What are the indications for steroid therapy?

From the Guidelines

Steroids are indicated for various medical conditions, including autoimmune disorders, asthma exacerbations, COPD flares, dermatological conditions, allergic reactions, and neurological conditions, with the goal of reducing inflammation and immune response while minimizing side effects and improving quality of life. The indications for steroid therapy are diverse and depend on the specific condition being treated. For autoimmune disorders such as rheumatoid arthritis, lupus, and inflammatory bowel disease, steroids like prednisone are commonly prescribed at doses of 20-60mg daily, with gradual tapering as needed 1.

In the context of acute asthma exacerbations, methylprednisolone 40-60mg IV or prednisone 40-60mg orally for 5-7 days is a standard treatment approach 1. For COPD flares, prednisone 40mg daily for 5 days is often used. Dermatological conditions like severe eczema or psoriasis may require topical steroids such as triamcinolone 0.1% cream applied twice daily for 1-2 weeks. For allergic reactions, dexamethasone 4-8mg IV/IM or prednisone 40-60mg orally is effective. In neurological conditions like multiple sclerosis flares, high-dose methylprednisolone 1000mg IV daily for 3-5 days is common.

Some key points to consider when prescribing steroids include:

• Starting with the lowest effective dose to minimize side effects
• Gradually tapering the dose as the condition improves
• Monitoring for adverse effects like hyperglycemia, hypertension, and bone loss
• Considering steroid-sparing alternatives for long-term management of conditions like sarcoidosis
• Using topical steroids for dermatological conditions when possible to reduce systemic side effects

The most recent and highest quality study on the management of pulmonary sarcoidosis recommends a treatment algorithm that includes corticosteroids as a first-line treatment, with the addition of second-line agents like methotrexate and biologics like infliximab for disease progression or toxicity 1. This approach highlights the importance of tailoring steroid therapy to the individual patient's needs and condition, while also considering the potential risks and benefits of long-term steroid use.

From the FDA Drug Label

The following should be kept in mind when considering alternate day therapy: Basic principles and indications for corticosteroid therapy should apply. The benefits of alternate day therapy should not encourage the indiscriminate use of steroids. Alternate day therapy is a therapeutic technique primarily designed for patients in whom long-term pharmacologic corticoid therapy is anticipated In less severe disease processes in which corticoid therapy is indicated, it may be possible to initiate treatment with alternate day therapy. More severe disease states usually will require daily divided high dose therapy for initial control of the disease process

The indications for steroid therapy are not explicitly stated in the provided text, but it can be inferred that corticosteroids are used for:

• Allergic diseases
• Collagen diseases
• Rheumatoid arthritis
• Other disease processes where corticoid therapy is indicated, although the specific conditions are not listed. 2

From the Research

Indications for Steroid Therapy

The indications for steroid therapy are varied and depend on the specific condition being treated. Some of the conditions that may be treated with steroids include:

• Inflammatory skin conditions such as psoriasis and atopic dermatitis 3
• Bell palsy and acute gout, for which there is evidence supporting the use of short-term steroids 4
• Septic shock, acute respiratory distress syndrome, severe pneumonia, COVID-19, and hypercapnic respiratory failure due to chronic obstructive pulmonary disease, which may be treated with systemic steroids in critically ill patients 5
• Atopic dermatitis (eczema), for which systemic treatments such as oral corticosteroids, cyclosporine, and methotrexate may be used 6

Conditions with Limited or No Evidence for Steroid Use

There are also conditions for which there is limited or no evidence to support the use of steroids, including:

• Acute bronchitis, acute sinusitis, carpal tunnel, and allergic rhinitis, for which there is evidence against steroid use 4
• Acute pharyngitis, lumbar radiculopathy, and herpes zoster, for which there is insufficient evidence to support routine use of steroids 4

Important Considerations for Steroid Therapy

When prescribing steroid therapy, it is essential to consider the potential risks and benefits, including:

• The risk of adverse effects, which can occur at a wide range of doses and vary depending on the route of administration 7
• The potential for steroids to exacerbate preexisting conditions or present new medical conditions 7
• The importance of correct patient application and dosage, particularly when using topical corticosteroids 3