Common Medical Conditions for Steroid Prescription
Steroids are commonly prescribed for a wide range of inflammatory, autoimmune, and allergic conditions where their potent anti-inflammatory and immunosuppressive effects can significantly reduce morbidity and mortality.
Endocrine Disorders
- Primary or secondary adrenocortical insufficiency 1
- Acute adrenocortical insufficiency 1
- Congenital adrenal hyperplasia 1
- Nonsuppurative thyroiditis 1
- Hypercalcemia associated with cancer 1
Rheumatologic Conditions
- Rheumatoid arthritis, including juvenile rheumatoid arthritis 1, 2
- Adult-onset Still's disease (AOSD) - most patients (88%) require prednisone at some point during their disease course 2
- Acute and subacute bursitis 1
- Ankylosing spondylitis 1
- Psoriatic arthritis 1
- Acute gouty arthritis 1
- Post-traumatic osteoarthritis 1
- Synovitis of osteoarthritis 1
Collagen Vascular Diseases
Dermatologic Conditions
- Severe psoriasis 1
- Pemphigus 1
- Severe erythema multiforme (Stevens-Johnson Syndrome) 1
- Exfoliative dermatitis 1
- Bullous dermatitis herpetiformis 1
- Severe seborrheic dermatitis 1
- Atopic dermatitis - topical steroids are used for short-term treatment 2
Allergic States
- Bronchial asthma 1, 3
- Seasonal or perennial allergic rhinitis 1
- Drug hypersensitivity reactions 1
- Serum sickness 1
- Contact dermatitis 1
- Atopic dermatitis 1
- Urticarial transfusion reactions 1
- Acute noninfectious laryngeal edema 1
Ophthalmologic Conditions
- Dry eye disease - topical steroids for short-term use in moderate to severe cases 2, 4
- Allergic conjunctivitis 1
- Keratitis 1
- Iritis and iridocyclitis 1
- Optic neuritis 1
- Herpes zoster ophthalmicus 1
- Allergic corneal marginal ulcers 1
Respiratory Diseases
- Symptomatic sarcoidosis 1
- Berylliosis 1
- Loeffler's syndrome not manageable by other means 1
- Aspiration pneumonitis 1
- Fulminating or disseminated pulmonary tuberculosis (with appropriate anti-TB therapy) 1
Gastrointestinal Diseases
Hematologic Disorders
- Acquired (autoimmune) hemolytic anemia 1
- Idiopathic thrombocytopenic purpura in adults 1
- Secondary thrombocytopenia in adults 1
- Erythroblastopenia (RBC anemia) 1
Neurological Conditions
- Cerebral edema associated with primary or metastatic brain tumor, craniotomy, or head injury 1
- Tuberculosis meningitis with subarachnoid block when used with appropriate anti-TB therapy 1
Otolaryngologic Conditions
- Sudden sensorineural hearing loss (SSNHL) - oral prednisone at 1 mg/kg/day (max 60 mg daily) for 10-14 days 2
- Hoarseness - not routinely recommended due to potential adverse effects 2
Special Considerations and Cautions
Potential Adverse Effects
- Lipodystrophy, hypertension, and cardiovascular disease 2
- Osteoporosis and avascular necrosis 2
- Impaired wound healing and myopathy 2
- Cataracts and other ophthalmologic disorders 2
- Increased risk of infections 2
- Mood disorders and hormonal changes 2
- Hyperglycemia and diabetes 2
- Adrenal suppression 2
Mechanism of Action
- Glucocorticoids bind to cytoplasmic receptors, dimerize and translocate to the nucleus 5
- They inhibit inflammatory gene expression by interacting with transcription factors like nuclear factor-kappa B 5
- This results in suppression of multiple inflammatory mediators and pathways 5
Treatment Resistance
- Some patients with chronic inflammatory diseases may develop corticosteroid insensitivity 6
- This phenomenon is seen in approximately 5% of asthma patients and also occurs in rheumatoid arthritis and inflammatory bowel disease 6
Route of Administration Considerations
- Inhaled steroids are preferred over oral steroids for chronic asthma when possible 3
- A daily dose of prednisolone 7.5-10 mg appears equivalent to moderate-high dose inhaled corticosteroids 3
- Intra-articular or soft tissue injections may be used for localized inflammatory conditions 1
- Topical steroids are preferred for dermatological and ophthalmological conditions when appropriate 2