Oral Steroids

What Are Oral Steroids? 

Steroids are used to suppress inflammation and come in many forms, including topical steroids, inhaled steroids, oral steroids, injectable steroids, and IV (intravenous) steroids. Oral steroids, also called systemic steroids, systemic corticosteroids, or glucocorticoids, are a class of steroids taken by mouth and used for many human diseases, including various skin conditions. They are synthetic forms of the natural hormone cortisol, which is produced by the adrenal gland. 

Below are oral steroids commonly used for skin conditions, including brand names and a comparison of their potencies:

How Do Oral Steroids Work? 

Oral steroids mimic the steroid hormones that are naturally produced by our adrenal glands and act on various receptors throughout the body to exert their anti-inflammatory effects. Steroids bind to glucocorticoid receptors in almost every cell of the body. These steroid/receptor pairs then bind to specific sequences of DNA to decrease the production of many different types of inflammatory molecules.^[7]

Through various mechanisms, most oral steroids decrease inflammation and work to:

• Prevent migration of immune cells called neutrophils into tissue
• Decrease the production of pro-inflammatory chemicals and molecules
• Reverse increased blood capillary permeability
• Suppress the normal immune system response

What Conditions Do Oral Steroids Treat? 

FDA approved^[8] uses of oral steroids for the skin:

Atopic dermatitis (eczema)
Bullous dermatitis herpetiormis
Exfoliative dermatitis
Exfoliative erythroderma
Mycosis fungoides
Pemphigus
Stevens-Johnson syndrome
Severe psoriasis (Editor’s note: Although FDA approved, steroids can lead to worsened flares of psoriasis when given orally.)
Severe seborrheic dermatitis

How Are Oral Steroids Given? 

• Oral steroids are used in both short-term “bursts” (four weeks or less) and for long-term (over four weeks) management of chronic skin diseases.^[9]
• Often oral steroids are initially given in a higher dose (such as 60 mg per day) to help get the disease under control, and then they are tapered to a lower dose a few weeks later. Without proper tapering, there is a risk of steroid withdrawal symptoms, including body aches, mood changes, headache, fatigue, and abdominal pain.^[10]
• Steroid dosage is often categorized as: (1) low dose: < 10 mg/day, (2) medium dose: 10-20 mg/day, or (3) high dose: >20 mg/day.

What Are Common Side Effects and Risks of Oral Steroids?

Treatment with oral steroids can involve a wide range of risks and side effects. Some patients have a much higher risk of side effects than others.  For example, women and the elderly are at greater risk for osteoporosis caused by steroid treatment.^[9]

Groups with Increased Risk for Steroid Induced Side Effects:^[9]

• People with liver disease and alcoholics – difficulty metabolizing exogenous steroids
• Children and adolescents – higher risk for osteoporosis and delayed growth
• Females, especially postmenopausal females – slower clearance of steroids and lower bone density increase risk for toxicity
• Elderly – higher risk for osteoporosis and complications due to physical inactivity

Additionally, there are different side effects that commonly occur with short-term versus long-term treatment with oral steroids.

Side Effects of Short-Term Oral Steroid Treatment:^[9]

• Fluid retention and/or swelling
• Upset stomach
• Weight gain
• Mood changes and difficulty sleeping
• Muscle weakness
• High blood sugar (hyperglycemia)
• Higher risk for infections
• Slow wound healing
• Loss of menstruation
• Acne-like skin rashes when the steroids are stopped