Glucocorticosteroids systemic

Author:Prof. Dr. med. Peter Altmeyer

Last updated on: 21.12.2021

Synonym(s)

Corticosteroids; Glucocorticoids systemic; Systemic glucocorticoids; Systemic glucocorticosteroids; System steroids

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DefinitionThis section has been translated automatically.

Hormones of the adrenal cortex, which have a particular effect on carbohydrate and protein metabolism. S.a.u. Cushing's Threshold.

Half-lifeThis section has been translated automatically.

1,7 h (cortisol), other half-lives apply to the fluorinated and/or methylated cortisol derivatives.

IndicationThis section has been translated automatically.

Glucocorticoids are used in dermatology for a number of clinical pictures in acute or long-term therapy.

Limited indicationThis section has been translated automatically.

Severe infections (only with simultaneous causal therapy), recent myocardial infarction, chronic inpatient psoriasis vulgaris, psychosis in the medical history, pregnancy 1st trimester (danger of cleft palate), lactation (growth inhibition possible), tuberculosis in the medical history (danger of reactivation).

Pregnancy/nursing periodThis section has been translated automatically.

In a meta-analysis (9 case-control studies), a dose-response relationship was demonstrated with regard to the use of glucocorticosteroids in pregnancy and low birth weight. The risk for low birth weight was increased if the pregnant women took more than 300 g of a potent glucocorticosteroid during the entire pregnancy. This side effect was not detectable with moderately and weakly active glucocorticoids.

Undesirable effectsThis section has been translated automatically.

Glaucoma, cataract, leukocytosis, amenorrhea, Cushing's syndrome, weight gain, menstrual disorders, metabolic alkalosis, edema, oligospermia, allergic reactions, petechiae, ecchymosis, skin atrophy, striae cutis distensae, acne, wound healing disorders, Increase in blood pressure, thrombosis, NNR insufficiency, susceptibility to infection, depression, pseudotumor cerebri, headache, sleep disorders, arthralgias, aseptic bone necrosis, myalgias, osteoporosis, spontaneous fractures, gastrointestinal ulcers, pancreatitis.

ContraindicationThis section has been translated automatically.

Glaucoma, 8 weeks before to 2 weeks after vaccination, severe osteoporosis, poliomyelitis (exception: bulbar encephalitis), systemic mycoses, duodenal ulcers, varicella;

crystal suspension: children < 6 years

LiteratureThis section has been translated automatically.

Chi CC et al.(2016) Safety of Topical Corticosteroids in Pregnancy. JAMA Dermatol 152:934-935.

TablesThis section has been translated automatically.

Glucocorticoid effects at therapeutic doses

Antiproliferative effect	Suppression of fibroblast formation and collagen synthesis (growth inhibition may result in children)
Anti-inflammatory effect	Reduction of local capillary permeability and vasodilation
	Reduction of leukocyte adherence to the vascular endothelium
	Reduction of leukocyte chemotaxis and migration
	Inhibition of phagocytosis capacity of granulocytes and macrophages
	Inhibition of granulocyte and macrophage accumulation at the site of inflammation
	Inhibition of macrophage bactericidal activity
	Inhibition of macrophage response to various lymphokines (e.g. IFN)
	Inhibition of IL-1 production by macrophages
	Inhibition of arachidonic acid metabolism by macrocortin-mediated phospholipase A2 inhibition
Immunosuppressive effect	Induction of lymphocytopenia and monocytopenia by redistribution
	Decrease in CD4/CD8 ratio due to greater decrease in CD4+ than CD8+ cells
	Decrease of B cells
	Increase of NK cells
	Decrease in serum IgG concentration (catabolism, decreased production, reduced primary response)
	decreased antigen processing by antigen presenting cells
	inhibition of IL-1 action on antigen-activated T cells
	Inhibition of IL-2 and IFNγ production by T cells.
	Decreased T cell proliferation to mitogens, antigens and alloantigens.
	Suppression of delayed-type immune response.

Effective potency of commercially available glucocorticosteroids.

Glucocorticoid	Trade name	Plasma protein binding (%)	HWZ (min.)	Relative glucocorticoid potency1	Cushing's threshold dose (mg/day)	relative mineralocorticoid potency1
Betamethasone	Celestamine, Celestan	67	300-400	30	1	0
Cloprednol	Synthestan	85	110-126	8	3,75	0,6
Cortisol (hydrocortisone)	Ficortril, hydrocortisone	87	78-96	1	30	1
Cortisone	Cortisone CIBA	88	80-95	0,8	40	0,8
Deflazacort	Calcort	65	110-135	3	10	< 0,5
Dexamethasone	Fortecortin	75	201-255	30	1	0
Fluocortolone	Ultralan	89	58-92	5	6	0
6α-methylprednisolone	Urbason	62	141-168	5	6	0
Prednisolone	Predni Hexal, Decortin H, Solu-Decortin H	87	162-240	4	7,5	0,6
Prednisone	Decortin, Prednisone Hexal, Rectodelt	87	162-240	4	7,5	0,6
Budesonide	Entocort	80-90	120-216	9,4	3	0
Triamcinolone	Berlicort, Delphicort, Volon	42	160-300	6	5	0

Indications of systemic glucocorticoids in dermatology (according to Niedner)

Diagnosis	Initial daily dose (mg prednisolone equivalent)	Duration of therapy (weeks)	Maintenance dose (mg prednisolone equivalent)	Duration of maintenance therapy (weeks)
Acute febrile neutrophilic dermatosis	40-80	1-3 days	10-20	Weeks
Alopecia areata totalis	20-40	2-3	5-7	4-26
Arteritis temporalis	120	2-3	10-15	1-2 years
Medicinal exanthema	60-80	few days	-	-
M. Behçet	60	1-2	5-10	Months
Bullous pemphigoid	60-100	1-3	10	Months
Cheilitis granulomatosa	40-60	1-2	Reduction	over weeks
Dermatitis herpetiformis	20	weeks to months (dapsone is better)	< 10	Weeks-Months
Dermatomyositis	80-100	2-4	15	1-2 years
Pressure urticaria	30-40	according to course	5-15	Weeks-Months
Dyshidrosis	40	1-2	5-15	months if necessary
Acute toxic contact dermatitis	40-60	Days	-	-
Allergic contact dermatitis	40-60	1-6	-	-
Seborrhoeic eczema	40-60	1-3 (+ antimycotic)	-	-
Microbial eczema	40-80	2-5 (+ antibiotic)	-	-
Atopic eczema	40	1-2	< 15	Weeks-Months
Eosinophilic fasciitis	60	4-6	10-20	Weeks
Epidermolysis bullosa group	60-120	1-2	5	Weeks
Erosive pustular dermatitis d. Scalp	60-100	1-2	10-15	Weeks
Erythema exsudativum multiforme	60-80-100	1-3	-	-
Erythema nodosum	40-80	1-2	-	-
Erythroderma	80-120	up to 6	5-15	Months
Granuloma anulare	30-40	2	5-15	Weeks
Hemangioma	1.5 mg/kg bw	2	-	-
Herpes gestationis	10-40	until healed	-	-
Herxheimer reaction	40	once	-	-
IgA linear dermatosis	40-60	1-2 months	5-10 (+ dapsone)	Weeks
Impetigo herpetiformis	60-120	according to clinic	-	-
Lichen planus exanthematicus	15-30	3	< 10	weeks
Lupus erythematosus, chronic discoid	60	few weeks	-	-
Lupus erythematosus, subacute cutaneous	60-80	1-2	5-10	months
Lupus erythematosus, systemic	100-200	some weeks	5-15	Months-Years
Mycosis fungoides	40	2	< 10	Months
Panarteritis nodosa	80-120	2	10-20	Months
Parapsoriasis	20-40	2	5-10	Weeks
Pemphigus vulgaris	100-200-400	6-10	< 10	Months-Years
Pityriasis rubra pilaris	20-40	2	5-10	Weeks
Pseudoallergic drug reaction	60-80	few days	-	-
Progressive syst. Scleroderma	40-60	Weeks-Months	5-15	Months
Pustular psoriasis	40-80	4-6	-	-
Pustulosis acuta generalisata	60-100	1-2	-	-
Pyoderma gangraenosum	60-80	until healing	5	weeks
Quincke's edema	100-200	once	-	-
Relapsing polychondritis	80-100	2-3	25	weeks
Sarcoidosis	40-60	8-12	10-20	Weeks
Sézary syndrome	20-40	> 1 year	10-20	Months-Years
Toxic epidermal necrolysis	500	2-5 days (never longer)	-	-
Vasculitis allergica	20-80	according to clinic	10-20	weeks, rarely months
Scarring mucous membrane pemphigoid	40-120	Weeks-Months	< 10	Week-months

Major interactions of glucocorticoids

Active ingredients	Drug Interactions
ACE inhibitors	Blood formation disorders ↑
Alcohol	Gastrointestinal bleeding
amphotericin B	Hypokalemia, superinfection
Anticholinergics	Intraocular pressure ↑ with long-term therapy
Antidepressants, tricyclic	Psychosis, exacerbation of steroid psychosis
Antihistamines	Intraocular pressure ↑
Coumarins	Coumarin effects ↓, gastrointestinal ulcers.
Diazoxide	Hypokalemia ↑
Cardiac glycosides	Hypokalemia ↑, glycoside toxicity ↑.
Insulin	Insulin action ↓
Laxatives	Hypokalemia ↑
Live virus vaccines	Avoid combination approximately 8 weeks before to 2 weeks after vaccination: increased viral replication, severe reaction possible.
Mesalazine	Gastrointestinal bleeding
Metformin	Metformin effect ↓
NSAIDS	Gastrointestinal ulcers
Pethidine	Reciprocal toxicity ↑ in glaucoma.
Phenobarbital	Glucocorticoid effect ↓ due to increased degradation.
Phenytoin	reciprocal effect ↓, symptom attenuation of phenytoin-induced hepatotoxicity
Primidone	Glucocorticoid effect ↓
Salicylates	Salicylate effect ↓, gastrointestinal bleeding
Saluretics	Hypokalemia ↑
Loop diuretics	Hypokalemia ↑
Sulfonylureas	Sulfonylurea effect ↓
Thiazide diuretics	Hypokalemia ↑
Inactivated vaccines	Avoid combination approx. 8 weeks before to 2 weeks after vaccination, vaccine effect ↓

Authors

Last updated on: 21.12.2021

Author: Prof. Dr. med. Peter Altmeyer