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STEROIDS (NON TABLET TREATMENT)

What are the types of Steroids ?

We are talking here of steroids given as inhalers, creams, ointments, drops, rectal preparations and injections into joints. The steroids we are describing include beclomethasone, fluticasone, budesonide, betamethasone, dexamethasone, aclomethasone and clobetasone. Anabolic steroids are different and are not included in this leaflet.

What are Steroids for ?

Steroids dampen down inflammation in body tissues and can be used in many conditions. They can be given by mouth: steroid tablets are described in a separate leaflet. For many conditions, it is better for the steroid to come into direct contact with the inflamed surface. For example the inside of your lungs using inhalers (puffers) for asthma; into your joints for arthritis; on to your skin as creams or ointments in eczema or dermatitis; into your eyes, nose or ears; by enema into the lower bowel for inflammation of the bowel. In asthma, inhaled steroids are used as preventers: they prevent you from getting attacks but don't act fast enough to help during an attack (see Asthma).

How do Steroids work ?

They act directly in the part where they are delivered. They reduce inflammation by stopping the production of chemicals called prostaglandins. These chemicals normally trigger pain, irritation and inflammation. Steroids also calm down your immune system, which is responsible for the body misbehaving in people with allergies. By using them directly on to the surface of the inflamed organ, you avoid the side-effects which would be much more likely if steroids were taken by mouth.

How should Steroids be used ?

You should use the steroid in exactly the way your doctor has told you to, and for the exact number of times a day prescribed. If you are not sure, ask your doctor or pharmacist, but check the label first! Don't stop using your steroid unless your doctor has told you to. Creams and ointments should only be applied lightly. Applying them too heavily is more likely to give you problems, such as thinning of your skin. Your doctor might advise other drugs as well to correct the underlying problem which is causing the inflammation. If you have asthma, and use another inhaler that opens up your airways (e.g. a reliever like salbutamol) you should use your steroid inhaler afterwards: this helps the steroid to get into your lungs better.

During Treatment with Steroids

If you put a steroid preparation directly on to the area of inflammation your condition should improve within a few days. Although very little gets into your body, you are unlikely to suffer the same side-effects as you might with steroid tablets. Nevertheless, big doses given for a long time can upset the way your own body makes its own particular steroid (called cortisol). Prolonged use of very high dosages may also affect your bones, leading to osteoporosis (thinning of bones). Inhaled steroids don't usually give you anything more serious than a sore mouth or throat, and occasional hoarseness. This is because some steroid hits these areas on its way to the lungs. Another problem is that the body's defence against infection may be affected. This might mean you get a fungal infection in your mouth or throat. This is less likely to happen if you rinse your mouth thoroughly and gargle with water after every dose. Although unlikely, if you experience breathing difficulties after a dose, stop using your inhaler and contact your doctor. Steroid drops might cause some redness on the applied areas, but this is not common. Nasal sprays might irritate your nose and make you sneeze. You may notice minor taste and smell changes. Steroid injections : occasionally a joint may swell up. If this happens, ice packs, rest and painkillers are useful, but tell your doctor. Loss of skin colour where the needle went in is rare. Creams and ointments rarely cause problems but if you use strong ones for a long time they can change your skin permanently: skin thinning is most common and can produce stretch marks. Fine blood-vessels can start to show under the surface of your skin. This is why steroids are not usually used on your face (except for hydrocortisone, which does not have this effect). If you have dark skin, you may get a temporary paler patch where you have been applying your steroid.

Drug Interference

Although steroid tablets can interfere with other drugs, the 'surface' preparations mentioned here rarely cause a problem. Very little steroid gets into the rest of your body.

What if Steroids are not taken ?

Your skin or other condition would persist: there are very few alternatives to steroids. If you have been using your steroids regularly for more than a week or two, and you stop suddenly before your doctor has advised you to, your condition might get worse. For short courses or for recurring problems, your doctor may advise you to stop as soon as the condition is better. If you have been using higher doses or stronger steroids for a long time, your doctor will advise you how to reduce the amount you use gradually over a few days or weeks. This depends on the dose you use, the strength of the steroid and how long you have been using it. If you miss a dose, get back to your normal schedule as soon as possible.

General advice on Steroids

Please tell your doctor if you are pregnant or breast-feeding: steroid preparations may be harmful to your baby. If you have an infection of any kind, steroids can mask (cover up) infections. If you have glaucoma (raised pressure in the eye) steroid eye drops can make it worse. If you have had tuberculosis, inhaled steroids can re-activate a chest infection. If you have any questions not dealt with in this leaflet, please ask your pharmacist or doctor. Keep this leaflet handy in case you need to refer to it at a later date.