She was a middle aged woman with chronic arthritis. Her main problem was weight gain in recent time and intermittent swelling. Reason for her problem was taking corticoids for several years intermittently for arthritis.

Corticosteroids are hormones produced by adrenal medulla, a small gland situated over the kidneys. The corticosteroid hormones have multiple functions in the body. They help in regulation of blood pressure, and fight against allergy and inflammation. Due to their beneficial properties, corticosteroids are manufactured synthetically and used for various medical conditions. They are available as tablets, injections, syrup, inhaler and ointments (that is to say, in various forms). They are very useful for conditions like severe allergy, eczema, bronchial asthma and rheumatoid arthritis. But continuous use for a long time tends to produce various adverse effects in the body.

Corticosteroid medications are easily available and are not very expensive. At some point an individual would have been prescribed prednisolone or some other corticosteroid and would have had benefitted from it. Thus after that whenever any similar problem occurs, the person may buy it directly from the pharmacy without realising that repeated use of this drug can be harmful. People at large are ignorant about the adverse effects of long term use of corticosteroids.

Corticosteroids tend to reduce the immunity of the body making one more susceptible to infections. Even when used locally in the form of ointments or spray, there is increased risk of local fungal and bacterial infections, after chronic use for a long time.

These drugs promote retention of salt and fluid in the body. Therefore, chronic use results in swelling over face and body. One gains weight and can develop hypertension. Chronic cardiac failure is induced or aggravated. Glaucoma (increase in the intraocular pressure), can be induced in the eyes.

There is also bruising over the body due to increased fragility of capillaries causing capillary bleeding.

Corticosteroids tend to cause resistance to the insulin present in the body, thus causing or aggravating diabetes mellitus.

Osteoporosis resulting in joint pains and spontaneous fractures occurs as long term side effect. The most significant effect of steroids is dependence. If an individual has taken corticosteroids for a long time for some chronic condition like asthma, body becomes resistant to effects of other drugs and responds to corticosteroids only.

Thus they have to take these drugs repeatedly and develop more side effects. It is because of this dependence on exogenous steroids, that a person can develop low blood pressure, if he discontinues use of steroids suddenly. This may be severe enough to cause symptoms like dizziness and falling down on standing up or with change of posture.

Women should be cautious while buying cosmetics. Many creams and lotions used for acne or blemishes problems contain corticosteroids like betamethasone or beclomethasone along with other chemicals. They provide improvement temporarily but long term use can lead to thinning of skin and local infections.

Considering all these side effects of corticosteroids, it is important that people should be aware of their uses and also side effects. They should be used judiciously and under medical supervision. In some situations, their use is unavoidable. Here also, it is better to use them in local form to avoid effects on entire body. Like a person suffering from chronic asthma can use corticosteroid inhaler instead of tablets. The use should be for minimal duration possible . If one has used corticosteroids for long time, they should not be stopped suddenly. The dose should be tapered gradually.

It should be understood that using these drugs for necessity is like magic in a sickness, but chronic use can be harmful.

Dr. Rachna Pande is a specialist in internal medicine at Ruhengeri Hospital