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Topical corticosteroids, or steroid creams, are medicines that reduce inflammation and irritation when applied directly to the skin. They are commonly used to treat inflammatory skin conditions like eczema, psoriasis, rashes, and dermatitis. While steroid creams are generally considered safe and effective, their misuse or overuse can lead to various side effects, including muscle loss or muscle weakness, also known as corticosteroid-induced myopathy. This condition is caused by the suppression of the immune system and the subsequent reduction in inflammation, which can lead to a decrease in muscle mass and strength.
| Characteristics | Values |
|---|---|
| Cause of muscle loss | Prolonged treatment with steroid creams can lead to hypocalcemia or low levels of calcium in the blood, which may cause muscle cramps |
| Type of steroids | Corticosteroids, anabolic steroids |
| Conditions treated with steroids | Asthma, chronic obstructive pulmonary disease, inflammatory processes, allergic reactions, poison ivy rash, eczema, psoriasis, rash, dermatitis |
| Side effects | Skin thinning, stretch marks, easy bruising, dilated blood vessels, increased hair growth, red rash around the mouth, acne-like rash, glaucoma, cataracts, stunted growth, elevated blood sugar levels, osteoporosis, endocrine suppression, kidney function suppression |
| Treatment for muscle loss | Taper steroids, switch from fluorinated to nonfluorinated glucocorticoids, alternate-day dosing, physical therapy, resistance and aerobic exercise |
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What You'll Learn
Steroid creams suppress the immune system
Steroids are often prescribed to treat inflammation caused by injuries and various health conditions. They are synthetic drugs that work similarly to cortisol, a hormone produced by the adrenal glands. Cortisol prevents the immune system from producing substances that cause inflammation.
Steroid creams, also known as topical corticosteroids, are a common way to administer steroids locally to a targeted area of the body. While these creams are generally considered safe and effective, they can, in rare cases, cause side effects, especially with overuse.
Topical corticosteroids suppress the immune system by slowing down the production of chemicals that cause inflammation. This can be beneficial in treating allergic reactions or severe rashes, but it can also increase susceptibility to infections. Prolonged use of oral corticosteroids (OCSs) has been linked to immunosuppression, making individuals more prone to opportunistic infections, especially those with underlying health conditions.
The suppression of the immune system by steroid creams can have both local and systemic effects. Local immunosuppression can lead to skin thinning, stretch marks, easy bruising, and dilated blood vessels. If strong steroids are used continuously for extended periods, the body can absorb enough of the drug to cause more widespread side effects, including elevated blood sugar levels, osteoporosis, and increased susceptibility to infections.
It is important to note that the risk of side effects from topical corticosteroids is typically lower than with other forms of steroid administration, such as injections or oral medications. Consulting a healthcare provider is essential to determine the appropriate strength and duration of treatment to minimize potential adverse effects.
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Long-term use can cause the drug to enter the bloodstream
Topical corticosteroids are a type of steroid medicine applied directly to the skin to reduce inflammation and irritation. They are available in a variety of strengths, and most adults and children can use them safely. However, it is important to exercise caution when using topical steroids, as abusing them could lead to a host of side effects, especially when used on areas like the face and genitalia.
Long-term use of potent or very potent topical corticosteroids can result in the medicine being absorbed into the bloodstream, leading to internal side effects. This occurs when the steroids are used continuously for long periods, allowing the body to absorb sufficient amounts of the drug to cause systemic effects. The risk of absorption into the bloodstream is higher when the steroids are used over a large area of the body or when the cream has a higher concentration.
The side effects of long-term steroid use can be serious and may include stunted growth, elevated blood sugar levels, and osteoporosis. Additionally, steroid myopathy, a condition characterized by muscle weakness, can develop as a result of an excess of endogenous or exogenous corticosteroids. This condition typically affects the proximal muscles of the upper and lower limbs and the neck flexors. The risk of developing myopathy is influenced by age, gender, and obesity status, with older individuals, males, and those with obesity being at higher risk.
To minimize the risk of side effects associated with long-term steroid use, it is important to use the appropriate strength for the specific problem and location on the body. Patients should follow the directions provided by their doctor or the patient information leaflet that comes with the medicine. In some cases, a steroid treatment card may be provided to help patients understand how to reduce the risk of side effects. Additionally, physical therapy, including aerobic and resistance exercises, can be effective in modulating muscle atrophy and improving skeletal muscle strength in patients with corticosteroid-induced myopathy.
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This can lead to hypocalcemia, or low calcium in the blood
Steroid creams, or topical corticosteroids, are medicines that reduce inflammation in the body. They are often used to treat skin conditions and allergic reactions. While they are usually safe, long-term use or overuse of steroid creams can lead to side effects, including skin thinning, stretch marks, easy bruising, and dilated blood vessels. In some cases, using strong steroids continuously for extended periods can result in body-wide side effects, such as stunted growth, elevated blood sugar levels, and osteoporosis.
One potential but rare side effect of steroid use is hypocalcemia, or low calcium in the blood. This condition can have serious health implications. While glucocorticoids, a type of steroid, are known to negatively affect calcium balance, they typically do not cause clinically significant hypocalcemia. However, in certain individuals, particularly those with hypoparathyroidism, steroid-induced hypocalcemia can occur. Hypoparathyroidism is a condition characterized by impaired parathyroid hormone function, which is crucial for maintaining calcium balance in the body.
Several case reports describe individuals who developed symptomatic hypocalcemia after receiving steroid treatments. For example, a young woman with post-surgical hypoparathyroidism experienced hypocalcemia following intravenous hydrocortisone treatment for allergic reactions. Another case involved a 7-year-old girl with hypoparathyroidism who maintained normal calcium levels with oral vitamin D and calcium supplementation but developed marked hypocalcemia after being administered prednisolone for aplastic anemia. Similar cases have been reported in adults with and without hypoparathyroidism who experienced hypocalcemia after receiving high doses of steroids for various medical conditions.
The mechanism behind steroid-induced hypocalcemia is related to the negative impact of glucocorticoids on calcium balance. Glucocorticoids interfere with the normal regulation of calcium by the parathyroid hormone, leading to a decrease in calcium levels. This disruption in calcium balance can result in hypocalcemia, especially in individuals with impaired parathyroid function or other underlying conditions.
The treatment for steroid-induced hypocalcemia typically involves discontinuing the steroid medication and providing intravenous or oral calcium supplements to restore normal calcium levels. In some cases, vitamin D supplementation may also be recommended to support calcium absorption and maintain healthy calcium levels. It is important for individuals taking steroids, especially those with hypoparathyroidism or other risk factors, to be monitored for signs and symptoms of hypocalcemia to ensure prompt treatment and prevent potential health complications associated with low calcium levels.
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Steroid myopathy can cause muscle weakness
Steroid myopathy, or corticosteroid-induced myopathy, is a toxic non-inflammatory myopathy that occurs as an adverse effect of prolonged oral or intravenous glucocorticoid use. It was first described in 1932 by Harvey Cushing, who observed it as part of a constellation of symptoms seen in Cushing syndrome. Cushing syndrome itself can be a complication of chronic steroid use, and its stigmata include moon facies and fat redistribution.
Steroid myopathy causes muscle weakness, predominantly affecting the pelvic girdle muscles, as well as the proximal muscles of the upper and lower limbs and the neck flexors. On physical examination, studies have shown that up to 20% of patients exhibit objective signs of muscle weakness, while a subjective feeling of weakness occurs in 60%. Steroid myopathy can also cause muscle atrophy, which may be severe, even when the muscles appear normal in size.
The condition is believed to be caused by an excess of either endogenous or exogenous corticosteroids. Excess endogenous corticosteroid production can arise from adrenal tumours, while excess exogenous corticosteroid can result from steroid treatments for conditions such as asthma, chronic obstructive pulmonary disease, polymyositis, connective tissue disorders, and rheumatoid arthritis. Additionally, long-term use of topical steroids on the face may cause a red rash around the mouth or an acne-like rash.
The risk of developing steroid myopathy is influenced by individual factors, with older age, male gender, and obesity being associated with a higher risk. Furthermore, higher doses of steroids are more likely to induce clinical myopathy.
Treatment for steroid myopathy typically involves tapering or discontinuing the use of steroids. Improvement in muscle weakness is usually observed within 3 to 4 weeks of tapering steroids, although full recovery can take months to a year. In some cases, switching from fluorinated glucocorticoids like dexamethasone to nonfluorinated glucocorticoids like prednisone can be beneficial. Physical therapy, including resistance and aerobic exercises, is also effective in treating and preventing muscle weakness and atrophy associated with steroid myopathy.
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There are withdrawal symptoms when stopping steroid use
While steroid creams are typically used without side effects, they can, in rare cases, cause muscle loss. This is due to corticosteroid-induced myopathy, a rare condition that can be caused by the long-term use of steroids. Corticosteroid-induced myopathy is a toxic, non-inflammatory myopathy caused by exogenous corticosteroids. This condition is almost always reversible, but it can take months to a year to recover, even after discontinuing steroid use.
Steroid creams are not the only way steroids are administered, and there are withdrawal symptoms associated with stopping steroid use. Steroids can be addictive, and it is important to slowly reduce, or taper, the dose over time. Abruptly stopping steroid use can trigger withdrawal symptoms, including mood swings, fatigue, restlessness, achy muscles, depression, and decreased appetite. In addition, if steroids were being used to treat an illness, those symptoms may return.
The severity and duration of withdrawal symptoms depend on the length of steroid use and the dosage. Withdrawal symptoms can vary in intensity and may last from a few days to several months. In some cases, steroid withdrawal can cause serious health complications, such as electrolyte abnormalities, dehydration, and other symptoms that can lead to further health problems. Therefore, it is important to work with a medical professional when discontinuing steroid use.
To prevent and treat steroid withdrawal, it is recommended to stay hydrated, eat a balanced diet, and engage in light physical activity. In some cases, supplementation may be needed for up to a year after discontinuing steroid use. For those struggling with anabolic steroid misuse, underlying body image problems or depression may have contributed to substance use, and it is important to seek rehabilitation and psychotherapy to address these issues.
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Frequently asked questions
Steroids are man-made versions of testosterone, a male sex hormone that helps build bigger muscles. They are often prescribed to treat conditions that cause swelling and inflammation in the body.
Steroid creams, also known as topical corticosteroids, are applied directly to the skin to reduce inflammation and irritation. They suppress the immune response of the body, preventing inflammation at the site.
Most topical corticosteroids are safe to use and do not cause side effects, especially when used for a short time or at a low dose. However, overuse or prolonged treatment with steroid creams can lead to skin thinning, stretch marks, easy bruising, increased hair growth, and even neurological problems.
Prolonged use of steroid creams can lead to hypocalcemia, or low levels of calcium in the blood, which can cause muscle cramps and weakness. Additionally, the withdrawal from chronic steroid use can result in muscle atrophy, which is a decrease in muscle mass and strength.
It is important to use steroid creams as directed by a healthcare professional and to be cautious when applying them to areas like the face and genitalia. If muscle loss occurs, physical therapy with aerobic and resistance exercises can effectively modulate muscle atrophy and improve skeletal muscle strength.
