Corticosteroid

Pronounced kor-ti-koh-STEER-oyd

Also known as Steroid, Cortisone, Glucocorticoid

Corticosteroids are medicines related to cortisol, the body's own stress hormone, and they are the most powerful suppressors of inflammation in general use. They are not the muscle-building steroids of the gym, which are a different class of drug entirely.

In Medicines & Safety

The adrenal glands make cortisol every day. Corticosteroid medicines — prednisolone, dexamethasone, hydrocortisone, betamethasone, budesonide, fluticasone — are versions of it, and they work by damping the immune signalling that produces . That makes them enormously useful in , , , severe allergy and autoimmune disease, and it makes them dangerous to take casually, because the same suppression applies to defences the body needs.

Route matters more than dose

Inhaled, in a preventer , delivers a tiny dose directly to the airway. Rinse the mouth afterwards to avoid thrush and hoarseness. Systemic effects at ordinary doses are minimal, and this is the safest long-term use there is.
Topical, as a skin cream, is graded from mild to very potent. Used correctly for short courses it is safe; used month after month, particularly on the face or in skin-lightening preparations sold without prescription, it thins skin permanently and causes visible vessels and rebound rashes.
Injected into a joint or a tendon gives weeks of relief with little reaching the rest of the body, but repeated injections into the same joint damage cartilage.
Tablets or intravenous, at meaningful doses, affect the whole body — this is where the serious effects live.

Important

Do not stop a course of steroid tablets abruptly if it has run beyond about three weeks. The body's own cortisol production shuts down while the medicine supplies it, and needs to be tapered back. Longer courses raise blood sugar, blood pressure and infection risk, cause weight gain and , and can trigger and stomach ulcers — which is why the shortest effective course at the lowest effective dose is the rule, and why steroids should not be bought over a counter for aches.

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