Glucocorticoids
Can Be An Effective Treatment, And Safe To Use Under Guidance

Also known as oral corticosteroids or oral steroids, glucocorticoids, along with injected steroids, are known as systemic steroids.

They are a second line eczema treatment.

They are used when your eczema is severe and widespread. If eczema covers a large area, using topical corticosteroids is impractical. The amount needed and the time it would take to apply it would be huge.

Glucocorticoids can be taken either in tablet or liquid form.

The most common ones used are prednisolone and prednisone.

They work by numbing down the immune system.

An overactive immune system can cause the symptoms of eczema.

They help to reduce inflammation, so helping to break the itch-scratch cycle.

They can be used by adults and children. But must not be used if you are pregnant or breastfeeding.

Glucocorticoids are normally prescribed as a short course, and the lowest dose is used. This dosage will help to clear the worst of it. After that, your regular eczema treatment should be used to keep the eczema under control. Use emollients and topical corticosteroids.

A short course usually lasts between 1-4 weeks. There are not normally any side effects when using them for a short time.

A long course can be prescribed. This usually lasts over 3 months. When glucocorticoids are used long term, a steroid use card needs to be carried at all times.

The longer the course the more likely there are of potential side effects.

Side Effects Of Glucocorticoids

Potential prednisolone and prednisone side effects include

• Osteoporosis. The thinning of the bones, or brittle bones. Can happen because the protein and minerals in the bones are reduced. The spine and hips are prone to fractures. There are ways to reduce the risk. Consume minimal alcohol. Take regular exercise, walking is beneficial. Also taking a calcium and vitamin D supplement can help. If you are at a high risk you may be given bisphosphonates. They are drugs that slow down or stop the thinning of the bones. A DEXA bone scan can be done at the start of the treatment. They are then done yearly or as a doctor advises. This scan measures bone density and shows if fractures may occur

• Weight Gain. Can be due to eating more and/or water retention. Water retention can cause swollen ankles. Even more likely is a puffy face, also known as 'moon face'. To help combat weight gain, eat a healthy diet, take some exercise and drink plenty of water

• High Blood Pressure. Only detected by having it checked. If there is any indication it is higher than it should be, medication can be given. Regular checks are then required. Healthy eating and exercise are also be beneficial

• Diabetes. Not a common side effect. It occurs when the amount of sugar in the blood increases. It can make you feel thirsty and you may go to the toilet very frequently. It is more likely to occur as a side effect if you are at a higher risk of developing it

• Skin Issues. Can cause the skin to heal slower than normal. You may find that you bruise more easily. The skin can also thin, making it more susceptible to damage

• Reduced Immune System. As the effectiveness of the immune system is reduced, it can make it harder for your body to heal after an illness. You may also be more likely to become ill. The main issue is chicken pox. You maybe more susceptible to getting a severe bout. If you come into contact with someone who has chicken pox or shingles, you are advised to see your doctor. If you had it as a child then you will be immune to it

• Changes In Mood. This can happen in both extremes. One person could feel over-active and full of energy. Someone else can feel depressed. Other issues can occur. It is not a common side effect. It will normally appear within the first month of taking the glucocorticoids. With long term use, high doses, some more serious conditions may occur. These include confusion, delusion and feeling suicidal. At any sign of any of these feelings, without delay, visit your doctor

• Reduced Growth In Children. This may happen with very long term use. It is not usually permanent. The child is very likely to 'catch up' and grow to their intended size. As a parent it is likely to be a worry. Your doctor will answer any questions you have

It may seem that there are more negatives than positives to taking glucocorticoids. It has to be remembered that it is only taken if your eczema is very severe. In most cases it is not needed for long periods of time. It tends to clear a flare up quickly, and then other treatments can be used to maintain the condition of the skin.

Finishing Treatment

When coming off the treatment, it must not be stopped suddenly. It has to be gradually reduced. Sometimes over days, and sometimes over weeks. It depends how long the treatment has been taken for.

One of the reasons it is done slowly is because of the body's own natural production of steroid. When a course of glucocorticoids are started the body stops producing it's own.

If the treatment is stopped in one go the body has had no time to make any of it's own. So there is none in the system. This can be dangerous. When the treatment is gradually stopped, the body has an opportunity to start making it's own again.

Prednisolone and prednisone withdrawal symptoms can include

• Low blood sugar
• Low blood pressure
• Diarrhoea
• Sickness
• Tiredness

Never come off the treatment yourself. Only do it on the advice of your doctor. They will monitor your progress.

When looking at using glucocorticoids, it is definitely worth looking into the benefits of the treatment. These could outweigh the potential side effects.

When you are use a stronger dosage and with a higher risk of side effects, it wil be more beneficial for your eczema.

Your doctor or dermatologist is always the best person to talk to. It can be very helpful to get some personal experiences of people who have used them.

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