Steroids: What They Treat and What They Cost

Corticosteroids — prednisolone, dexamethasone, methylprednisolone, hydrocortisone, and inhaled or topical forms — suppress inflammation and the immune response. Used correctly they save lives and preserve organs. Used casually they cause serious, sometimes permanent harm.

The problem in India is not the drug. It is that steroids are widely available without prescription, are added to unlabelled “pain powders”, tonics and fairness creams, and are given for ordinary fever and body ache because the person feels dramatically better within a day.

What they legitimately treat

• Asthma and COPD flares, and inhaled steroids as long-term asthma control
• Autoimmune and inflammatory conditions: rheumatoid arthritis, lupus, inflammatory bowel disease, vasculitis
• Severe allergic reactions and drug reactions
• Some kidney diseases, notably nephrotic syndrome
• Certain cancers, as part of a regimen
• Adrenal insufficiency, as physiological replacement
• Severe COVID-19 with low oxygen — but not mild disease, where they cause harm

Why they feel so good, and why that is a trap

A steroid reduces inflammation everywhere at once. Fever settles, joints loosen, appetite returns, energy rises. Someone taking one for undiagnosed fever may feel transformed within 24 hours — while the underlying infection, whether tuberculosis, typhoid or something else, is left untreated and free to spread because the immune response has been suppressed.

This is why a steroid should never be taken for an undiagnosed illness.

The harms, by timescale

Short courses (days to two weeks): raised blood glucose, raised blood pressure, insomnia, mood change and irritability, increased appetite, fluid retention, stomach irritation.

Longer use (weeks to months):

• Weight gain with a characteristic round face and central fat
• Diabetes, or loss of control in existing diabetes
• Osteoporosis, with fractures; this begins within months, not years
• Cataracts and glaucoma
• Thinning skin, easy bruising, stretch marks
• Muscle weakness, particularly in the thighs
• Increased susceptibility to infection, including reactivation of tuberculosis
• Avascular necrosis of the hip
• Growth suppression in children
• Adrenal suppression

Adrenal suppression: the reason you never stop abruptly

When steroids are taken for more than about two to three weeks, the body’s own cortisol production shuts down. Stopping suddenly leaves the person unable to mount a stress response, which can cause an adrenal crisis — vomiting, collapse, dangerously low blood pressure — and can be fatal.

Steroids taken beyond a short course must be tapered under medical supervision. Anyone on long-term steroids should carry a card stating so, and should be told that doses may need to be increased during illness or surgery.

Steroid abuse in over-the-counter products

• Skin creams sold for fairness or for “any skin problem” frequently contain potent steroids. Prolonged use on the face causes thinning skin, visible vessels, acne-like eruptions and a dependence in which stopping causes a severe rebound.
• Unlabelled “pain relief” powders and some traditional preparations have repeatedly been found to contain steroids, which is why they work so quickly.
• Anabolic steroids for muscle building are a different class of drug but also widely misused, with effects on the liver, heart, fertility and mood.

If a remedy produces dramatic relief within a day and nobody can tell you exactly what is in it, that is a reason for suspicion.

Using steroids safely when they are prescribed

• Take the dose in the morning where advised, which reduces sleep disturbance
• Take with food
• Monitor blood glucose, especially if diabetic
• Ask about calcium, vitamin D and bone protection for courses longer than about three months
• Have blood pressure and eyes checked periodically on long courses
• Report fever or any sign of infection promptly, since the usual signs may be muted
• Never stop a long course without instructions

When to see a doctor

• Any steroid course lasting more than a few weeks that was started without supervision
• Fever or infection while on steroids
• New, severe hip or groin pain
• Visual change
• Severe mood disturbance
• Skin problems that keep returning whenever a cream is stopped

This article is general health information. Steroids should only be taken on the prescription of a qualified doctor, and never stopped abruptly after a prolonged course.