The many dangers of steroids

They have a place in the treatment of eczema, but it's good to know enough to be careful.

It seems to be an ongoing problem with our health care system that we patients do not get sufficient information regarding the potential side effects of the prescribed medications. This is especially problematic with systemic and topical steroids used in dyshidrosis. Strong topical steroid creams damage the skin with prolonged exposure. (Weak OTC hydrocortisone preparations can be used for longer periods.) Some doctors, in their effort to make cortisone creams better and faster absorbed by the eczematous skin, recommend plastic wraps to patients, despite warnings against this practice in the medical literature. Such plastic occlusion increases the dangers of skin damage and possible systemic effects. The most common skin problems caused by steroid topical medications are permanent skin thinning and scarring, and purpura (bleeding into the skin). Strong steroid creams should only be used for 2 weeks at a time, with a rest period of 2 weeks following. They should be applied sparingly.

The most serious problems reported, usually with systemic steroids (pill or injection) are those affecting the eye, and the skeleton. These include the increase in eye pressure and formation of cataracts. Because glucocorticoids accelerate bone resorption while inhibiting bone formation, their use is associated with especially rapid bone loss. The resulting osteoporosis can be quite severe and disabling.

Corticosteroids adversely affect many organs throughout the body. These effects range from those that are not necessarily serious but alter a person’s appearance, to those that are life-threatening (e.g., serious infections). Unfortunately, many early side effects may be largely asymptomatic (e.g., vertebral osteoporosis, early cataracts) until later when medical procedures become necessary.

Other concerns include suppression of the adrenal system, diabetes, interference with growth in children, muscle weakness, and rebound effect (worsening of the condition originally prescribed against). Corticosteroids are not recommended during pregnancy, as they have been shown to increase the chance of birth defects like cleft lip and other problems.

Here is a cautionary tale from a person with DE who's learned the hard way to be cautious with steroids:

My doc also gave me a steroid (topical) with my first DE attack. I was suffering so much I used it for a couple of days. However, got off of it as fast as possible. Previously I had been prescribed a steroid inhaler for bronchitis and developed cataracts within two weeks of use. The cataracts were a direct result of the steroid. Started going blind virtually overnight and had to have double eye surgery - so I don't trust much in the way of steroids unless there are absolutely no other options.

When prescribing, the pulmonologist told me that there was very little steroid in the inhaler and would cause no problems. When I was examined by the ophthalmologist a month later, he immediately identified the problem as "steroid-induced" because of the way the cataracts had formed. My Aunt gained a lot of weight and became bloated when using steroids. And I have heard that they can cause the skin to become thin. So. . . I am very cautious with their use. Changed pulmonary doctor, too! It's been three years and I am doing great with non-steroid med - didn't need it in the first place. (Rec'd autumn 2006).

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Written by Vera Bradova © 2004-2007
Updated 12-8-2006

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