What are steroids and how can I manage the side effects?

Steroid medicines – known as corticosteroids – are ‘copies’ of these hormones. They can help treat inflammation caused by various medical conditions, from skin conditions such as eczema to joint conditions such as arthritis.

Most steroids are only available with a prescription from a doctor. But a few – such as some creams or nasal sprays – can be bought from pharmacies and supermarkets. As with any medication, you can get side effects from corticosteroids, especially if you’ve been taking them for a long time or at a high dose.

Here’s what you need to know about the side effects of steroids and how to manage them, so you can get the benefits of your medication.

What are the different types of steroids, and what are they used for?

There are 2 types of

medicines, which are used to treat different medical conditions:

• topical steroids– these are applied just to the area that needs treatment, such as your skin or eyes, and so they don’t get into your whole body. They include steroid drops, ointments and

  creams
  ,
  inhalers
  and
  nasal sprays
  . Drops can be used in the eyes to reduce inflammation, ointments and creams are used to help treat skin conditions such as
  eczema
  and
  psoriasis
  , inhalers help in the treatment of
  asthma
  and nasal sprays are used to treat
  allergies
  and
  hay fever

• systemic steroids – these include

  steroid tablets
  and
  injections
  . Tablets and injections into your bloodstream work throughout your whole body, to reduce inflammation when you have a long-term condition and there isn’t just 1 area to treat. Injections can also be used in a specific area where they’re needed, such as a joint, to try to target this area. Tablets are used to treat conditions such as asthma,
  inflammatory bowel disease (IBD)
  and
  rheumatoid arthritis
  , while injections can help to treat problems such as
  arthritis
  and
  sciatica

What’s the difference between anabolic steroids and corticosteroids?

Although

have some medical uses and can be prescribed to treat certain conditions, they’re better known for being used illegally, without medical advice, to help build muscle and improve athletic performance.

They’re completely different from corticosteroids. So don’t worry – you’re not going to develop big muscles if you need to use corticosteroids for a medical condition.

How likely am I to get side effects from steroids?

Many people who use corticosteroids don’t get side effects. You’re more likely to get them if you’re taking systemic steroids, such as tablets. The good news is that if you take them at low doses and for a short period of time, they won’t usually cause side effects that will seriously impact you.

Your risk of getting side effects mainly depends on:

• whether you’re taking topical or systemic steroids – tablets are more likely to cause side effects than inhalers or nasal sprays
• the dose and how long you take them for – higher doses and longer-term use mean a greater risk of side effects
• your age – you’re more likely to get side effects if you’re a child or elderly

Here’s what you need to know about side effects for each type of steroid.

Steroid tablets

Taking steroid tablets for less than 3 weeks isn’t likely to cause any significant side effects. But you may get some side effects if you need to take them for longer periods, at a high dose, or more than 3 to 4 times a year.

Side effects that affect more than 1 in 100 people taking steroid tablets include:

• indigestion
• problems sleeping (
  insomnia
  )
• sweating
• weight gain – due to increased appetite
• feelings of restlessness
• mild mood changes

If you take steroid tablets at a high dose or for a long time, you’re more likely to get more serious side effects. Read more about

.

Steroid injections

Possible side effects depend on where the injection is given. If you have an injection into a joint or muscle, you may get pain and discomfort at the injection site for a few days, go red (flushed) in the face for a few hours, or notice a loss of fat or paler skin where the injection was given.

If you have an injection into your bloodstream or deep muscle, possible side effects are similar to those for steroid tablets (see above). Read more about

.

Steroid inhalers

Steroid inhalers usually cause few or no side effects, if used correctly and at normal doses.

Some people get side effects such as a sore mouth or throat, a hoarse or croaky voice, or thrush in the mouth (

). Read more about .

Steroid nasal sprays

Side effects are usually mild if nasal sprays are used correctly and at the normal doses.

Possible side effects include a stinging sensation in your nose, an unpleasant taste in your mouth, dryness or crustiness in your nose, and nosebleeds. Read more about

.

Steroid creams and ointments

If you use them correctly, steroids you apply to your skin rarely cause serious side effects. The most common side effect is a burning or stinging sensation when you put them on, but this usually gets better once your skin gets used to the cream.

Side effects are more likely if you’re using a very strong corticosteroid, or you use it for a long time or on a large area of skin. Read more about

.

How can I manage the side effects of steroids?

You’ve been prescribed steroid medicines because of a health problem you need to solve. If you get side effects, your doctor can review these with you and discuss your options, to make sure you get the treatment that’s right for you.

There are also some steps you can take to help prevent or minimise the impact of side effects.

Use your medicines correctly

Depending on the type of steroids you’re taking, the way you use them can help reduce the risk of side effects:

• if you’re using a steroid inhaler, rinsing your mouth out with water after use will help to remove any medicine that’s stuck in your mouth. And using a spacer device with your inhaler can help the steroid get straight to your lungs, reducing side effects as a result
• if you’re using steroid nasal sprays, always follow the instructions carefully. If your nose hurts or stings, or you start to have nosebleeds, stop using your spray for a day or 2. Making sure you angle the nozzle away from the middle of your nose can also help prevent nosebleeds
• if you’re using steroid creams or ointments, long-term use doesn’t usually cause any problems, provided you follow the instructions and don’t use too much, and especially if you have regular check-ups with your doctor

Self-care tips

• boost your immunity – if you take systemic steroids such as tablets for a long time, they can reduce your immunity to infection, so make sure you get your annual flu jab
• take your meds in the morning – if you’re taking steroid tablets, taking your whole daily dose in the morning can help reduce your chances of insomnia (evening doses sometimes make it difficult to fall asleep)
• snack wisely – if your appetite has increased due to taking steroids, choose low-calorie snacks such as vegetable sticks with low-fat hummus, or fill up with a bowl of soup before your main course. And if you feel you want something sweet, eat a piece of fresh or dried fruit, then decide if you still need it. Drinking lots of water and herbal tea can also help you feel fuller
• exercise
  and eat a
  healthy diet
  – to help limit weight gain. While any increased appetite will go away once you’re no longer taking steroids, it’s better to try to avoid putting on weight in the first place, rather than having to lose it later
• protect your bones – taking steroid tablets for longer periods can increase your risk of weak bones (
  osteoporosis
  ). So speak to your doctor about what dose of
  vitamin D
  supplement you should take, and whether you also need to take extra
  calcium
  (you might get enough from your diet).
  Smoking
  and
  alcohol
  can increase your risk of osteoporosis, so it’s a good idea to avoid these, and make sure you’re doing some weight-bearing exercise, such as walking or running, to help keep your bones strong
• keep an eye on your eyes – if you’re taking systemic steroids, you should get your eyes checked by an optician every 6 months, as you may have an increased risk of
  glaucoma
  or
  cataracts

How your doctor can help

Your doctor will only prescribe steroids for you if they’re necessary, and will use topical steroids if possible. They’ll use the smallest dose needed to control your symptoms, for the shortest possible time, then gradually reduce the dose or stop them once your problem is controlled.

Depending on what you’re taking, they may also monitor your

and blood sugar levels. If you need to take steroids longer term, or take them frequently, they’ll also monitor your , and prescribe medication to maintain your bone health if needed.

If you’re taking steroids at a high dose, or for more than a few weeks, your doctor may give you a steroid card. You should show this when you have any treatment from healthcare professionals (or tell them you’re taking steroids if you don’t have a card). They need to be aware that you need steroids, as your body may not be making enough of the steroid hormone cortisol. You may also need to be given extra steroids if you’re unwell.

Stopping steroid treatment

You shouldn’t stop steroid treatment without speaking to your doctor first. This is because taking steroids for longer periods can affect the way you produce hormones – your body starts to rely on the medication, rather than making its own. Stopping suddenly can make you very unwell, and may also lead to your symptoms coming back.

You may need to gradually reduce your dose of steroids if:

• you’ve been on a high dose of tablets – more than 40mg a day – for over a week
• you’ve been taking them for more than 3 weeks

When to see a doctor

Whether you get side effects from steroids can depend on what type and strength you’re taking, and how long you take them for. But if you’re concerned about any side effects or symptoms, speak to your doctor.

If you’re taking steroid tablets at a high dose or for longer than 3 weeks, you’re more likely to get side effects, some of which can be more serious. Read about

.

You should call an ambulance or go to an emergency department if you have any of these serious side effects:

• you notice any signs of a rare but severe allergic reaction called
  anaphylaxis
• you have a high temperature (fever) and feel very unwell or have other signs of possible blood poisoning (
  sepsis
  ), such as difficulty breathing or breathing very fast, slurred speech, confusion, pale, blotchy or blue skin, or a rash that doesn’t fade when you roll a glass over it (you may not have all these symptoms)
• you notice swelling or throbbing in your arms or legs, or you feel breathless or notice chest pain – these can be signs of
  deep vein thrombosis (DVT)
  or a
  blood clot
• you’ve been on steroids for more than 3 weeks and are getting fevers, dizziness, weight loss, tiredness, nausea and muscle pain – these are signs of
  adrenal insufficiency

Your health questions answered

Do topical steroids weaken your immune system?

Answered by:

“For most people, topical steroids won’t weaken your immune system. These steroids are applied to your skin or taken as an inhaler or spray, and although some of the medicine can get into your bloodstream, it’s usually only a very small amount. This won’t cause any problems, unless strong topical steroids are used on large areas of the skin for a long time.”

How long do steroid tablets take to work?

Answered by:

“If the dose you’ve been prescribed is enough to reduce the level of inflammation in your particular condition, steroid tablets (such as prednisolone) generally work quickly – usually within 1 to 4 days. In fact, some people notice beneficial effects a few hours after taking their first dose.”