Steroids: Our Love-Hate Relationship With These Tiny Tablets of Wonder

It’s November, the month of gratitude and stress. What better time to talk about something we’re both grateful for and occasionally grumble about: steroids! (No, not the kind that make you look like a bodybuilder. We’re talking about the medical kind: prednisone, methylprednisolone, hydrocortisone, and their many cousins.)

When Do We Use Steroids?

Steroids are the Swiss Army knives of internal medicine. We reach for them when your immune system is a little too enthusiastic/distracted, or when inflammation is making life miserable.

Here are some common reasons you might find steroids on your prescription list:

1. Asthma and COPD flares: When your lungs are staging a protest, steroids help calm things down.

2. Allergic reactions: From poison oak to that mysterious rash after eating shrimp, steroids can help.

3. Autoimmune conditions: If your immune system is attacking your joints (rheumatoid arthritis), skin (eczema), or even your own adrenal glands, steroids can help force the immune system back into its lane. 

4. Severe sore throats: Sometimes, a single dose of steroid can make swallowing less like swallowing glass (especially in bad pharyngitis).

5. Skin conditions: Topical steroids are the MVPs for eczema, psoriasis, and more.

Why We Love Steroids

• They work fast. When you’re wheezing, itching, or swollen, steroids can be a miracle.

• They’re versatile. Pills, creams, inhalers, injections, sprays, liquids, ointments, shampoos, eye drops... steroids come in all shapes and sizes.

• They save lives. In severe allergic reactions or asthma attacks, steroids can be the difference between a quick recovery and a trip to the ER.

• They're cheap, even if insurance doesn't cover, which we are unfortunately seeing more and more these days.

Why We (Sometimes) Hate Steroids

• Side effects, side effects, side effects. Even short courses can cause insomnia, mood swings (“roid rage” is real!), increased appetite, and puffy faces, even in the absence of an increased appetite. 

• Long-term risks. Prolonged use can lead to bone thinning, skin thinning, high blood sugar, easy bruising, and a higher risk of infections. The most feared and famous long-term side effect is weight gain, of course.

• Masking the real issue. Using steroids inappropriately on a fungal rash can suppress redness and inflammation but allow the fungus to persist deeper, then requiring a longer course of oral antifungals, no thank you. Please make sure you check in with your provider with any rash before putting steroids on it!

Steroid Myths Busted!

“Steroids are always dangerous.” 

Not true! Short courses, especially for things like asthma or severe allergies, are generally safe, and can be life changing.

"Topical steroids will thin my skin instantly.” 

Only if you use the strong stuff for too long, especially on delicate areas like the face. For most people, using the right strength for the right amount of time is safe.

“Steroids cure everything.” 

If only! They’re powerful, but not a cure-all. Sometimes, rest, fluids, and time are the best medicine.

A Few Pro Tips

1. Take as directed. 

   Don’t stop steroids suddenly if you’ve been on them for more than a few weeks, this can cause bad stuff. 

2. Report side effects. 

   If you’re feeling extra moody, can’t sleep, or notice swelling, you need to let Dr C know. 

3. Don’t share. 

   I can't believe I have to say this, but your spouse's leftover prednisone is not a good idea for your back pain.

In Summary

Steroids are like that relative who’s great at parties but can overstay their welcome. Used wisely, they’re lifesavers. Used carelessly, they can cause trouble. As always, we’re here to help you get the benefits, without the baggage.

Wishing you a healthy, happy, and inflammation-free November!

Warmly,

Aditi Correa, MD, MSCP

Your Partner In Health