Corticosteroids

Expert review by:

Madeeha Waheed, Oncology Pharmacist at Bupa, Medical Policy Team

Corticosteroids (also known as ‘steroids’) are a type of medicine that help to control many functions in your body. There are various types of corticosteroid, which are used to treat many different medical conditions.

Uses of corticosteroids

Corticosteroids can help to treat conditions that involve inflammation (swelling and redness) or an overactive immune system. These conditions include:

Inflammatory bowel conditions, such as Crohn’s disease and ulcerative colitis.
skin conditions – for example, eczema and dermatitis
allergic conditions and reaction, including hay fever.
respiratory conditions, including asthma and chronic obstructive pulmonary disease (COPD).
conditions affecting your joints such as rheumatoid arthritis and systemic lupus erythematosus.
certain cancers – for example some cancers of the blood (leukaemia).

Your doctor can also prescribe corticosteroids if your body doesn’t produce enough of its own steroid hormones. This can happen in conditions such as Addison’s disease. Corticosteroids can also stop your immune system from rejecting a donated organ if you’ve had a transplant operation. They can reduce the side-effects of some cancer treatments, too.

Although they can be very effective treatments, corticosteroids can also have a lot of different unwanted effects on your body. For more information, see our section on side-effects. Your doctor will recommend corticosteroids only if the benefits are greater than the risks.

How corticosteroids work

Corticosteroids are synthetic (laboratory-made) versions of the steroid hormones that your body makes naturally. They have many different effects in the body.

One of the main ways that corticosteroids work (their mechanism of action) is by reducing inflammation (swelling and redness). They do this by blocking the action of certain substances in your body that cause inflammation. They also reduce the activity of your immune system by affecting a type of white blood cell called a T cell.

These actions mean that corticosteroids can help in medical conditions where there is inflammation, swelling, or an overactive immune system.

Types of corticosteroid

There are different forms of corticosteroid and the form you take depends on why you’re taking them.

Inhaled corticosteroids. You take these using an inhaler to get the medicine directly into your lungs. They’re often used to treat asthma.² One example of this is Qvar, a strong corticosteroid inhaler.
Oral corticosteroids. These come as tablets that you swallow, tablets that dissolve in water, and solutions. The oral medicines are absorbed into the bloodstream so they get to all the different parts of your body.
Topical corticosteroids. The medicine goes directly onto the place where it’s needed to ease your symptoms. You might have creams and ointments for your skin. For example, clobetasol is a very strong corticosteroid cream for some skin problems. Or you might have drops for your eyes, ears, and nose.
Injected corticosteroids. These may be injected directly into your bloodstream if you have a severe flare-up of a condition or need rapid treatment. They also include injections directly into a joint or around a tendon (a tissue that attaches a muscle to a bone). You may have these injections for conditions such as rheumatoid arthritis.
Corticosteroid enemas, foams, and suppositories that you insert into your rectum (up your bottom).

You may have heard the term ‘systemic corticosteroids’. This is another way of saying corticosteroids given orally (by mouth) or by injection into a vein or muscle. Systemic corticosteroids reach all parts of your body. Topical corticosteroids affect only the area of your body where they’re applied.

Corticosteroids come in a variety of strengths. They may be used for different lengths of time and in different doses according to what medical condition you have. You might take a high dose for a very short time to help with a serious or life-threatening complication. Or you could take corticosteroids for a long time at low doses. Your doctor will recommend the type of corticosteroid that is best for you.

Taking corticosteroids

Read the patient information leaflet that comes with your medicine and follow what it says about how to take it. If you have any questions, you can ask your pharmacist or doctor for advice.

Below are some important things to be aware of when taking corticosteroids.

Stopping corticosteroids safely

If you’ve been taking corticosteroids for more than three weeks, don’t stop taking them suddenly unless your doctor tells you to. You’ll usually need to gradually reduce your dose to allow your body’s natural steroid level to get back to normal. This is important because it prevents serious side-effects and stops your condition from returning. Speak to your doctor before you stop taking corticosteroids.

Avoiding infections when taking corticosteroids

Taking corticosteroid tablets for a long time makes it more likely you’ll get infections, especially if you’re taking higher doses. You may also get one of the more severe infections. These include measles, chickenpox , and shingles. Try to avoid close contact with anyone with these infections if you’re taking corticosteroids long term. If you haven’t had these infections before and you’ve recently come into contact with someone who has one of them, contact your GP for advice.

Corticosteroids and vaccines

There are certain vaccines that you shouldn’t have if you’re taking high doses of corticosteroids. This includes the flu vaccine. You may need to wait for three months after you’ve stopped corticosteroid treatment to have these vaccines. This delay doesn’t include the COVID-19 vaccination though. It’s safe to have the COVID-19 vaccination if you’re taking corticosteroids. In fact, if you’re taking corticosteroids that give you a weaker immune system, you should be in a priority group for COVID-19 vaccination.

If you need any vaccinations, tell the doctor or nurse about your steroid treatment. They can then talk to you about whether to have that particular vaccine at that time.

Corticosteroids and diabetes

If you have diabetes, taking oral corticosteroids can cause your blood sugar levels to go up. Discuss with your doctor or your diabetes team the best way to manage this. If you take medicines for diabetes, you may need a higher dose while on corticosteroids or you may need to start having insulin injections. You may be able to stop this once your corticosteroid treatment ends. Please speak to your doctor before stopping any corticosteroids.

Corticosteroids and pregnancy

Let your doctor know if you’re pregnant or there’s any chance of you becoming pregnant. Some corticosteroids can reach your baby – particularly those you take by mouth. Taking steroid tablets many times or for a long time may affect your baby’s growth, so this will be monitored carefully.

Short-term steroids and inhaled steroids don’t seem to have this effect. Your doctor will recommend corticosteroids in pregnancy only if the benefits are greater than the risks. You and your doctor can discuss the benefit of taking corticosteroids versus the risks. You will have regular checks on your baby’s growth when you go for your pregnancy scans.

Your doctor is likely to recommend you take only low doses of corticosteroids if you’re breastfeeding. This is because small amounts may get into your breast milk.

Steroid treatment cards

Your doctor or pharmacist may give you a steroid treatment card to carry. This shows the details of what you’re taking, the dose, and for how long. Show the card to anyone who gives you medical treatment. They’ll then know you’re taking these medicines and can take that into account when planning any other treatment with you.

Interactions of corticosteroids

Corticosteroids can interact with a lot of other medicines. This means different treatments may affect each other, making the actions stronger or weaker. These medicines include

anticoagulants (‘blood thinners’).
certain anti-arrhythmic drugs.
diabetes medicines.
epilepsy drugs.
HIV treatments.
non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.

This tends to be more of a problem with high doses of corticosteroids and ones you take by mouth (oral corticosteroids).

It’s important that your doctor knows about any medicines you’re already taking when they prescribe you oral corticosteroids. If you’re taking corticosteroids, check with your pharmacist or doctor before you start a new medicine or herbal remedy. If you have a steroid card, always show this to anyone treating you.

Side-effects of corticosteroids

Corticosteroids can cause a range of different side-effects. Your chance of getting side-effects mainly depends on:

the type of corticosteroid – tablets cause more side-effects than inhaled or topical corticosteroids
the dose – the higher your dose, the greater the chance of side-effects
how long and how often you take the medicines – taking them regularly or for a long time makes side-effects more likely

Because of this, your doctor will try to prescribe the lowest dose that works, and for the shortest time.

Side-effects from topical corticosteroids

Topical corticosteroids can cause side-effects in the area where you apply them. You may get a burning or stinging sensation over the treated area for a few days, but this usually passes. Using some of the stronger corticosteroid creams long term may make your skin thinner. Treatment may also cause allergic reactions and stretch marks. You’re unlikely to get side-effects in parts of your body away from where you’re applying the medicine. But this wider effect can happen if you use strong corticosteroids over a large area for a long time.

You’re less likely to get side-effects from topical corticosteroids if you apply a small amount to a small area of skin for a short time.

Side-effects from inhaled corticosteroids

Inhaled corticosteroids can sometimes make you sound a bit hoarse, and can also affect your sense of taste. They can make it more likely you’ll get oral thrush, which is a fungal infection in your mouth. Rinsing your mouth with water after using your inhaler may help to prevent this. Your GP may offer you a spacer device to use with your inhaler, which can help to make side-effects less likely.

As with topical corticosteroids, you’re unlikely to have side-effects affecting other parts of your body. But this can happen if you use high doses for longer.

Side-effects from oral corticosteroids

You may get side-effects from oral corticosteroids if you take them for a long time (more than three weeks) or you need frequent courses. Side-effects can include:

fluid retention
fat build-up, especially around your neck and shoulders, and on your face – causing a puffy, rounded face (known as Cushing’s syndrome)
high blood pressure
osteoporosis (weakening of your bones)
diabetes (you may develop diabetes for the first time or, if you already have diabetes, your condition may get worse)
changes in mood and behaviour
disturbed sleep
thinning of your skin and delayed wound healing
indigestion and stomach ulcers
weight gain
eye problems, including glaucoma and cataracts
increased risk of infections (for more information, see our section on taking corticosteroids)
stunted growth in children and young people

Your doctor will want to check you often if you’re taking long-term oral corticosteroids. They may want to measure your blood pressure and weight regularly. They’ll also check for signs of diabetes, osteoporosis, and eye problems. They may prescribe medicines to help to prevent side-effects – for example, a proton pump inhibitor to protect your stomach.

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The main types of corticosteroids include oral corticosteroids, inhaled corticosteroids and topical corticosteroids. Oral corticosteroids are ones that you take by mouth. Inhaled corticosteroids go straight into your lungs. You apply topical corticosteroids directly to the affected area (eg your skin).

For more information, see our section on types of corticosteroid.

Corticosteroids reduce inflammation and immune activity in your body. This means they can help treat conditions that involve inflammation and an overactive immune system.

For more information, see our section on how corticosteroids work .

Corticosteroids are used to treat health conditions that involve inflammation or an overactive immune system. These include conditions affecting your bowel, skin, and joints. Inhaled corticosteroids can treat asthma and other problems affecting your lungs and airways.

Steroid is just a shorter word for corticosteroid, so there’s no difference between a steroid and a corticosteroid. The term ‘steroid’ might be used to describe a natural hormone in the body. And a corticosteroid might be the laboratory-made version. Cortisol is one example of the body’s natural steroid hormones; it has a role in reaction to stress.

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Content review by:

Markus MacGill, Content editor

Page last reviewed: 31 January 2024
Next review date: January 2027

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