What Are the Different Types of Systemic Steroids?

A. Reed

All hormones of the adrenal cortex are steroids synthesized naturally from cholesterol which is made in the liver. The adrenal cortex produces three principle hormones, two of which are made synthetically for pharmacologic purposes: glucocorticoids and mineralcorticoids. Glucocorticoids include the hydrocortisones and mineralcorticoids that regulate the metabolism of minerals, particularly useful for balancing fluids and electrolytes. Systemic steroids refer specifically to those produced for systemic effect, stimulating a general response as opposed to a topical steroid administered on the skin in the form of a cream. Steroids acting systemically are either taken orally in tablet or syrup form, or administered through an intramuscular injection; in addition, they can also be given intravenously or as an inhaled steroid.

Inhaled steroids may be taken using a metered dose inhaler.
Inhaled steroids may be taken using a metered dose inhaler.

As drugs used to reduce symptoms of inflammation such as itching and redness, the hydrocortisones include a number of medications indicated for eczema, asthma, and arthritis. This classification of systemic steroids include hydrocortisone, prednisone, and methylprednisolone, all of which are synthesized to behave much like cortisol, a glucocorticoid hormone normally present in minute amounts produced by the adrenal glands. Cortisol increases glucose production and the breakdown of fats. More importantly, it also suppresses the immune response which is accompanied by inflammation and hypersensitivity.

Prednisone is a type of systemic steroid.
Prednisone is a type of systemic steroid.

Dextamethasone and fluocortolone belong to the betamethasone category of systemic steroids. A highly potent medication, dextamethasone is particularly indicated for treatment of allergies, colitis, and autoimmune disorders including lupus, a group of diseases affecting generally all body systems characterized by joint, muscle pain, and fatigue. While fluocortolone is typically used topically in the form of a cream or eye drops, it is also taken orally as tablets in the countries of Germany, Africa, and Turkey. Commonly prescribed for asthma and skin conditions, adverse reactions from fluocortolone may cause symptoms to worsen.

Acetonide systemic steroids include triamcinolone acetonide, a drug most noted for its antipruritic and anti-inflammatory properties. It is indicated for dermatologic conditions, including dermatitis, eczema, and other allergy-related problems. It is most remarkable is its potency, as triamcinolone acetonide is eight times the strength of prednisone and is commonly used in cancer treatment. Available as an inhaler, injection, or in tablet form, patients prescribed this medication orally should take it with milk or a meal as it can cause gastrointestinal upset or they may be instructed to adhere to a specified diet like one containing low-salt or high-protein. Nausea, vomiting, and acne are side effects of using triamcinolone acetate.

Sometimes systemic steroids are prescribed for individuals who have a deficiency in steroid production such as Addison's disease, a condition resulting from adrenal gland damage generally caused by infections or autoimmune disorders. Typically prescribed for the treatment of Addison's disease, fludrocortisone acetate has very potent mineralcorticoid properties and is given to patients for only this purpose. Taken as a tablet, fludrocortisone acetate has some side effects, including sodium retention and increased blood pressure.

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