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Steroids - The Good, The Bad, The Ugly
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Steroids      -      the Good, the Bad, the Ugly

Here are some things you should know about these much maligned medications

WHAT ARE STEROIDS?

They are synthetic version of a group of hormones produced by the adrenal glands which lie just above the kidneys.

There are two main types. The most common are corticosteroids, while anabolic steroids have won a dubious reputation in the world of sport and athletics.

Steroids can dramatically improve a number of physical ailments. But these power drugs need to be used with care.

Corticosteroids are produced by the outer part of the adrenal glands, are regulated by the pituitary gland and are responsible for controlling the body’s reaction to stress and regulating body volume.

The two important ones are

  • Glucocorticoids, which are vital for the utilization of carbohydrates, protein, and fat by the body.
  • Mineralalocorticoids, which regulate the body’s salt and mineral levels.

CAN STEROIDS BUILD MUSCLES?

People are often confused about the two different types of steroids.

Corticosteroids, the type most commonly prescribed, are used to reduce inflammation and suppress the overreaction of the immune system. They do not have a muscle building effect.

Anabolic steroids, which act in a similar way to the make sex hormone testosterone help to build up muscles, which is why they are often used – and abused – by sports people. On the flip side they promote recovery after injury and strengthen bones and may, very occasionally, be prescribed to help recovery after a severe illness or major surgery. But these conditions warrant strict medical supervision. Anabolic steroids can pose serious health risks including liver damage and tumor, adrenal gland damage, infertility, and impotence.

So beware of anonymous powders which promise you a rock-solid body. They could be stuffed with anabolic steroids.

WHAT NAMES DO CORTICOSTEROIDS GO BY?

A wide number of synthetic drugs which mimic the body’s corticoid hormones are available. Beclomethasone, betamethasone cortisone, dexamethasone, hydrocortisone, methyl-predisolone, prednisolone, prednisone, triacinolone, are all glucocorticoids and are among the most frequently prescribed steroids.

Corticosteroids can be inhaled, taken orally, injected, or applied to the skin as creams or ointments.

WHAT IS THE MOST COMMON REASON FOR STEROID TREATMENT?

Asthma. 9 out of 10 people with asthma have a mild form of the disease which can be successfully treated with inhaled steroids in low doses.

WHAT ELSE?

Steroids are also used for a variety of other conditions such as eczema, rheumatoid arthritis, Crohn’s disease (stricture in the bowel), kidney and liver disease, blood cancer, multiple sclerosis, and to prevent transplanted organs being rejected. Very low doses are also available in OTC ointments for problems such as mild eczema and dermatitis.

HOW DO STEROIDS WORK?

The major action of steroids and the reason they help so many different conditions is that they are strong anti-inflammatorily. As they suppress the immune system, they restrict the population and activity of the white blood corpuscles, the body’s fighter cells that accumulate in the area affected by disease or injury and which often cause the inflammation.

At the same time they block the actions of prostaglandin's, chemicals that trigger inflammation and pain.

CAN STEROIDS CURE INFECTIONS?

No, On the contrary steroids slow down the immune responses. This is very useful in the case of certain autoimmune diseases such as rheumatoid arthritis and in organ transplants, where they are used to stop the body from rejecting the new organ. However, they can leave patients more susceptible to infection by preventing the body from fighting off germs.

WHAT ABOUT STEROID OINTMENTS?

They can be very effective at treating conditions such as eczema, but need to be used with care. The ointments should not be used on the face, on broken or infected skin, or around the genitals. Use a product with the least steroid and apply thinly. Symptoms may worsen if treatment is suddenly stopped, so reduce dosage gradually.

Never use a steroid cream for dry skin. This can make it thinner and more fragile, causing blood vessels to become visible, bruising to occur more easily, and hair growth to increase.

AND EYE DROPS WITH STEROIDS?

Steroid eye drops should only be used for certain conditions, under an ophthalmologist’s prescription. The danger is that by interfering with local defense mechanisms, they may either aggravate an existing eye infection, specially when it is due to a virus or fungus, or weaken your eye’s ability to fight infection and repair injuries. For example, Pyrimon eye drops (containing dexamethasone) which are freely bought across a chemist’s counter during a conjunctivitis epidemic are contraindicated in the viral form (nobody knows whether specifies red eyes are caused by bacteria or virus) and may lead to glaucoma, cataract, or fungal infections.

DO STEROIDS ALWAYS CAUSE UNWELCOME SIDE EFFECTS?

Used correctly steroids are quite safe and have minimal side effects. As with many other drugs, their side effects are related to the dose and length of time they are used. With mild asthma, for example, low doses of inhaled steroids are used and hardly any medication gets into the bloodstream, so the risk of side effects is very low. There may be a slight throat irritation or husky voice due to the growth of candid in the back of the throat as a result of the lowered immune response. People with moderate to severe asthma who may be taking higher doses of inhaled steroids together with short courses of steroid tablets may have an increased appetite. However, even with these side effects, taking steroids is still much safer than taking no medication, which carries the risk of death from an asthma attack.

With oral steroids there is also a risk of erosion in the stomach and duodenum which may lead to ulceration and bleeding. In these cases the steroids are given with a preparation called misoprostol which helps to protect the linings of the stomach and duodenum.

With steroid ointments some areas of the body such as the face and the genitals are more difficult to treat than others and may be more susceptible to side effects.

HOW CAN YOU MINIMIZE SIDE EFFECTS?

  • By taking as low as possible a dose, for as short a time as possible.
  • By asking whether you can use an alternative drug.
  • By using it locally, by way of an inhaler or injection rather than by a tablet, which affects the whole body.

WHAT ABOUT LONG TERM USAGE?

Strong doses should not be used for any length of time.

Long term use of large steroid doses can cause serious complications such as stunted growth in children; osteoporosis (bone thinning) caused by slower calcium absorption; diabetes due to suppression of insulin activity; acne; raised blood pressure; muscle weakness; weight gain caused by metabolic malfunctioning; bloating due to sodium and fluid retention. Mental effects can include depression, insomnia, irritability, and artificial feelings of elation.

Since high doses can reduce the body’s ability to protect itself resulting in serious infection, see your doctor if you develop a fever, diarrhea, or start vomiting.

WHEN IS LONG TERM STEROID TREATMENT NECESSARY?

Permanent treatment with steroids is essential for life to continue in cases where the adrenal glands above the kidneys are not functioning properly or have failed entirely. The most common form of this condition is known as Addison’s disease, which is probably caused by an autoimmune response, in which the body turns against itself. Addison’s disease can be fully controlled by treatment with cortisone or hydrocortisone taken by mouth.

HOW DO YOU STOP STEROID TREATMENT?

Very gently, or there may be a rebound effect.

If you’re been on steroids for a few weeks your body will stop producing the relevant natural hormones. If you suddenly stop, your body will be short of these vital hormones with potentially fatal results. It’s important to reduce the dosage gradually over several months to start producing hormones again before stopping entirely. However this rule does not apply to medium or low doses of steroids which have been taken for less than a week. If you’re been taking tablets for over a month you should carry a steroid warning card, as you may need additional steroids, if for example you need emergency surgery.


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