For what conditions are systemic corticosteroids used?

Corticosteroids belonging to the glucocorticoid class influence the body system in several ways, but they are used mostly for their strong anti-inflammatory effects and in conditions that are related to the immune system function such as:

• arthritis (for example, rheumatoid arthritis),
• colitis (ulcerative colitis, and Crohn's disease),
• asthma,
• bronchitis,
• some situations involving skin rashes,
• allergic or inflammatory conditions involving the nose and eyes.

Glucocorticoid corticosteroids are used to treat systemic lupus, severe psoriasis, leukemia, lymphomas, idiopathic thrombocytopenic purpura, and autoimmune hemolytic anemia. These corticosteroids also are used to suppress the immune system and prevent rejection in people who have undergone organ transplant as well as many other conditions.

Fludrocortisone (Florinef), a potent systemic oral mineralocorticoid corticosteroid is used to treat Addison's disease and diseases that cause salt loss as in congenital adrenal hyperplasia. It also is used commonly to treat conditions of low blood pressure (hypotension) although this is not a Food and Drug Administration (FDA) approved indication.

Are there any differences among the different types of systemic corticosteroids?

Corticosteroids differ in their relative amount of anti-inflammatory and mineralocorticoid potency and they are used according to these effects. Among the systemic (oral and injectable) corticosteroids, fludrocortisone (Florinef) has the most significant mineralocorticoid (salt retaining) actions and is best used for this effect despite it's strong anti-inflammatory action.

Other systemically available corticosteroids have mostly glucocorticoid effects, and are used for their anti-inflammatory activities. Examples of these include the naturally occurring hydrocortisone (Cortef) and cortisone, and the synthetic corticosteroids including:

• bethamethasone (Celestone)
• prednisone (Prednisone Intensol)
• prednisolone (Orapred, Prelone)
• triamcinolone (Aristospan Intra-Articular, Aristospan Intralesional, Kenalog)
• methylprednisolone((Medrol, Depo-Medrol, Solu-Medrol)
• dexamethasone (Dexamethasone Intensol, DexPak 10 Day, DexPak 13 Day, DexPak 6 Day).

Among all glucocorticoids, prednisone is not effective in the body unless it is converted to prednisolone by enzymes in the liver. For this reason prednisone may not be very effective in people with liver disease because of a reduction in their ability to convert prednisone to prednisolone.

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