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Corticosteroids: Classification, Mechanism, and Uses

1. Oral Corticosteroids

  • Examples: Prednisolone, Dexamethasone, Methylprednisolone
  • Mechanism of Action: Inhibit inflammation by binding to glucocorticoid receptors and modulating gene transcription.
  • Therapeutic Uses:
    • Acute inflammation (e.g., rheumatoid arthritis)
    • Chronic inflammatory diseases (e.g., asthma, COPD)
    • Allergic conditions (e.g., allergic rhinitis, eczema)
    • Organ transplantation
  • Adverse Effects:
    • Weight gain, fluid retention
    • Hyperglycemia
    • Osteoporosis with prolonged use
    • Cataracts and glaucoma
    • Gastrointestinal ulcers
  • Contraindications:
    • Active infections (e.g., tuberculosis, fungal infections)
    • Severe hypertension
    • Peptic ulcer disease

2. Parenteral Corticosteroids

  • Examples: Hydrocortisone (IV), Methylprednisolone (IV), Dexamethasone (IV)
  • Mechanism of Action: Rapid anti-inflammatory action through binding to glucocorticoid receptors and modulating gene transcription.
  • Therapeutic Uses:
    • Acute exacerbations of autoimmune diseases
    • Severe asthma attacks
    • Shock and adrenal insufficiency
    • Anaphylaxis and severe allergic reactions
  • Adverse Effects:
    • Increased risk of infection
    • Hyperglycemia
    • Cardiovascular issues
    • Gastrointestinal disturbances
  • Contraindications:
    • Active infections
    • Uncontrolled hypertension

3. Inhaled Corticosteroids

  • Examples: Beclometasone, Fluticasone, Budesonide
  • Mechanism of Action: Acts locally on the airways to reduce inflammation and inhibit inflammatory cell activation.
  • Therapeutic Uses:
    • Chronic asthma
    • Chronic obstructive pulmonary disease (COPD)
    • Allergic rhinitis
  • Adverse Effects:
    • Oral thrush
    • Hoarseness
    • Coughing and throat irritation
    • Growth retardation in children (with prolonged use)
  • Contraindications:
    • Hypersensitivity to corticosteroids
    • Active respiratory infections

4. Topical Corticosteroids

  • Examples: Hydrocortisone, Betamethasone, Clobetasol
  • Mechanism of Action: Reduces inflammation by binding to glucocorticoid receptors in the skin, inhibiting inflammatory cytokines and reducing vasodilation.
  • Therapeutic Uses:
    • Dermatological conditions (e.g., eczema, psoriasis, contact dermatitis)
    • Inflammatory skin disorders
  • Adverse Effects:
    • Skin thinning (atrophy)
    • Striae (stretch marks)
    • Systemic absorption and Cushing’s syndrome
    • Contact dermatitis
  • Contraindications:
    • Skin infections
    • Active acne or rosacea
    • Perioral dermatitis