Steroids

"Steroids" refers to two very different groups of medicines. This page is about corticosteroids — powerful anti-inflammatory and immune-suppressing drugs such as prednisolone, dexamethasone, hydrocortisone, betamethasone and inhaled steroids. (Anabolic steroids — the ones linked to bodybuilding — are covered on a separate page.)

Why they are used

• Severe asthma and COPD flare-ups.
• Severe allergic reactions.
• Autoimmune diseases (rheumatoid arthritis, lupus, IBD).
• Some skin conditions.
• Nephrotic syndrome, certain cancers.
• To prevent rejection after organ transplants.
• In critically ill hospital patients (life-saving in some settings, such as severe COVID-19).

Forms

• Tablets (prednisolone, dexamethasone).
• Inhalers (for asthma, COPD).
• Nasal sprays (for allergies, sinus disease).
• Creams and ointments (eczema, psoriasis).
• Injections (joint, muscle, intravenous).
• Eye drops.

Major side-effects of long-term oral steroids

• Weight gain (face, belly, upper back).
• Raised blood sugar; may unmask or worsen diabetes.
• Raised blood pressure.
• Osteoporosis and fractures.
• Cataracts and glaucoma.
• Skin thinning, stretch marks, easy bruising.
• Infections — the immune system is suppressed.
• Mood changes, sleep disturbance.
• Adrenal suppression — sudden stopping after long use can be dangerous.

India-specific cautions

• Over-the-counter steroid skin creams are misused across India for rashes, fungal infections and skin-lightening — they make many conditions worse, trigger resistant fungal infections, and cause permanent skin damage. Use a steroid cream only when a Health Expert prescribes it.
• Hidden steroids in some unregulated ayurvedic, siddha or herbal preparations have been reported — particularly for arthritis and asthma. Unusual rapid relief from such a product is a warning sign.
• Long-term steroid use silently weakens bones — Indian diets often low in calcium and vitamin D make this worse. Ask a Health Expert about supplements and bone monitoring.
• Never stop a steroid course abruptly after more than 2-3 weeks of use — it must be tapered down.

Used correctly, they are life-saving

Short, supervised courses of steroids are safe and effective for many conditions. Inhaled steroids for asthma, in particular, prevent attacks and do not carry the side-effects of tablets. The problem isn't the medicine — it's unsupervised and unnecessary use.