Patient Education: Potent and effective

Sharjah-based dermatologist Dr Minal Patwardhan shines a spotlight on "miracle" drugs and
treatments every fortnight. Today: Steroids


What are steroids or cortisone?

Steroids are the most potent and effective anti-inflammatory medication available to us. They are the therapy of choice in most skin disorders (not diseases, systemic diseases) and even in life threatening conditions (cardiac, neurological etc). So many misconceptions abound that it's a tough job convincing the person that the medication is necessary.

Do steroids deserve their fearful reputation?

The first thing to comprehend is the fact that it is not steroids that are harmful… it is their abuse by patients, doctors, pharmacists and even body builders that is dangerous. Used in the right doses, potency and for the appropriate length of time, steroids are like wonder drugs.

Availability

• Steroids are available as tablets (oral use).
• Injections (systemic use).
• Creams, ointments and lotions (local applications).

They have been commercially viable since 1952. Over the years we have discovered better and better formulations which reduce their side effects, increase the longevity of action and increase their efficacy.

They are widely used because...

• Broad applicability in treating a wide variety of diseases.
• Easy availability, variable preparations and cost effectiveness.
• Rapidity of action.
• Absence of pain, odour and lack of sensitisation.
• Prolonged stability and compatibility with almost all medications.

Dos and don'ts

If you are dealing with a competent and qualified doctor never fear the usage of steroids. It is also important for the doctor to explain the pros and cons of this medication to the patient. Why? Because these medications are so effective that once healing takes place, the patients tend to continue unsupervised treatment!

Do not consider your pharmacist a doctor and pick up any medications directly.
Absolute contraindication for steroids is presence of any infection in the body. Why?

Steroids lower the immune response in the body and cause the infection to spread rampantly. Whenever unavoidable, we always give a broad antibiotic cover while administering steroids.

Diabetes and hypertension: Avoid steroids as far as possible and if a must then strict control and follow ups are required.

Psoriasis: Steroids are not given systemically. They cause a superb and immediate clearing of all lesion but as their effects wear off the disease flares up and becomes twice as bad . Also it can fulminate and become pustular which is then a medical emergency. Beauty creams and directly-from-pharmacy preparations are to be avoided.

What is the right way to use them?

Whenever steroid creams are used it is better to use high potency creams for a shorter period to bring the disease under control and later maintain it with medium and low potency steroids. The systemic absorption is negligible but remember to complete the course.

As far as oral steroids are concerned, the ideal dose is to be taken once in the morning after breakfast with a glass of cold milk or an antacid to reduce acidity.

This ensures that the cortisone follows the body's normal routine levels of steroids and just gives the additional peak required to bring the disorder under control whereas it minimises the action on the HPA Axis hence reduces hormone imbalance.

Injectable steroids are either given intravenously for fast action and life saving procedures or intramuscularly for prolonged levels and rapid action. These are ideally repeated monthly and then tapered slowly. Or they can be given intralesional, directly into the lesions to prevent absorption and to give potent local action.

Other than intralesional, all steroids whether systemic or local are best stopped by gradual tapering of their dose. Surprisingly for short term reactions they are safe in pregnancy, at least safer than most other medications.

What are the side effects?

Prolonged unsupervised use can cause thinning of the skin, spider veins, stretch marks or localised overgrowth of hair, change in skin colour, pustular eruptions and acne like lesions.

Intralesional injections can cause thinning and depression in the skin, localised tufts of hair and localised loss of skin colour.

Systemic steroids: Weight gain with facial puffiness and a buffalo like hump.

Overt diabetes or hypertension
• Sudden eruption of acne (pimple) like lesions all over the body.
• Electrolyte imbalance.
• Generalised striae.
• Steroid psychoses.
• Posterior cataracts in the eye.