Steroid medicines are used for many different medical conditions. Steroids can be given as creams/ointments (eg, for eczema or dermatitis), as a nasal spray (eg, for hay fever or allergic rhinitis), as inhalers (eg, for asthma), as tablets (eg, for inflammatory bowel disease) or as an injection (eg, for arthritis).
What are steroids?
Steroids are hormones that occur naturally in the body. Steroid medicines are man-made and are similar to the natural hormones made in the body. The type of steroids used to treat disease are called corticosteroids. They are different to the anabolic steroids which some athletes and bodybuilders use. Anabolic steroids have very different effects.
Types of steroids
Steroids come in many different forms. The main types of steroids are:
Oral steroids reduce inflammation and are used for treating many different conditions, including:
- Crohn's disease.
- Ulcerative colitis.
- Multiple sclerosis.
- Adrenal insufficiency.
- As part of the treatment for various cancers.
Topical steroids are used on the skin. See also the separate leaflet called Topical Steroids (excluding Inhaled Steroids).
Topical steroids used for the skin are available as creams, ointments or lotions. Topical steroids are used for various skin conditions. The amount of topical steroid that you should apply is commonly measured by fingertip units. For more information see the separate leaflets called Topical Steroids for Eczema and Fingertip Units for Topical Steroids.
Steroids can also be given as:
- Eye drops to reduce inflammation on the surface of the eye such as caused by uveitis. These should only ever be started by a specialist eye doctor (ophthalmologist) who will usually have used a machine called a slit lamp to look into the back of your eye first.
- Rectal foam or suppositories to treat ulcerative colitis (proctitis) or for Crohn's disease affecting the rectum.
Steroid nasal sprays
Steroid nasal sprays are medicines that are commonly used to treat symptoms of stuffiness or congestion in the nose. They are used most often for allergies of the nose, such as hay fever. They can be bought over the counter at a pharmacy - in general, treatment of hay fever should usually be bought over the counter rather than asking your GP for a prescription. See also the separate leaflet called Steroid Nasal Sprays.
Steroid inhalers are steroids that are breathed in and down into your lungs. Inhaled steroids are mainly used to treat asthma and chronic obstructive pulmonary disease (COPD). For more information see the separate leaflets called Inhalers for Asthma (including Inhaled Steroids) and Inhalers for COPD (including Inhaled Steroids).
Steroid injections can be used for joint problems and rheumatoid arthritis. They can also be used for some conditions affecting soft tissues, like tendon inflammation or tennis elbow. They can sometimes be given at the GP practice, if there is a doctor, nurse or physio there who has had special training to do this. In more complicated situations they may be given in a hospital, using ultrasound guidance. For more information see the separate leaflet called Steroid Injections.
How do steroids work?
Steroids are a man-made version of hormones normally produced by the adrenal glands, which are just above each kidney. When taken in doses higher than the amount your body normally produces, steroids:
Inflammation occurs when the body's immune system responds to injury or infection. When this affects the skin and tissues under the skin then the area can become painful, hot, red and swollen. Inflammation usually helps to protect you but sometimes inflammation can cause harm to your body. Steroids can help to treat inflammatory conditions such as asthma and eczema - they are a type of anti-inflammatory drug.
Reduce the activity of the immune system
The immune system is the body's natural defence against illness and infection. This can help treat autoimmune conditions, such as rheumatoid arthritis, autoimmune hepatitis or systemic lupus erythematosus (SLE), which are caused by the immune system mistakenly attacking the body.
Side-effects of steroids
Steroids don't tend to cause significant side-effects if they're taken for a short period of time or at a low dose. Side-effects are much more common with oral steroids or if you take them for a long time.Side-effects can include:
- Indigestion (dyspepsia).
- Heartburn (acid reflux).
- Increased appetite, which may cause weight gain.
- Difficulty sleeping (insomnia).
- Increased risk of infections, especially viral infections such as shingles or measles.
- Pre-diabetes or type 2 diabetes.
- Weakening of the bones (osteoporosis).
- High blood pressure (hypertension).
- Cushing's syndrome due to excessive steroid in the body, which can lead to various effects on the body, including thinning of the skin, easy bruising and stretch marks.
- Eye conditions, such as glaucoma and cataracts.
- Mental health problems, including:
- Changes in mood (mood swings) and behaviour - eg, feeling irritable or anxious.
A short course of steroids can be taken and then stopped, but if using them for a long time, they must be slowly tapered off rather than stopping suddenly. Speak to your doctor if you are unclear about whether you need to taper your steroids - generally speaking if you have been taking them for more than a week or two, this might be necessary.
Further reading and references
Clinical guideline for the prevention and treatment of osteoporosis; National Osteoporosis Guideline Group (updated September 2021)
British National Formulary (BNF); NICE Evidence Services (UK access only)
Corticosteroids - inhaled; NICE CKS, May 2020 (UK access only)
Corticosteroids - oral; NICE CKS, June 2020 (UK access only)