Steroids, also referred to as corticosteroids, are a type of anti-inflammatory drugs. They are not similar to anabolic steroids that are utilized by body builders and athletes to enhance their performance. Steroid medicines are used in the treatment of lupus, allergies, asthma, rheumatoid arthritis and other illnesses. They are available in the forms of soluble tablets, tablets, ointments, creams, injections and inhalers. However, side effects can occur due to ingestion of steroid drugs.

Steroid Side Effects

Adverse Effects of Steroidal Tablets

Ingesting steroidal tablets for a period of less than 3 weeks is not likely to result in any significant adverse effects. However, you may develop side effects if you take them for a longer duration or at a higher dose.

Side effects that can occur due to ingestion of steroidal tablets are:

• Heartburn or indigestion
• Increased hunger which may result in gaining of weight
• Sleeping difficulties
• Changes in behavior and mood, including anxiousness and irritability
• A raised risk of developing infections such as shingles, chickenpox and measles
• Diabetes or increased blood sugar
• Osteoporosis or reduction in bone mass
• Increased blood pressure
• Cushing’s syndrome – development of symptoms such as stretch marks on thighs, thinning of skin that is bruised easily, and deposition of fat in face
• Problems in the eye such as cataracts and glaucoma
• Psychological problems such as suicidal thoughts or depression

Majority of the side effects will improve once you stop the treatment.

Adverse Effects of Steroidal Inhalers

Steroidal inhalers generally cause no or few steroid side effects if they are used correctly and in normal doses.

Some patients may develop:

• A sore throat or mouth
• A croaky or hoarse voice
• Cough
• A fungal infection of the mouth that is characterized by symptoms of redness, soreness and white patches in the mouth
• Bleeding from nose

If you are ingesting a higher dose of steroid inhaler for a long duration, there are chances that you may develop some of the adverse effects of steroidal tablets, including mood changes, increased appetite and difficulty in sleeping.

Adverse Effects of Steroidal Nasal Sprays

There are generally no significant adverse effects of steroidal nasal sprays if they are used correctly and in normal doses.

Some of the adverse effects may include:

• A burning or stinging sensation inside the nose
• Crustiness and dryness inside the nose
• An irritated and dry throat
• Development of an unpleasant taste
• Redness, swelling and itchiness inside the nose
• Bleeding from the nose

Adverse Effects of Steroidal Injections

Possible adverse effects of steroidal injections depend on the site of the injection. Steroid side effects of steroidal injections in the muscles, joints or spine may include:

• Discomfort and pain present for a couple of days
• Temporary bruising of the skin
• Flushing on the face for a couple of hours
• Development of an infection, resulting in swelling, redness and pain – seek medical advice as early as possible if you develop these symptoms.
• Loss of fat from the site where the injection was administered – this can lead to dimple formation in the skin and is usually permanent.
• Color of the skin around the site of injection becoming pale
• Increase of blood sugar for a couple of days
• Blood pressure readings increasing for a couple of days

Occasionally, you may develop pounding headaches from epidural injections. These headaches get better only by lying down.

Adverse of injections administered into the blood are similar to the steroid side effects of steroidal tablets, including increased hunger, sleeping difficulties and changes in mood.

Adverse Effects of Topical Steroids

The most common adverse effect of topical steroids is a stinging or burning sensation after the medicine is applied. But this sensation generally improves as you get used to the application of the medicine.

Less common adverse effects are:

• A pre-existing infection of the skin getting worse
• Development of folliculitis, an inflammation of hair follicles
• Skin where the medicine is applied becoming thin
• Development of stretch marks which are usually permanent, though they may become less with time
• Contact dermatitis – irritation of the skin due to a mild allergic reaction to the ingredients in a particular topical steroid
• Acne or the existing acne getting worse
• Rosacea, the face becoming flushed and red
• Color of skin changes
• Excessive growth of hair on the skin that is being treated

Very young and elderly individuals are more prone to develop steroid side effects.

If topical corticosteroids of very high potency are used for a long duration or over a large area of skin, then there exists a risk of the medicine being absorbed in the blood, resulting in internal adverse effects, including:

• Cushing’s syndrome
• Reduced growth in children

Do Adverse Effects of Steroids Develop in Everyone?

No. The frequency of development of side effect varies in different people. If use of steroid is for a short duration, then probably no side effects may occur. The adverse effects usually do not occur when steroid injection is given occasionally for tendinitis, arthritis or bursitis.

However, if high doses of steroids are used for a long duration such as for a couple of months, the listed side effects may occur.

How to Reduce the Risk of Steroid Side Effects

• Take steroids in low doses or intermittent dosing. Enquire your physician about utilizing low-dose medicines that are for short-term use or taking them on alternate days, instead of daily.
• Change to non-oral forms of steroids. For instance, if you take steroid inhalers for asthma, the medicines reach the lungs directly, which reduces the exposure of rest of the body.
• During therapy, eat a healthy diet, maintain optimum weight and participate in activities that strengthen muscles and bones.
• Reduce your dosage gradually. You may experience symptoms of body aches, lightheadedness and fatigue if the dose of steroids is decreased too quickly.
• Wear a bracelet with a medical alert that says that you are on a long-term steroid therapy.
• Get regular whole body checkups if you are taking steroids for a long duration.

Who Should Not Use Steroids?

Generally, individuals who have the following medical illnesses should not use steroids:

• Infection
• Diabetes (uncontrolled)
• Peptic ulcer
• Glaucoma
• Osteoporosis
• Congestive heart failure or uncontrolled hypertension