Side Effects of Taking Steroids

Steroids are medications that are used to decrease inflammation in the body and while they can be extremely helpful, it’s important to speak with your doctor about possible side effects. We spoke with one of Hoag Orthopedic Institute’s non-operative Sports Medicine specialists, Adam Rivadeneyra, MD, to go in-depth on what steroids are used for and common side effects.

Q: What are steroids? What conditions are they most commonly prescribed for?

A: Steroids (or corticosteroids) are a type of anti-inflammatory, hormone-related medication commonly prescribed to treat painful, inflammatory, or allergic medical problems. Conditions like eczema, asthma, COPD, arthritis, sports injuries and traumas, and certain severe infections are commonly treated with steroid medications.

Q: How do steroids act on the body?

A: Steroids can be used in a variety of ways, so they effect or act on the body in different ways. Common uses are topical ointments and creams, eye drops, nose sprays, pills, injections, respiratory inhalers, etc. The way they are used determines the way they act on the body.

When they act locally on a specific place, they typically decrease your body's natural reaction to something inflammatory or irritating. This helps sometimes to prevent swelling, scarring, itching, etc. When they act on the body as a whole, they decrease your body's natural production of certain "stress" hormones like cortisol and several others.

Q: What are the most common side effects of steroids? What causes them? Do they differ between oral, inhaled or topical steroids?

A: Common side effects with topical steroids are thinning and lightening of the skin. Inhaled steroids can cause mouth or throat irritation and infection. Eye drops with steroids can increase risk for glaucoma. Oral steroids in short term dosing can cause sleeplessness, increased stress/mania, upset stomach and high blood sugar. Long term oral steroids can cause weight gain, osteoporosis, increased risk of infection.

Q: Are any side effects particularly concerning?

A: The main side effects to worry about are typically the immune suppression risk, and increased risk for severe infection. Steroids purposely decrease your body's immune response to the main inflammatory condition you're trying to treat. But with that comes a risk of a decreased immune response to certain bacterial or fungal infections. Long term bone loss and hormonal changes that can lead to complications of diabetes are also a major concern.

Q: Should someone experiencing side effects stop their steroids? Why or why not?

A: Not all side effects are truly harmful, but they should all be discussed with your doctor. The benefits vs. the risk should always be considered carefully. It can be very dangerous for your health if you stop your steroid medication without your doctor's supervision. High doses, or long-term treatment typically requires a taper, or gradual decrease of the steroids over several weeks.

Q: Who is most at risk for experiencing side effects from steroids?

A: Patients at high risk for infections, older patients, and those with diabetes are susceptible to more frequent and severe side effects.

Q: Overall, what’s the most important thing people should know about steroid side effects?

A: Steroid medications can be extremely useful and safe for a majority of patients on a short-term basis - typically a few days at a time - and when monitored by a physician. Unsupervised use of steroid medications at high doses or long-term treatment more than 1-2 weeks can be very harmful with some permanent complications or side effects. Sometimes, patients require daily steroid use at a low dose to suppress conditions like Rheumatoid Arthritis or Lupus or Asthma/COPD. Regular supervision is very important to balance the risk and benefit in these patients and always try to minimize any harm.

Even over-the-counter steroid medications like anti-itch cream (Hydrocortisone) can cause harm with consistent use, so it's important to seek medical treatment beyond several consecutive days/weeks of use and always use them sparingly.