From : http://www6.infi.net/~cwt/steroids.txt S T E R O I D H A Z A R D S A Brief Anthology January 1994 C. W. Tazewell, Editor STEROID HAZARDS Cortisone inhibits the growth of collagen (the material that holds your body together). It actually lowers your blood supply to injured tendons. It decreases immunity... increases your cravings for sweets... causes water retention, blurred vision and insomnia. (1) Corticosteroids are adrenal hormones that ... must be used with caution and only for short periods of time. The side effects of steroids and other immunosuppressants include puffing or rounding of the face, facial hair, acne, weight gain, diabetes, cataracts, osteoporosis, peptic ulcers, and infection, which make prolonged use dangerous. Steroids may shut down the body's own adrenal hormone production.(2) Despite their many uses, steroids cannot cure anything. At best they may relieve symptoms,... PREPARATIONS CONTAINING STEROIDS (CORTISONE) Treating The Skin Steroid creams and ointments are the most commonly prescribed medical treatment for eczema, and this has been the case for many years now. When they arrived on the scene thirty or so years ago, these preparations were hailed as saviours of all eczema sufferers, miraculously healing the rash, itch and dry skin. Traditional treatments such as tar and zinc pastes, bandaging and herbal remedies mostly went out of the window. With the blessing of the medical profession patients applied steroid preparations for every rash, from the mildest to most severe, often using them as lavishly as they would any face cream or lotion. It was only gradually that dark rumours of side effects began to filter through, and people began to wonder whether the creams and ointments were so harmless after all.... Hidden Threat This, then, should be the age of reason as far as the treatment of eczema with steroid preparations goes. Yet many people are more worried than ever, both by the attitude and actions of certain doctors and by the still unclear but possible threat of side-effects. Basically, the steroids used to treat eczema are laboratory-manufactured hormones which are similar to the cortisol produced naturally by the body to control inflammation. Since eczema is a type of inflammation, it has been found that this artificial cortisol can help keep rash under control. Hydrocortisone, the weakest of the steroid preparations, is simply cortisol which has been produced in a laboratory. Betnovate, Locoid, Dermovate and many other preparations now available are specially formed to be more powerful and may have other ingredients added, including lubricants and antibiotics. If these preparations are used on the site of the inflammation - that is, the skin - they are called topical steroids. Systemic steroids reach organs of the body through the blood and are given by injection or in tablet form by mouth. As the specialist already quoted goes on to explain, there are two main problems associated with excess use of steroids - one is the suppression of the body's own steroid glands, called adrenal suppression, and the other is the thinning of the skin, or atrophy. The suppression of the body's own steroid glands means that the artificial steroids, if absorbed into the bloodstream, might lessen the production of natural cortisol by the body so that if the patient has an infection or shock, such as an operation, there is less resistance. Atrophy develops because steroids weaken and lessen the collagen content of the skin which is its basic support protein. This not only affects the top layer of the skin, the epidermis, but also lower layer of the skin, the dermis. The skin can become thinner so that it cracks and blood vessels become more prominent, giving a flushed appearance, particularly to the face. The loss of collagen can also lead to striae, or stretch marks, which are similar in appearance to the stretch marks of pregnancy. But the first of these side effects, this specialist says, only become a problem when large quantities of a very strong steroid are used over a short space of time. The risk of stretch marks and skin thinning, however, is more complex. This depends not only on the strength and quantity of steroid use, but also on duration of use and site of application. For instance, one should be especially careful when using steroid preparations on the face, in the body folds or on children. Research at this specialist's hospital suggests that weak hydrocortisone does not cause skin thinning, but the risk with other steroids varies according to their potency. The stronger the steroid, the more risk of skin thinning. Even though with the strongest steroid this appears to be reversible in the short term, when used over a period of several years - or even months - then the effects can be permanent. Unknown Precautions So it seems the safe use of steroids depends on both doctors and the people using the preparations being aware of the possible side-effects and sticking carefully by the rules, using only the weakest preparations for as short a time as possible on less vulnerable areas of the body. Unfortunately this is all too often not the case, mainly because, whether out of ignorance or carelessness, many doctors and even skin specialists do not pass on the necessary information to their patients. Mothers are still being prescribed medium to strong steroid preparations for their young babies, and adults are receiving repeat prescriptions for the strongest preparations without clear instructions of how or where to put them.... The trouble for patients if they are not given proper advice is that at present, there is no way they can know the dangers from looking at packets or tubes. These bear no indication of strength and very often no further instructions than the brief: "Apply as directed." Now that hydrocortisone can be bought over the chemist's counter without a prescription, the need for more detailed information has become even greater. But even those who have learned about their correct application still have serious misgivings about using the steroid preparations. Often this is because they are unnecessarily and inappropriately prescribed.... Too many GPs seem to rush to prescribe steroids when some other course of treatment could and should be taken. Too many GPs seem to rush to prescribe steroids when some other course of treatment could and should be taken. In emergency and after other alternative treatments have been tried there is no doubt that steroid preparations can suppress symptoms and ease discomfort, but they should not be the first line of defence. Hidden Effects Another reason for patients and their families to be wary of steroid use is that, in spite of all the assurances to the contrary, it is not certain that all the facts about side-effects are being made clear. For instance. doctors have been saying for years that the greater risks lie with systemic steroids taken internally, and that, used sensibly, topical steroids are safe because, of course, they cannot be absorbed through the skin and into the blood-stream.... ... when the skin is damaged and thin, absorption is possible... (As a layman, I am convinced that almost all substances that touch the skin are absorbed to some degree. Obviously, this is more pertinent with liquids - and with all liquids, creams, lotions, ointments, etc. If it's something you shouldn't drink, be careful about touching it {and breathing its fumes}. Ed.) Steroids are known to have a rebound effect, and if stopped suddenly the eczema will become much worse. Patients often notice, too, that after using a preparation on a small patch of eczema, the patch will come back again twice as big. One preparation, Dermovate, has been proved actually to cause a rash if used around the mouth. There seems to be patient evidence that the skin builds up a type of immunity to preparations, so that even if a weaker one is used to start with, stronger and stronger preparations are needed to keep the rash at bay. The name given to this particular side-effect of some modern drugs is iatrogenic: illness caused by medical treatment. In his book _Diseases of Civilisation_ Brian Inglis gives a whole list of these diseases, and included steroid treatments in all their forms because of the effects they can have. Topical steroid treatments, he points out, can give short-term relief, but they can also do long-term harm and few manufacturers enclose warnings with their products. If they do, then the chemist is likely to take them out with the excuse that "it is up to the doctor what to tell the patient." ... we are trying alternative methods ourselves, such as ultra-violet light (PUVA), bandages impregnated with tar and, most recently, acupressure and massage. It is interesting to see that the best GPs and skin specialists are turning to the more traditional methods of soothing the skin and calming the itch. It is interesting to see that the best GPs and skin specialists are turning to the more traditional methods of soothing the skin and calming the itch. They, too, are concerned about the long-term effects of steroid preparations, particularly among young children, and until these fears have been definitely allayed prefer to keep them to a minimum, or substitute alternatives that are tried, tested and known to be completely safe. (3) CORTISONE-TYPE DRUGS ARE PRETTY MUCH THE SAME Despite their many uses, steroids cannot cure anything. At best they may relieve symptoms, and that can sometimes be lifesaving. In most instances, however, they afford the promise of relief but at the cost of physical and psychological addition. Even though the list of cortisone-type drugs is long, they're pretty much the same, being synthetic modifications of cortisol, a natural hormone. Such steroids are used for an incredible number of diseases and conditions. They are injected into the bruised and battered knees of football players and the elbows of tennis bums in order to relieve the inflammation associated with abused joints. They are taken orally by patients with rheumatoid arthritis to decrease the pain and swelling. They are even used as cancer chemotherapy for children and adults with leukemias and lymphomas. They are also used for a variety of allergic conditions, for preventing tissue rejection in some organ-transplant operations, and, of course, for bronchial asthma. Despite their many uses, steroids cannot cure anything. At best they may relieve symptoms, and that can sometimes be lifesaving. In most instances, however, they afford the promise of relief but at the cost of physical and psychological addiction. Continued use of these medications can produce some very serious adverse reactions such as increased susceptibility to infection by suppressing the body's normal defense mechanisms. Other adverse reactions include increased blood pressure from fluid retention, thinning of the bones, menstrual irregularities, psychological disturbances, complications in diabetes management, growth suppression in children, impaired wound healing, and skin problems. These drugs seem to cause ulcers or make them worse. They may bring on cataracts, produce muscle cramps and weakness, and make people depressed or nervous. Anyone who has taken high-dose steroids for any length of time is truly addicted and can't just stop cold turkey. If you do suddenly stop taking your medication, your body is left defenseless, since your system can no longer manufacture its own supply of this essential hormone. Slow withdrawal under a doctor's care in imperative. Very gradual tapering over a period of many weeks to months is necessary for your body to recover its normal hormonal functions. The really big question is, are the benefits of cortisone-like drugs worth the risk for asthma patients? According to Drs. Vincent Fontana and Angelo Ferrara of the Department of Pediatric Allergy at St. Vincent's Hospital and Medical Center of New York: "The insidious side effects that follow long-term steroid therapy are what concern us, and they should be considered by all physicians. It has been our experience, and certainly the experience of others who have been left with the responsibility of "weaning" children from steroid therapy, that the most disastrous effects of cortisone treatments are not metabolic. The more important iatrogenic effects [illness caused by doctors] are: addiction, the postponement of proper allergic investigations and management, emotional changes, and, last but not least, unresponsiveness of the child to all other anti-asthmatic medications after he has been on steroid therapy for a long period of time... a grave responsibility rests with the physician who starts a child on steroids except in life-threatening situations. After years of steroid therapy, these children are both pulmonary and emotional cripples who ultimately become the responsibility of the convalescent homes." (This is just one example of the problems in the use of just one kind of drug for one disease [asthma in children]. Ed.) In a report prepared by the Drug Committee of the Research Council of the American Academy of Allergy, some startling facts came to light. Of 122 patients, 76 were "steroid dependent." That is, they could have given up the drugs only with great difficulty, if at all. The side-effect rate was 2.44 per patient. This heavy-duty committee concluded, "The Committee does not condone the use of any of the corticosteroids, unless a life-threatening situation is involved. Before corticosteroid therapy is undertaken, every other means of controlling the patient should be attempted. (4) COMMENT BY A SCOTCH DERMATOLOGIST Most people suffering from dermatitis will have had a prescription for one of the topical steroid or cortisone-containing preparations. These have now been in use for more than 20 years and are one of the most important advances made in treating dermatitis this century. The preparations have an anti-inflammatory effect on skin which is red, scaly, moist and sore. The cells from the bloodstream (lymphocytes and neutrophils) which have helped cause the redness and soreness tend to move away from the skin treated with these creams and so the itch is less troublesome. Properly used they are extremely helpful, but like all powerful forms of treatment they carry the risk of possible side-effects, particularly if used over large areas of skin on a young child, or on the thin skin of your face. Signs that the skin has had an overdose of one of these creams include the development of small visible blood vessels on your skin, and stretch marks - as seen in pregnancy - in your body folds. Nowadays these cortisone-containing creams can be divided into four main groups: 1. Weak such as Hydrocortisone. 2. Medium such as Locoid, Eumovate and Haelan. 3. Strong such as Synalar, Propaderm, Betnovate and Valisone 4. Very Strong such as Dermovate and Synalar forte. Your doctor will decide which strength is needed for your skin but if a strong preparation is required, he may well try to switch to a milder preparation at the next visit. Most doctors will try to use as mild a steroid or cortisone preparation as is required to control dermatitis, which is why you receive many changes of prescription. All steroid/cortisone preparations should be used sparingly and a very thin film is all that is required. Often they contain extra substances such as antibiotics to prevent or help clear additional infection - Locoid C, for example. Many of these cause a slight yellow staining of the skin. It is often necessary to use two different preparations at the same time - a mild one would be prescribed for the face and a stronger one for the body. Be careful not to mix the two and use them in the wrong places. (5) SPORTS NUTRITION NUTRITION, NOT STEROIDS, ACCELERATES BODYBUILDING While the prudent bodybuilder moves toward his/her goal with proper nutrition, supplements and weight training, the naive athlete may opt for illegal, anabolic-androgenic steroids (AAS), which are associated with aggressive behavior, crimes against property, and a long list of other potential side-effects, including death.... "Although higher rates of AAS use are reported among competitive athletes, a significant number of recreational athletes, including women, seem to be using these drugs." The authors note that AAS has been associated with harm to the liver, serum lipids and reproductive systems, as well as a suspected impact on glucose tolerance and hyperinsulinism, cerebrovascular accidents, prostatic changes and immune function. While some physicians maintain that weight gained while taking steroids is mostly fluid retention and that any strength gain is largely psychological, other researchers point to more ominous side-effects, such as increased hostility, depression, paranoia, psychotic behavior and irritability. AAS users are more likely to gravitate to other illicit drugs, alcohol and tobacco. Criminal activity is also a possiblity.... Getting back to steroid users, researchers at the Department of Nutrition at Case Western Reserve University and the Cleveland Clinic Foundation in Ohio, reported in the _Journal of the American College of Nutrition_ in 1989, that steroid abuse is associated with an increased risk of developing heart and circulatory problems.... (6) DRUG INTERACTIONS When 1 and 1 May Equal 3 All of sudden, what had been of only theoretical concern became all too real. Readers related horror stories that sent chills up and down my spine. One woman from Orlando, Florida, wrote about her sister: My sister was taking Valium, Lanoxin, Enduron and Emfaseem every day. When her ankles swelled her doctor prescribed Lasix and Inderal. I was with her when she asked the doctor what medication she should stop while she took these new prescriptions. He told her just to add them to the others. She became extremely weak and lost ten pounds of fluid very suddenly, so she went back to her doctor. He just told her to keep taking all the medicine. When she complained that all the drugs were making her feel week and tired, he answered, "If playing bridge and going to the hairdresser means more to you than getting well, then do whatever you like." Naturally she did what her doctor told her. She died a month later, a senile old lady, though she had been an active, outgoing person before. The death certificate just read "cardiac arrest." That only means her heart stopped beating, but I think all those medications killed her. This is only one case, but we received so many other heart-wrenching letters it makes you want to cry. I'll never forget the young mother who was put on Reglan for her heartburn, Asendin for depression, Halcion for insomnia, and Valium for anxiety. This combination turned her into a zombie, barely able to walk or talk. One of her drugs (Reglan) could have brought on insomnia, anxiety, and depression by itself, and could also have produced drowsiness and dizziness. The other medications prescribed to treat the insomnia, depression, and anxiety only added to the problem by increasing her sedation, disorientation, fatigue, and faintness. When a new doctor advised her to stop all medications abruptly, she went through hell and even weeks later was having a terrible time sleeping. (The author continues with "Hospitals Can Be Hazardous to Your Health.") (4) SOME DRUG INTERACTIONS With Cortisone-type Medications Anticonvulsants May require increased dose of steroid, etc. Antituberculosis Probable worsening of steroid-treated condition, need increased steroid dose, very difficult to balance these drugs Aspirin, etc. Steroids reduce levels Barbiturates Reduce effect of steroids, need more Diuretics Causes potassium deficiency Oral Contraceptives Possible steroid toxicity Vaccines Could do you in! From Source (4) INTERNATIONAL DRUG NAME EQUIVALENTS GENERIC NAME UK US beclomethasone dipropionate Propaderm not available betamethasone valerate Betnovate Valisone chlorpheniramine maleate Piriton Chlor-Trimeton clobetasol propionate Dermovate not available clobetasone butyrate Eumovate not available fluocinolone acetonide (0.025%) Synalar Synalar; Fluonid fluocinolone acetonide (0.2%) Synalar Forte Synalar-HP flurandrenolone/ fluradenolide (US) Haelan Cordran hydrocortisone Efcortelan Cortril, Alphaderm Hydrocortone Dermacort, etc Cortril, etc. hydrocortisone butyrate Locoid not available (The source book also lists equivalents in Canada, Australia and South Africa.) (5) [Generic names of cortisone drugs frequently have the endings "sone" and "lone," as in triamcinolone.] A STEROID IS A STEROID IS A STEROID The amount that reaches the bloodstream is one key to the hazards. Before carticosteroid therapy is undertaken, every other means of controlling the patient should be attempted. S O U R C E S (1) HOW TO STAY OUT OF THE DOCTOR'S OFFICE: An Encyclopedia for Alternative Natural Healing, by Dr. Edward M. Wagner (2) PRESCRIPTION FOR NUTRITIONAL HEALING by James F. Balch, M.D. & Phyllis A. Balch, C.N.C. Garden City Park, NY: Avery Publishing Group Inc., 1990, p.232 (3) ECZEMA RELIEF: A Complete Guide to All Remedies - Alternative and Orthodox by Christine Orton. London: Grafton Books, 1990 (4) THE PEOPLE'S PHARMACY by Joe Graedon. NY: St. Martin's Press, 1985, p. 169-170, 229-235, 338-339 (5) ECZEMA AND DERMATITIS: How to Cope with Inflamed Skin by Rona Mackie, MD, FRCP. London: Martin Dunitz Ltd., 1983 (6) BETTER NUTRITION FOR TODAY'S LIVING, Dec. 1993, p. 20-23 Despite their many uses, steroids cannot cure anything. At best they may relieve symptoms,...