Professional Documents
Culture Documents
of Steroids
Annie Kung
Specialist in Endocrinology, Diabetes
& Metabolism
Types of Steroids
• Replacement Therapy
• glucocorticoid (hydrocortisone)
• mineralocorticoid (fludrocortisone)
• Anti-inflammatory Therapy
• Short acting: hydrocortisone
• Intermediate acting: prednisolone;
methylprednisolone; triamcinolone
• Long acting: dexamethasone
Chinese Translation for Steroid
From Google; English-Chinese Dictionary
Steroid 類固醇
Corticosteroid類固醇;皮質類固醇;
糖皮質激素;皮質激素
Hydrocortisone副腎荷爾蒙;腎上腺荷爾蒙
Routes of Administration
• Systemic : oral, transrectal, IV, IM
• Local: topical, intranasal, intraocular,
intraarticular
Availability of International Guidelines
on Use of Steroid
• No one-for-all guideline
• Glucocorticoid Replacement Therapy : Guidelines
published by Royal College of Physicians of
London, UK ; not available from Endocrine Society,
USA.
• Systemic Use of Glucocorticoid: Guidelines
available for EULAR (European League for
Rheumatology)
• Local Use of Steroid: guidelines on individual
disease, general guidelines not available
Royal College of Physicians of London Guidelines
on Glucocorticoid Replacement Therapy
• Recommended Daily Dose for Glucocorticoid
• Hydrocortisone (cortisol) 15-30mg
• Cortisone acetate 25-37.5mg
• Prednisolone 5-7.5mg
• Dexamethasone 0.5mg
• Recommended Daily Dose of Mineralocorticoid
• Fludrocortisone 100-200mcg
Monitoring hydrocortisone replacement
• Trigger finger
• Carpel tunnel syndrome
• De Quervain’s tenosynovitis
• Joint Arthritis
• Chronic spinal pain/facet joint pain
• Sacroiliac joint arthritis
• Osteoarthritis
• Rheumatoid arthritis
Side-effects of Steroid Injection Therapy
• Systemic Side-effects • Local Side-effects
• Facial Flushing • Post-injection flare of
• Menstrual Irregularity pain
• Hyperglycaemia • Skin depigmentation
• Suppress pituitary- • Subcutaneous atrophy
adrenal axis • Bleeding
• Emotional upset • Infection
• Anaphylaxis • Steroid Arthropathy
• Tendon rupture/atrophy
• Soft tissue calcification
Frequency of Intra-articular Steroid
Injection
• Prolonged steroid injection is associated with
osteonecrosis
• Injection frequency into major joints in lower
limbs at no less than 3-4 month intervals. This
is based on consensus rather than evidence
• Joint sepsis is a known complication but rare
(1 in 17,000-77,000)
• Injection should be given by trained personnel
Use of Topical Corticosteroids according to
British National Formulary
• Indications: inflammatory condition of the skin other than infection.
• Common indications: eczema, contact dermatitis, insect sting,
eczema of scabies
• Contraindications: infection (bacteria/viral/fungal), rosacea
• Use of systemic and potent steroid in psoriasis should be avoided or
given only under specialist supervision
• BNF Formulary Guide: potency grouped as
Mild/Moderate/Potent/Very Potent
• Potent topical steroid should generally be avoided on the face and
skin flexures except under special circumstances by specialist
supervision
• Intralesional steroid injection should be reserved by severe
cases/localised lesions, eg keloid scars, hypertrophic lichen planus,
alopecia areata
Side-effects with topical Steroid
• Spread/worsening of untreated infection
• Thinning of skin
• Irreversible striae and telangiectasia
• Contact dermatitis
• Perioral dermatitis
• Acne, worsening of acne rosacea
• Depigmentation
• hypertichosis
Caution with Topical Steroid
• No more frequently than twice daily, apply thinly
to the affected area only
• Use the least potent formulation which is fully
effective
• Avoid prolonged use on the face and keep away
from eyes
• Caution in children and during pregnancy
• Suppression of pituitary adrenal axis and even
cause Cushing’s syndrome with prolonged use in
large area