Most Common Side Effects of Steroid Use
The most common side effects of steroid use include weight gain, mood changes, sleep disturbances, hyperglycemia, increased risk of infection, skin changes, and osteoporosis. 1, 2
Systemic Effects
Metabolic and Endocrine Effects
- Hyperglycemia and worsening of diabetes are common, particularly with prednisone, requiring monitoring of blood glucose levels 1, 2
- Weight gain and increased appetite are frequently reported side effects 2
- Cushingoid features (moon face, buffalo hump) develop with prolonged use 2
- Fluid retention and sodium retention leading to edema 2
- Hypokalemia, especially when used with potassium-depleting agents 2
Musculoskeletal Effects
- Osteoporosis and increased fracture risk are significant concerns with long-term use 1, 2
- Muscle weakness and loss of muscle mass (steroid myopathy) 2
- Aseptic necrosis of femoral and humeral heads in severe cases 2
- Growth suppression in pediatric patients 2
Neuropsychiatric Effects
- Mood disturbances ranging from euphoria and hypomania (more common with short-term use) to depression (more common with long-term use) 3, 4, 5
- Sleep disturbances occur in >30% of patients taking corticosteroids 3
- Insomnia, restlessness, and nervousness 1, 3
- In severe cases, psychosis, delirium, and cognitive impairments may occur 4, 6
- Memory deficits, particularly in verbal or declarative memory 4, 5
Dermatologic Effects
- Skin thinning and atrophy 7, 2
- Acne and acneiform eruptions 2
- Striae (stretch marks) 1, 2
- Impaired wound healing 2
- Telangiectasia (visible small blood vessels) 7, 2
Gastrointestinal Effects
- Gastric irritation and increased risk of peptic ulcers 2
- Nausea and vomiting 2
- Increased risk of gastrointestinal perforation 2
- Pancreatitis (rare) 2, 8
Cardiovascular Effects
- Hypertension or worsening of existing hypertension 2
- Fluid retention potentially leading to congestive heart failure in susceptible patients 2
- Increased risk of thromboembolism 2
Immune System Effects
- Increased susceptibility to infections 2
- Masking of infection signs and symptoms 2
- Suppression of skin test reactions 2
Ophthalmic Effects
- Cataracts (including posterior subcapsular cataracts) with prolonged use 1, 2
- Increased intraocular pressure and glaucoma 1, 2
- Central serous chorioretinopathy 2
Topical Steroid Side Effects
Local Cutaneous Side Effects
- Skin atrophy 7
- Telangiectasia (dilated blood vessels) 7
- Striae (stretch marks) 7
- Purpura (bruising) 7
- Contact dermatitis 7
- Rosacea 7
Systemic Effects from Topical Use
- Hypothalamic-pituitary-adrenal axis suppression may occur with medium- and high-potency topical steroids 7
- Increased risk in children due to higher skin surface/body mass ratio 7
- Growth retardation is a potential concern in pediatric patients 7
Risk Factors for Side Effects
- Higher doses and longer duration of treatment increase risk of adverse effects 1, 6
- Use in steroid-sensitive areas (face, intertriginous areas) increases risk of local side effects 7
- Children and elderly patients are at higher risk for certain side effects 2
- Patients with diabetes, hypertension, or osteoporosis are at increased risk for worsening of these conditions 2
Monitoring and Prevention Strategies
- Use the lowest effective dose for the shortest duration possible 1, 3
- Regular monitoring of blood pressure and blood glucose 1, 2
- Calcium and vitamin D supplementation for osteoporosis prevention 1
- Bone mineral density monitoring with DEXA scans for long-term users 1
- Regular skin checks for patients on long-term therapy to assess for atrophy 7
- Assessment of growth in children using topical corticosteroids long-term 7
- Ophthalmologic evaluation for patients on prolonged therapy 1
Special Considerations
Pediatric Patients
- Growth velocity may be affected even at low systemic doses 2
- Regular monitoring of height, weight, and blood pressure is essential 2
- Increased risk of systemic effects from topical steroids due to higher skin surface/body mass ratio 7