when taken with some corticosteroids.
  
  
• Diuretics (water pills). Can cause the diuretic to be less effective and may increase the loss of potassium.
  
  
• Griseofulvin (used to treat skin infections). Can reduce the effectiveness of corticosteroids.
  
  
• Heart medications. Can increase the risk of having an irregular heartbeat or other problems by decreasing the amount of potassium in the blood.
  
  
• Medicines containing potassium (used to treat high blood pressure). Can interfere with potassium levels in the blood.
  
  
• Medicines containing sodium. Can cause the body to retain excess sodium and water, which can cause high blood sodium, high blood pressure and excess body water.
  
  
• Mitotane (used to treat some cancers). Can decrease the effectiveness of some corticosteroids.
  
  
• Phenylbutazone (used to treat fever, pain and inflammation). Can reduce the effectiveness of corticosteroids.
  
  
• Ritodrine (used to stop premature labor). May cause serious side effects when taken with corticosteroids.

In addition, licorice (candy made from the licorice plant’s root) can increase the effects of corticosteroid medications.

Symptoms of overdose can be similar to the medication’s side effects, but are usually more severe. Patients exhibiting any of these symptoms should contact their physician immediately:

• Acne
• Blurred vision
• Bone fractures
• Excessive hair growth (females)
• Fullness in the face, neck or trunk
• High blood pressure
• Impotence (males)
• Increased urination or thirst
• Menstrual changes
• White patches in throat

Animal studies have shown an increased incidence of birth defects in animals given large amounts of topical corticosteroids. However, studies on birth defects have not been performed in humans.  It is believed that topical corticosteroids do not present a problem in pregnant women when used as directed.

Animal studies have also demonstrated that oral and intravenous use of corticosteroids during pregnancy can cause birth defects. Using a higher dosage of corticosteroids has also been shown to cause unwanted effects during a pregnancy, including slower infant growth and adrenal gland problems. These problems were more likely to occur if the higher dosage was taken in the first trimester.

Most physicians agree that the rewards of using corticosteroids on some types of conditions often outweigh the risks. However, pregnant women should always discuss the use of corticosteroids with their physician before using the medication.

Women who are breastfeeding should exercise caution when nursing. Though most types of corticosteroids do pass into breast milk, they are generally present at such low levels that they do not affect the infant. However, the corticosteroid dexamethasone has been linked to slow growth in nursing infants when used by the mother. Breastfeeding mothers should consult their physicians before taking corticosteroids. In addition, topical corticosteroids should not be applied to the breasts before nursing.

Corticosteroids have a range of side effects that tend to be more pronounced in children than in adults. A child should never take any type of corticosteroid treatment without first seeing a physician.

Children who are using corticosteroid drugs and contract certain infections (e.g., measles, chickenpox) may experience more severe infections. To avoid this, a physician may recommend vaccinations for some types of infection or suggest an alternative treatment, if appropriate.

Children and teenagers who take corticosteroids can experience slowed growth, particularly if the medication has been taken for a long period of time. This is due to the medication’s interference with the function of the adrenal gland. Although the risk of this side effect usually is higher in children who take oral corticosteroids, it can also occur as a result of potent topical corticosteroids that are absorbed through the skin. The risk is lower when low-potency topical corticosteroids are used.

An injection of corticosteroids is often given to young children who have a hard time swallowing the foul-tasting liquid form of the medication. Some children vomit after taking the liquid form. The effectiveness of a corticosteroid injection is comparable to that of the liquid form.

In some cases, corticosteroids may be used to treat diaper rash. When this is the case, parents are advised to avoid dressing their child in tight-fitting diapers or plastic pants. These may increase the risk of absorption of the medication through the skin and into the body, which can result in side effects.

Corticosteroid treatments may be less effective for infants under the age of 1.

Some older individuals may experience side effects that are more pronounced. Older adults have an increased risk of developing high blood pressure or osteoporosis (loss of bone density) when taking corticosteroid drugs. Women, in particular, are at risk for this condition.

Corticosteroids sometimes cause thinning of the skin, and this effect can be more pronounced in older patients, whose skin usually is thinner than younger people. Thinning of the skin may result in skin tears and blood-stained blisters on the skin.

Patients over the age of 50 also risk the development of cataracts (clouding of the lens of the eye) and glaucoma (a group of diseases that can damage the optic nerve, resulting in vision loss). For this reason, older adults taking high doses of corticosteroids may be advised to undergo eye examinations.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians. Patients may wish to ask their doctor the following corticosteroid-related questions:

1. Are corticosteroids an effective treatment for my skin condition?
   
   
2. What type of corticosteroid is best for me?
   
   
3. Will you be prescribing corticosteroids for my skin condition in pill form or as a topical treatment?
   
   
4. What risks do I face by taking this drug?
   
   
5. What side effects may I develop while taking this drug?
   
   
6. For what side effects should I seek medical attention?
   
   
7. How and when should I take this drug?
   
   
8. How long will I have to take this drug?
   
   
9. How long will it take for the drug to take effect?
   
   
10. How will I know if the drug is working?
    
    
11. Can I continue to take my regular medication(s) while I am using corticosteroids?
    
    
12. Am I at risk for thinning of the skin from corticosteroids because of my age?