The 11 Types of Corticosteroids and Their Effects
Inflammatory diseases are very common in general society. For example, rheumatoid arthritis affects 0.5% of the world’s population, while asthma occurs in almost 4.5% of people in high-income countries. The different types of corticosteroids are of great help in these and many more clinical conditions, as they have very effective anti-inflammatory and immunosuppressive effects.
There are many types of corticosteroids depending on their active ingredients, and each of them is used differently. Here are the most important ones according to their mechanism and dosage, but keep in mind that each and every one of them must be prescribed by a medical professional. If you want to know more, keep reading.
What are corticosteroids and what are they for?
As indicated by the Navarra University Clinic (CUN), corticosteroids are steroid hormones synthesized in the adrenal cortex. Compounds within this group that are produced normally in the human body are aldosterone and hydrocortisone (cortisol), each with a number of specific functions.
Corticosteroids, whether synthetic or natural, perform their physiological function through various mechanisms. In general, their effects are anti-inflammatory, immunosuppressive, metabolic as far as carbohydrates and proteins are concerned, and they also cause electrolyte, blood and nerve changes. There are 2 types depending on their functionality:
- Glucocorticoids: bind to the cellular glucocorticoid receptor and regulate the metabolism of proteins, fats, and carbohydrates. Beyond macronutrients and their assimilation, they also have anti-inflammatory, immunosuppressive, antiproliferative and vasoconstrictor effects. They are used mainly in autoimmune diseases and in cases of sepsis.
- Mineralocorticoids: Unlike their sister group, mineralocorticoids are more involved in electrolyte regulation and water balance. In other words, they modulate the transport of ions in the renal tubules, which favors the internal homeostasis of the organism.
Synthetic corticosteroids have different degrees of properties to glucocorticoids and mineralocorticoids. In any case, when we talk about these drugs we usually refer to the effect of the first group, that is, anti-inflammatory and immunosuppressive.
According to the Statpearls portal, they are some of the most prescribed drugs in the world, generating $10 billion annually in prescriptions and sales.
Most of the functionality of synthetic corticosteroids is of the glucocorticoid type.
What types of corticosteroids are there?
From a physiological point of view, there are only 2 types of corticosteroids: glucocorticoids and mineralocorticoids. However, we are interested in cataloging the most used active principles within this group according to their range of action: short, intermediate, and prolonged. In the following lines, we’ll show them in detail.
1. Short-acting corticosteroids
Based on the potency and duration of its effect, within this group, we find hydrocortisone, cortisone, corticosterone, 11-dehydrocorticosterone, and 11-deoxycorticosterone. We’ll have a look at the 2 most relevant drugs in detail.
The term hydrocortisone refers to a corticosteroid analogous to cortisol, since it practically only differs from it due to its pharmacological nature (whereas cortisol is synthesized naturally). This drug was patented in 1936 and its use was approved in 1941. Today, it’s the 144th prescription drug.
Hydrocortisone has a low potency, hence it is one of the most commonly used corticosteroids in mild conditions. It should be noted that other synthetic corticosteroids such as prednisolone or dexamethasone are 4 to 40 times more potent than this drug. In any case, it is very useful to reduce inflammation and to alleviate arthritic conditions, skin, blood, kidney, intestine, and thyroid disorders, among others.
It is also the hormone replacement drug par excellence in cases of adrenocortical deficiency. In other words, it replaces cortisol when not enough is synthesized.
Cortisone is a naturally occurring corticosteroid metabolite, but it is also used on a pharmaceutical level. In other words, it is the inactive form of cortisol and differs from it by its mode of action. Therefore, when it enters the body, it must be transformed into cortisol by a type of dehydrogenase enzyme.
Cortisone is applied by several routes, including oral, intravenous, intra-articular, and transcutaneous. Like hydrocortisone, it suppresses several inflammatory mechanisms and acts as an immunosuppressant, reducing pain, swelling, and redness in certain conditions. Cortisone cream is widely prescribed for treating eczema.
2. Intermediate-acting corticosteroids
Within this group, we find some of the most famous corticosteroids, such as prednisone, prednisolone, or methylprednisolone. It is also the one that encompasses the most glucocorticoids, so we will only briefly go through the variants most consumed by the general population. Keep reading.
Prednisone is one of the most famous glucocorticoid drugs and is used to suppress the immune system and reduce inflammatory conditions. It is very useful in diseases such as asthma, chronic obstructive pulmonary disease (COPD), and long-term arthritic pathologies.
This drug was patented in 1954 and began to be used in the United States 11 years later. It is the 21st medication in terms of prescriptions, since in this same region more than 27 million prescriptions are issued annually. Undoubtedly, these data indicate that it is one of the most widely used types of corticosteroids (if not the most).
As indicated by the National Library of Medicine of the United States, prednisone is also used to treat conditions in which the body doesn’t produce enough corticosteroids naturally. It is generally prescribed as a tablet to take orally, but the lowest possible dose is always recommended due to its side effects.
Fluid retention and excess blood glucose in diabetic patients are some of the most common side effects.
Prednisolone is an active metabolite of prednisone, so it’s easy to assume that its uses are quite similar. However, it differs from many other types of corticosteroids in that it is sometimes used to alleviate certain symptoms derived from carcinogenic conditions. According to the Navarra University Clinic, its most common form of administration is through drops of oral intake.
Methylprednisolone is another drug derived from prednisone and hydrocortisone. This drug inhibits the formation of arachidonic acid, a direct regulator of localized muscle inflammation, also affecting immediate and non-immediate responses to inflammatory processes. It can’t be used for long periods of time, because in the long term it causes severe side effects.
Methylprednisolone is associated in the long term with pathologies such as osteoporosis, obesity, glaucoma and psychotic symptoms.
Deflazacort is another of the types of corticosteroids used to reduce inflammation, but it differs from the rest due to one of its specific tasks. As indicated by the United States Food and Drug Administration, this drug is one of the first-line treatments to alleviate the symptoms of Duchenne muscular dystrophy, a serious degenerative disease of the muscles.
Its potency is 70-90% compared to prednisone, but it is much stronger than other corticosteroids already mentioned. For example, 7.5 milligrams of deflazacort is equivalent to 25 milligrams of cortisone and 20 milligrams of hydrocortisone. It has a high therapeutic index, although it also reports certain side effects that cannot be ignored.
2.5 Other intermediate-acting corticosteroids
As we have said, this is the broadest group of corticosteroids of all. As collecting the properties of each active ingredient separately would be too tedious, we present the rest of the representatives and their general use in the following list:
- Triamcinolone: It’s often used as a topical cream to treat eczema, psoriasis, and eye inflammation.
- Paramethasone: This corticosteroid is used in combination with chlorpheniramine. Thanks to their union, a greater antiallergic power is obtained due to the synergy of its components.
- Fludrocortisone: Unlike other drugs mentioned here, this one has a much more mineralocorticoid action than glucocorticoid. Its main use is to promote sodium retention in the body and promote vasoconstriction.
3. Long-acting corticosteroids
In this group, we’re only going to mention two drugs: dexamethasone and betamethasone.
Dexamethasone is one of the most potent types of synthetic corticosteroids on the market. We’ll remind you of a fact we mentioned at the beginning of this list: dexamethasone is 40 times more powerful than hydrocortisone, so it is more effective and aggressive at the same time. It is used to treat the symptoms of multiple sclerosis, brain edema, allergies, inflammatory processes, and shock.
It’s a glucocorticoid with little or no mineralocorticoid action. It works by inhibiting the migration of neutrophils (immune cells) and reducing the rate of proliferation of lymphocytes, which reduces the immune response and therefore inflammatory processes. It also slows the release of cytokines and some prostaglandins.
This drug was first synthesized in 1957, but its use was not approved in the United States until 4 years later. We are interested in reviewing some of its most widespread uses, as it’s a very important corticosteroid with considerable potency:
- Anti-inflammatory: This drug is used in various chronic or severe inflammatory diseases, such as rheumatoid arthritis, bronchospasm, and idiopathic thrombocytopenic purpura. It is also administered in high doses in the emergency room when a patient arrives with an allergic-type anaphylactic shock.
- Cancer: Dexamethasone is used to counteract certain side effects in cancer patients. For example, it acts as an antiemetic that relieves the symptoms of chemotherapy. It also reduces the chances of brain edema appearing in tumor processes in the brain.
- Endocrine problems: When patients with natural corticosteroid deficiencies don’t respond well to prednisone or methylprednisolone, dexamethasone is used.
Despite its great utility, dexamethasone has many side effects. Acne, insomnia, vertigo, weight gain, euphoria, hypertension, nausea, irritability, and cataracts (in long-term treatments) are quite common clinical signs when taking this drug.
Betamethasone is the other type of long-acting corticosteroid par excellence. However, unlike dexamethasone, it is usually administered in the form of creams or sprays, in order to relieve itching, dryness, crusting, and other inflammatory symptoms of the skin. It can also be used orally for various allergic reactions.
Interestingly, studies have shown that creams with 0.05% betamethasone are helpful in treating phimosis. If applied at the right time interval, it can be very effective in avoiding circumcision.
Corticosteroids: a homogeneous group of drugs
As you can see, almost all types of corticosteroids have common anti-inflammatory and immunosuppressive functions. Each of these drugs shines in its own field due to their own individual methods of administration and potency.
Dexamethasone can be used in near-fatal anaphylactic conditions, while hydrocortisone cream is easily prescribed for mild inflammation.
In any case, it is necessary to emphasize that this whole group reports various side effects, as depressing the immune system to alleviate inflammation also leaves the patient somewhat more unprotected. Never take corticosteroids without a prescription and don’t consume them in higher doses and times than those indicated by your doctor.
- Corticoide, Universidad Navarra. Recogido a 5 de septiembre en https://www.cun.es/diccionario-medico/terminos/corticoide
- Hodgens, A., & Sharman, T. (2020). Corticosteroids. StatPearls [Internet].
- Prednisona, Biblioteca Nacional de Medicina de los Estados Unidos. Recogido a 5 de septiembre en https://medlineplus.gov/spanish/druginfo/meds/a601102-es.html
- Prednisolona, Clínica Universidad Navarra (CUN). Recogido a 5 de septiembre en https://www.cun.es/enfermedades-tratamientos/medicamentos/prednisolona
- CENTER FOR DRUG EVALUATION AND RESEARCH ADVANCING HEALTH THROUGH INNOVATION 2017 NEW DRUG THERAPY APPROVALS, FDA. Recogido a 5 de septiembre en https://www.fda.gov/media/110526/download
- Moreno, G., Corbalán, J., Peñaloza, B., & Pantoja, T. (2014). Topical corticosteroids for treating phimosis in boys. Cochrane Database of Systematic Reviews, (9).