Uses of Corticosteroids and Contraindications of Corticosteroids

Corticosteroids

Corticosteroids are broadly divided into Glucocorticoids and Mineralocorticoids.

Glucocorticoids such as cortisol affect carbohydrate, fat, and protein metabolism, and have anti-inflammatory, immunosuppressive, anti-proliferative, and vasoconstrictive effects. Anti-inflammatory effects are mediated by blocking the action of inflammatory mediators (transrepression) and inducing anti-inflammatory mediators (transactivation).



Mineralocorticoids such as aldosterone are primarily involved in the regulation of electrolyte and water balance by modulating ion transport in the epithelial cells of the renal tubules of the kidney.

Glucocorticoids can be : Natural Glucocorticoids (Cortisone, Hydrocortisone, Corticosterone) or Synthetic Glucocorticosteroids (Prednisone, Triamcinolone, Dexamethasone, Betamethasone )

Betamethasone is the most potent glucocorticoid followed by paramethasone and prednisolone.

Uses of Corticosteroids: 


  • In Addisons disease 
  • In allergic diseases like Asthma (betamethasone) 
  • Skin diseases like Exfoliative dermatitis, Psoriasis 
  • and Contact dermatitis. 
  • In autoimmune diseases like Lichen planus, 
  • Erythema multiforme, Pemphigus etc. 
  • In Rheumatoid Arthritis and Rheumatic fever. 
  • Gastro intestinal diseases like ulcerative colitis.

Dental uses: 
  • in severe cases of Desquamative Gingivitis 
  • in autoimmune diseases like Lichen planus, Pemphigus and Erythema Multiforme. 
  • In Oral Submucous Fibrosis. 
Preparations :
i) Cortisone acetate tablets - 50 -400 mg daily 

ii) Hydrocortisone hemisuccinate is readily water soluble and is used as intramuscular, intralesional 
and intravenous infusion. 

iii) Topical corticosteroids 
  • Triamcinolone  ---- 0.2 %
  • Flucinolone   ---- 0.025 %
  • Clobetasol proprionate   ---- 0.05 %
  • Hydro cortisone   ----- 1 %

The very potent topical glucocorticoid is Clobetasol propionate. 

iv) Prednisolone tablet : 10-100mg daily in divided doses. 

Stopping the therapy: While stopping the therapy, the dose should be tapered gradually. Abrupt termination results in adrenal insufificiency. 

Corticosteroids are contraindicated in: 

-- Cushing's syndrome, and 
-- Acute inflammatory diseases like ANUG (Acute Necrotizing Ulcerative Gingivitis) and Herpes (stomatitis, labialis and zoster) infections. 

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