Corticosteroids are anti-inflammatory drugs that are synthetic versions of steroids naturally found in the body. They are used to manage many health conditions, but they can cause adverse effects in people who use them long term.
What Are Corticosteroids?
Corticosteroids, also referred to as steroids, are anti-inflammatory drugs that suppress the immune system and reduce inflammation. They are versatile and can treat the symptoms of infections, allergies, autoimmune diseases, skin disorders, and many other health conditions.
Corticosteroids come in a variety of forms. Mild topical creams can be bought over the counter. Stronger topical creams, sprays, and tablets are available only with a prescription.
Topical preparations target a specific area, while systemic drugs, like tablets and injections, work throughout the body. Corticosteroid injections are administered by a healthcare professional.
Corticosteroids are different from anabolic steroids, which are sometimes used by athletes and bodybuilders to build body mass and improve performance.
What Conditions Do Corticosteroids Treat?
Corticosteroids can be used for a wide variety of health conditions to help reduce inflammation in the body. Examples of conditions that corticosteroids may help treat include:
Allergies, including asthma, rashes, swelling, and rhinitis
Since they’re used for so many different types of ailments, corticosteroids are available in many forms. One may be more suitable than another depending on the specific health condition being treated, such as using a cream for a skin rash or injections for joint pain. Corticosteroids are also made with different types of steroids, including:
Cortisone
Dexamethasone
Prednisone
Methylprednisolone
One way of categorizing the different types of corticosteroids is based on how we use them. Here are the different forms of corticosteroids and how they are used.
Topical Corticosteroids
As the name suggests, these creams, ointments, solutions, gels, foams, and other preparations are applied to the skin to treat dermatological problems. They typically only impact the area of the body where they’re applied. They vary in potency from low to ultrahigh. Examples include:
Different formulations (for example, a cream or an ointment) and concentrations can make the same kind of topical corticosteroid have different potencies.
Nasal Sprays and Inhalers
Nasal corticosteroids enter the body through the nose and can be used to treat nasal or sinus allergies or sinus inflammation. Inhalers enable you to inhale the corticosteroids deeply into the lungs. This makes them suitable for treating COPD or asthma, but they can also cause adverse side effects. Both delivery methods allow the medicine to circulate through the entire body once it’s inhaled. Examples include:
Fluticasone nasal (Flonase)
Ciclesonide nasal (Omnaris)
Cilesonide inhalation (Alvesco)
Fluticasone and salmeterol inhaler (Advair Diskus)
Beclomethasone (Qvar Redihaler)
Eye Drops
Eye drops work similarly to nasal sprays, but they target the eyes. Your doctor may prescribe them if you have swelling or irritation in the eye due to surgery, an injury, some inflammatory eye conditions, or exposure to certain chemicals. These drugs are by prescription only. Examples include:
Dexamethasone (Dextenza, Maxidex)
Prednisolone acetate (Pred Forte)
Loteprednol (Inveltys)
Oral Corticosteroids
Corticosteroids taken by mouth are called oral steroids. They include pills, liquids, capsules, or syrups, and there are many types. Doctors prescribe oral steroids to help treat systemic conditions, such as RA, IBD, and MS.
Oral corticosteroids enter the bloodstream more easily than topical ones, and they are more likely to have adverse effects, especially with long-term use. These medications include:
Prednisone (Deltasone)
Dexamethasone
Methylprednisolone (Medrol)
Injected Corticosteroids
You might need steroid injections if you have carpal tunnel syndrome, arthritis, or bursitis. Your doctor will inject the steroid directly in the affected joint or muscle. This can bring relief from inflammation, pain, and swelling for several weeks or months.
Doctors usually recommend leaving at least 12 weeks between injections, due to the risk of adverse effects. Common shots include:
Hydrocortisone (Solu-CORTEF)
Triamcinolone (Zilretta)
Methylprednisolone (Medrol)
Intravenous Corticosteroids
Intravenous corticosteroids, such as methylprednisolone (Solu-Medrol), enter the bloodstream directly and start working quickly. Doctors can use them to treat severe inflammation from autoimmune disorders such as RA and lupus.
How Do Corticosteroids Work?
Corticosteroids decrease inflammation and suppress the immune system. They are similar to cortisol, an anti-inflammatory hormone made by the body’s adrenal glands.
When the immune system isn’t working properly and the body is revved up, the body’s tissues can become inflamed and suffer damage. Corticosteroids can help quiet that activity by affecting the way white blood cells work. Signs of inflammation include:
Redness
Warmth
Swelling
Pain
What Are the Possible Side Effects of Corticosteroids?
Prolonged use, high dosages, and potent corticosteroids can cause many different kinds of side effects, some of them severe. Up to 90 percent of patients who take them for more than 60 days will experience adverse effects. Those may include:
If you take prednisone for more than a few weeks, you may need to taper off it slowly. Stopping abruptly can cause withdrawal symptoms such as fatigue, weakness, body aches, and joint pain. It can also make the symptoms you’re being treated for worse. If you want or need to stop taking prednisone, talk to your doctor about how to do that safely.
There are also some drug interactions to consider. The effectiveness of corticosteroid drugs may be strengthened or weakened if you are taking antiviral medications at the same time. In addition, taking steroids and nonsteroidal anti-inflammatory drugs simultaneously may increase the risk of peptic ulcer disease.
Oral corticosteroids may harm an unborn baby, especially if the drugs are taken during the first trimester. If you’re pregnant, may become pregnant, or are breastfeeding, be sure to let your doctor know when discussing treatments.
Your diet may also impact your corticosteroid use. You may need to avoid grapefruit and grapefruit juice while taking corticosteroids, as the fruit can affect how these drugs work in your body. Talk to your doctor if this is a concern.
The Takeaway
Corticosteroids are anti-inflammatory drugs that can help treat many different health conditions, and they come in various strengths and forms.
High doses and long-term use, however, can cause serious adverse effects. Contact your healthcare provider if you experience any significant reactions to these medications.
If corticosteroids are being discussed as part of your treatment plan and you are pregnant or may become pregnant, be sure to let your healthcare provider know.
Natalia Johnsen, MD, practices internal medicine and lifestyle medicine. She works as an internist for the Vancouver Clinic in Vancouver, Washington.
Johnsen trained and worked as ob-gyn in Russia before coming to the United States in 2000. Subsequently, she interned in internal medicine at the University of Nevada and completed her residency at a Stanford-affiliated program in Santa Clara, California. After that she worked as a general internist for two years before to switching to full-time hospital work.
Johnsen has always been fascinated by the effects that lifestyle can have on physical and mental health, and she fell in love with the concept of lifestyle medicine as a specialty after seeing patients struggle with issues that could have been prevented had they known more about a healthy lifestyle. To make an impact on her patients through lifestyle interventions, she launched her own lifestyle medicine clinic, Vivalso Health and Longevity.
Yvette Brazier's career has focused on language, communication, and content production, particularly in health education and information. From 2005 to 2015, she supported learning in the health science department of a higher education establishment, teaching the language of health, research, and other language application skills to paramedic, pharmacy, and medical imaging students.
From 2015 to 2023, Yvette worked as a health information editor at Medical News Today and Healthline. Yvette is now a freelance writer and editor, preparing content for Everyday Health, Medical News Today, and other health information providers.
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
Hodgens A et al. Corticosteroids. StatPearls. May 2023.
