Local gks. Characteristics and list of drugs of glucocorticosteroids: rules for the use of hormonal agents in renal diseases. Indications and contraindications

Different groups of drugs are used to treat kidney diseases. One of them is glucocorticosteroids. Medicines have a variety of effects on the body. They are often used as a means of emergency care for complications and exacerbations of diseases.

Glucocorticosteroids (GCS) is a generalized name for hormones produced by the adrenal cortex. This group includes glucocorticoids (cortisone, hydrocortisone) and mineralocorticoids (aldosterone). Today, synthetic corticosteroids are actively used for treatment. But until now, their safety and effectiveness for the body is still being studied, many aspects of use are quite controversial.

Classification and release form

Glucocorticosteroids are produced by the adrenal cortex under the influence of the central nervous system and pituitary gland. Regulates the synthesis of hormones - the hypothalamus. With a lack of GCS in the blood level of hydrocortisone and stressful situations (trauma, infection), it synthesizes corticoliberin, which is a stimulator of ACG release from the pituitary gland. Under the action of this hormone, glucocorticosteroids are produced in the adrenal cortex.

GCS have an anti-inflammatory effect, regulate carbohydrate, lipid, protein metabolism, control kidney function, the body's response to stressful situations. In medical practice, natural hormones and their synthetic analogues are used.

As medications, corticosteroids began to be used in the middle of the last century. Synthetic hormones have the same properties as natural ones. They suppress the inflammatory process, but do not affect infectious agents. As soon as the corticosteroids stop working, the infection can resume.

Glucocorticosteroids, on the one hand, produce a powerful therapeutic effect, allow you to achieve a positive result in a short time. On the other hand, their use is fraught with numerous adverse reactions from various systems and organs.

Hormones cause stress, which leads to a weakening of the immune system, since it is normally provided in a calm state. In addition, synthetic corticosteroids inhibit the work of natural ones, which can lead to impaired adrenal function. That's why taking corticosteroids should be strictly regulated by a doctor and they should be prescribed only in case of ineffectiveness of other drugs.

Glucocorticosteroids are produced in the form of:

tablets;
solutions for injections;
aerosols;
ointments, creams.

Indications and contraindications

The action of GCS is very diverse:

anti-inflammatory;
antiallergic;
immunomodulatory.

Drugs are used to stop the inflammatory process in many diseases:

rheumatism;
blood diseases;
systemic lupus erythematosus;
bronchial asthma;
pneumonia;
dermatitis;
neurological diseases;
allergies and many others.

Corticosteroids can be used for such renal pathologies:

kidney tumor;
congenital dysfunction of the adrenal cortex;
lupus;
nephrotic syndrome.

Contraindications:

individual intolerance;
chickenpox;
vaccination with a live vaccine;
severe infections.

Hormones are prescribed very carefully in the presence of the following diseases:

diabetes;
hypertension;
stomach ulcer;
heart failure;
thrombosis;
glaucoma and cataract;
tuberculosis;
mental disorders.

Mineralocoritcoids should not be taken with hepatic and hypertension, diabetes and potassium deficiency in the blood plasma.

On a note! GCS can cause many side effects in different areas of the body. Weakly active and moderately active hormones with short-term use, as a rule, rarely cause severe complications. To reduce the risk of developing undesirable consequences, it is necessary to respond in time to any changes in the body and adjust the dosage of drugs.

Use in kidney disease

There are no specific recommendations regarding the use of GCS. They are not specific therapies. An exception is adrenal insufficiency, in which glucocorticoids perform the function of replacement therapy. Before prescribing any hormonal remedy for diseases of the urinary system, the doctor must weigh the pros and cons.

For each patient, the dosage is selected empirically to achieve the desired effect. From time to time it is revised, based on changes in symptoms and the development of side effects. 1 dose of GCS is safe for health. And a 1-week course of admission without contraindications practically does not harm the body. On the contrary, if severe adrenal insufficiency is suspected, a single intramuscular injection of corticosteroids can save the patient's life.

It should be borne in mind that abrupt discontinuation of hormonal drugs can cause iatrogenic adrenal insufficiency. If long-term use of corticosteroids in renal diseases is expected, the minimum dose sufficient to achieve positive dynamics is selected. But long courses are prescribed, as a rule, if the disease directly threatens the life of the patient.

Therapy for kidney disease with corticosteroids can be:

intensive- used in life-threatening conditions, administered intravenously.
limiting- with long-term chronic diseases, preference is given to tablets that need to be taken for a long time. A discontinuous reception scheme is used.
alternating- use GCS short-acting and with an average duration of action, once in the morning, once every 2 days.
Intermittent- take courses for 3-4 days, then pause for 4 days.
Pulse therapy- a single injection of corticosteroids into a vein of at least 1 g as an emergency.

Treatment of kidney diseases with hormonal drugs should be accompanied by the intake of vitamin D and calcium to prevent osteoporosis. To reduce the effect of GCS on the stomach, it is recommended to use Almagel, Phosphalugel.

Regarding the use of glucocorticosteroids in kidney disease, there are many disagreements among specialists. a mild form is usually amenable to corticosteroid therapy, drugs are first-line agents for the disease. The first week, patients are given Prednisolone at a dosage of 1-2 mg / kg. For 6-8 weeks, the amount of the drug taken is gradually reduced. Some doctors recommend taking the medicine every other day.

Often, after the abolition of glucocorticosteroids, relapses occur. Such patients are considered resistant to corticosteroids, and treated with other immunosuppressants (Azathioprine). Lupus nephritis is also treatable with hormonal agents. With membranous hormones are prescribed (Prednisolone 120 mg) for 2-2.5 months every other day, with a gradual decrease in the dose for the next 1-2 months.

Look at the list and characteristics of inexpensive ones for kidney pathologies.

Instructions for the use of the drug Nolicin for cystitis are described on the page.

Read about what an ultrasound of the bladder in men shows and how to prepare for the study.

Drug withdrawal rules

If taking hormones for a long time, then they need to be canceled gradually. Medicines inhibit the work of the adrenal cortex, if you abruptly interrupt the reception, then this threatens the patient with adrenal insufficiency.

There is no clearly established scheme for reducing the dosage of GCS. It all depends on the duration of the course of therapy and the activity of the drug. If the therapy is short, the intake of GCS can be reduced by 2.5 ml every 3-4 days (for example, Prednisolone). If the treatment is longer, then the dosage reduction should be slower - 2.5 mg every 7-20 days.

Carefully reduce the dose to less than 10 mg - 1.25 mg every 3-7 days. If GCS was initially prescribed in a high dosage, then the reduction can be carried out more intensively (5-10 mg in 3 days). If a dose of 30% of the initial dose is reached, thereafter reduce by 1.25 mg every 2-3 weeks. Thus, it is possible to achieve a maintenance amount of the drug for a sufficiently long time.

List of glucocorticosteroids

GCS are divided into several groups according to the duration of their action.

Short action:

Cortisone;
Hydrocortisone;
Mazipredone;
Solu Cortef;
Fluticasone;
Cyclesonide.

Average duration:

Prednisolone;
Prednisol;
Aceponate;
Medopred.

Long lasting:

Dexamethasone (Dexamed, Megadexan);
Betamethasone (Celeston);
Triamcinolone (Kenalog, Berlicort, Triacort).

The cost of glucocorticosteroids may vary depending on the manufacturer, the form of release and the pricing policy of the pharmacy chain.

The average cost of the most common drugs:

Prednisolone - 100 pieces of tablets 5 mg 103 rubles, 3 ampoules of 1 ml (30 mg) 48 rubles;
Dexamethasone - 1 ml solution 25 ampoules 130-180 rubles, 0.5 mg tablets 10 pieces 45 rubles;
Hydrocortisone - ampoules 2 ml 2.5% 10 pieces 148 rubles;
Metipred - tablets 4 mg 30 pieces 175-190 rubles;
Diprospan - 1 ampoule 1 ml 217 rubles.

Glucocorticosteroids are hormones synthesized by the adrenal glands. They are distributed throughout all tissues in our body and perform a number of functions. In some diseases, including kidney diseases, synthetic and natural corticosteroids are used to combat inflammation and other problems. But therapy with glucocorticosteroids has two sides. Their use can lead to many unpleasant consequences. Therefore, it should be strictly regulated by a doctor.

Video - review and feedback on the features of the use of glucocorticosteroids and how to avoid side effects from the use of drugs:

Glucocorticosteroid hormones are those that are synthesized by the adrenal cortex. Hormonal compounds of steroid nature are widely used in modern medicine both in their natural form and in the form of synthetic analogues.

General information

The adrenal cortex produces 3 types of hormones:

controlling potassium-sodium metabolism (mineralocorticoids);
responsible for reproductive function (sex steroids);
glucocorticosteroids, whose duty is to regulate intermediate metabolism.

The production of corticosteroids is under the control of the pituitary and hypothalamus, but is carried out in paired endocrine organs that are located above the kidneys, for which they got their name.

For the first time, these hormones were used as medicines in the 40s of the last century, they got their name due to their ability to regulate glucose metabolism. Further clinical studies have shown that hormones not only affect lipid, carbohydrate, protein metabolism, but also regulate the activity of the circulatory system, kidneys, immune system of the body, participate in the development and metabolism of bone tissue, and significantly affect the central nervous system.

The use of hormones in their natural form, despite the significant effectiveness of the impact, is limited due to the large number of negative side effects.

Structural and functional analogues

Glucocorticoids are structural and functional analogs of those hormones that are synthesized in the adrenal cortex, in its fascicular zone. The drugs presented in this group are divided into:

glucocorticoids of natural origin (cortisone, as a prodrug that forms an active metabolite,);
synthetic drugs derived from hydrocortisone () by attaching various chemical compounds to its molecule.

It is they who determine the difference in the directions used, the significant change in properties that the attached chemical gives.

Fludrocortisone, formed by adding a fluorine atom to cortisone, has 12 times the glucocorticoid activity and 125 times the mineralocorticoid cortisone.

Dexamethasone, with a 16-methyl group added to the fludrocortisone molecule, retains glucocorticoid activity, but has a slight mineralocorticoid activity.

Methylprednisolone, to which 1 radical was added, exceeds the prodrug by 5 times in terms of the degree of glucocorticoid activity.

Artificial medicinal analogs of adrenal cortex hormones are used in medicine in severe cases, when the medicinal benefits of them outweigh the harm from their side effects. Sometimes, due to the extreme condition, or the concomitant severity of the lesion, there is no other way out than the use of hormonal drugs. Corticosteroids are used to provide:

anti-inflammatory;
desensitizing;
antitoxic;
antishock;
immunosuppressive action.

These are far from all the medicinal effects that can be obtained with a calculated dosage and an individual approach to prescribing. In diseases of the spine, glucocorticoid drugs are also used because of their ability to multiply the effect of drugs used in the course of complex therapy in parallel.

The main principle of prescribing GC preparations is to achieve the maximum effect, at the lowest possible doses. For this purpose, synthetic analogues are being developed that have a much more pronounced effect, which makes it possible to reduce the dosage and the duration of the prescribed course.

Classification and subdivisions of drugs

The generally accepted classification of drugs using adrenal hormones has not yet been developed. Practitioners subdivide HA according to the place and method of application. According to this, a very conditional division into subgroups, the following types of drugs are distinguished:

injection;
tableted;
topical agents in the form of ointments, creams, gels and suspensions.

The second principle of categorization is the division according to the main active substance in the composition of the drug. Medications are differentiated according to the dominant component:

prednisolone;
methylprednisolone;
betamethasone;
dexamethasone etc.

There is a clinical difference in hormonal preparations for the duration of exposure, which has been established with the help of scientific studies. Glucocorticoids are divided into means:

short exposure;
average duration;
long (prolonged) action.

The means of short exposure include, which is a synthetic analogue of the hormone. Due to the relative invariability of its composition, it practically does not affect the water-salt exchange balance, and does not disrupt cellular metabolism.

Betamethasone and dexamethasone, with a modified structure formula, are able to have a long-term effect, while prednisolone and methylprednisolone are drugs of an average duration of influence.

In medicine, there is another division of glucocorticoids, which distinguishes them by the use of the main substance, and implies the isolation of:

endogenous (natural) compounds;
synthetic analogues (oil-containing);
synthetic analogues (fluorine-containing).

None of the existing gradations, due to the wide use of various forms of HA, does not include the full characteristics of the hormonal drug, and is used in the professional terminology of certain qualifying scientific circles.

Hormonal preparations for internal exposure

Internal drugs are also divided into:

intranasal (applied through the nose);
parenteral;
oral (swallowed at the time of admission);
inhalation.

Such a division of drugs provides for a clear gradation of diseases, when prescribing the form of the drug. Intranasals are commonly used to treat:

allergic rhinitis;
idiopathic inflammation of the nasal mucosa;
with polyps in the nose.

Parenteral are applicable for diseases of the adrenal cortex, some diseases of the thyroid gland, and other complex pathologies.

Inhalation drugs differ in the specificity of the impact, and are prescribed for complex dysfunctions of the respiratory system. Bronchial asthma, COPD, allergic rhinitis are treated with these drugs as basic therapy. Of the most widely used inhalation drugs, it can be noted:

triamcinolone acetonide;
beclomethasone dipropionate;
mometasone furoate;
budesonide;
fluticasone propionate.

Cases of serious pathologies of the respiratory organs forced to undertake clinical trials of new inhaled drugs for the treatment of bronchial asthma during pregnancy. They showed that treatment with vapors of the drug at the site of pathology not only did not increase the incidence of endocrine diseases in children, but also made it possible to note their appearance in children who were born to mothers with asthma and did not use inhalers to alleviate their condition.

The emergence of intranasal and inhaled formulations of drugs has relieved patients of some of the risks that are common with the use of parenteral drugs using GCs.

With the development of pharmacotherapeutic forms, and new synthetic analogues, the use of glucocorticoid hormones, which are used without affecting internal organs and metabolic systems, becomes less dangerous.

Pharmacodynamics and mechanism of action

The natural connection of hormones produced by the adrenal glands is coordinated by the pituitary and hypothalamus, and is carried out using the complementary correspondence of a certain hormone code to the cell receptor. The search for a match between binding components can be carried out both inside the cell membrane and outside, if the hormone cannot diffuse into the cell. GCs bind to special glucocorticoid receptors inside the cell membrane, which causes the appearance of RNA and the concomitant synthesis of regulatory proteins.

There is a cytostatic mechanism that can stop the effects of hormones, and enzymatic and chemical substances that accelerate the process of interaction.

The main effects achieved by the use of corticosteroids in the human body can be called the following:

violation of the synthesis of inflammatory mediators (and leukotrienes), by blocking and inhibiting the phospholipase enzyme;
in different dosages, providing immunosuppressive and immunostimulating effects, inhibition of antibody production, production of lymphokines and cytokines;
obstruction withdrawal , mast cell membrane stabilization;
influence on the metabolism of protein, carbohydrates, calcium, fats, water and electrolyte metabolism;
increased sensitivity of the walls of blood vessels, and the heart muscle to and;
stimulation of the formation of red blood cells and platelets;
inhibition of the production of leukocytes, basophils and eosinophils;
effects on other hormones, including sex, luteinizing, thyroid hormones.

When ingested, they are rapidly absorbed in the small intestine, reaching the maximum concentration in less than an hour. The introduction of parenteral is variable, and is provided for by the characteristics of the drug. They are excreted through the kidneys, bind to proteins in the blood, and are partially destructured by the liver. The method of administration depends on the nature of the drug, and the characteristics of the disease. In the treatment of the musculoskeletal system, intra-articular injections are also used.

List of hormonal drugs

The list of drugs of the group of glucocorticoid hormones is quite extensive, but in clinical practice, the most commonly used are:

Prednisolone;
Triamcinolone;
Dexamethasone;
Betamethasone.

Analogues of drugs, under commercial names, or certain varieties with a modified form, are considered less common, and require study of the instructions for use, with a clear description of contraindications and indications, the structure of the chemical formula, and the features of the appointment.

They belong to list B, require certain storage conditions. Before self-use of such drugs, you should consult a doctor, pay special attention to the possibility, or contraindications of the drug, in its use for newborns, children, pregnant women.

All drugs of the group of glucocorticoid hormones are described in the Anatomical Therapeutic Chemical Classification (ATC), which has a hierarchical structure and facilitates the search for the right medication. Any drug in this group undergoes an indispensable clinical trial, and is described by specialists.

Indications for use

To date, not only side and therapeutic effects have been studied quite well, but also the interaction of HA with many drugs, the required dosages, and complex therapy schemes have been developed. This made it possible to use drugs in many branches of medicine, as basic and auxiliary drugs.

Pathological conditions in which GCs are undoubtedly useful will make up an incredibly long list of chronic, systemic and acute pathologies. In rheumatology, they are used to treat:

systemic lupus erythematosus;
ankylosing spondylitis;
systemic scleroderma;
rheumatic polymyalgia.

Glucocorticoids are used in the treatment of vasculitis and pyelonephritis, in endocrinology they are treated with:

insufficiency of the adrenal cortex;
thyrotoxicosis and deficiency.

In gastroenterology:

nonspecific ulcerative colitis;
severe forms of hepatitis;
Crohn's disease in the acute stage.

But the scope of application of hormone-containing drugs is not limited to this. Cardiology uses for:

some types of pericarditis;
postviral and nonspecific leukocyte myocarditis.

For pulmonologists:

with bronchial asthma;
eosinophilic pneumonia;
alveolitis and bronchiolitis;
sarcoidosis of the lungs.

In hematology, hormonal drugs treat thrombocytopenia and anemia.

GCs are indispensable drugs of choice in acute conditions and in transplantology. Despite contraindications and side effects, glucocorticoids are among the widely used, and sometimes indispensable means, for severe lesions and acute conditions. In the treatment of diseases of the spine are used for therapy:

osteochondrosis;
pain relief;
non-infectious arthritis;
ankylosing spondylitis;
injuries of the spine and its membranes.

The creation of synthetic drugs has accelerated and increased the impact of this group of drugs, further expanding the scope of their activities.

Contraindications to the use of hormonal drugs

There are certain contraindications to the appointment of drugs in a specific form. Intra-articular injections of hormones are prohibited for:

diseases affecting blood clotting;
severe osteoporosis;
a significant infectious process of a systemic or local nature.

An obstacle to such an injection may be an articular fracture, or a pronounced destruction of the joint. GCs are conditionally not recommended (this is called relative contraindications), with:

diabetes mellitus;
stomach ulcer and duodenal ulcer;
arterial hypertension;
heart failure;
mental disorders;
epilepsy.

The use of glucocorticoids in severe, threatening conditions, as an effective method of exposure, has led to the fact that, most often, relative contraindications in critical situations are not considered. However, the appointment of hormone-containing drugs in situations of less pronounced urgency forces the doctor to take into account some general parameters of the physical and pathological state of a person.

tuberculosis;
syphilis;
viral eye infections and glaucoma;
herpes and systemic mycoses.

Any use of drugs containing adrenal hormones, or their synthetic analogues, should be made only on medical advice, and under strict medical supervision.

Side effects of hormonal drugs

One of the discoverers of the therapeutic effects of glucocorticosteroid hormones said that they should be used only if the expected healing result exceeds the degree of negative impact.

The emergence of synthetic analogs, acting many times faster, somewhat reduced the side effects from the use of glucocorticoids, but did not exclude the possibility of their development with prolonged use. In order to prevent the pronounced negative consequences of the use of GCs, prophylactic administration of the necessary drugs is carried out.

As manifestations of side effects of drugs with analogues, or natural hormones of the adrenal cortex, there may be:

violation of lipid volume and a significant increase in body weight;
susceptibility to infections increases and their prolonged course is noted;
pancreatitis develops;
violations of linear growth, and puberty in children;
steroid diabetes and steroid ulcers of the digestive system;
osteoporosis, and compression fractures, against the background of the treatment of diseases of the musculoskeletal system.

The psycho-emotional state, especially in women, deteriorates significantly, aggressiveness, excitability and drowsiness appear at the same time, pronounced mood swings. Hormonal disorders caused by significant doses of drugs can lead to infertility, loss of libido, and sleep disturbances. Some side effects are well known to modern medicine, but their occurrence today can neither be prevented nor corrected.

So, with intra-articular injections of drugs, damage to the nerve trunks, calcification of the joint, or its atrophy, destruction (steroid arthropathy), and tendon rupture can occur. This will certainly lead to disability and limited mobility, but it saves lives. This is the reason for the careful use of hormone-containing drugs, and their replacement in cases of moderate severity, with non-steroidal anti-inflammatory drugs, which also have side effects, but less pronounced.

Features of the therapeutic use of hormones and precautions

Glucocorticosteroids, due to their wide application, are used in various branches of medicine for the treatment of a variable spectrum of diseases. For almost all known conditions, therapeutic schemes and protocols have been developed, in conditions of varying severity.

The duration of the action of the drug, the degree of its recommendation, the duration of the treatment course, the short duration or prolongation, and even a certain dosage - everything is within the competence of a doctor who knows how to handle a specific medication.

That is why so much is said about the inadmissibility of self-prescription of synthetic hormonal drugs, the extreme caution of their use, the careful and thoughtful handling of drugs in this group. Any, the most healing agent, with an unqualified appointment, and unjustified intake, can bring significant harm to the human body. Therefore, only a doctor who is familiar with all the intricacies of the effects of a particular drug should produce treatment.

Topical glucocorticosteroids in the form of hydrocortisone ointment were proposed for use in clinical practice in 1952 by M. Sulzberger (Sulzberger M.V.) and
W. Witten (Witten V.H.). All subsequent topical glucocorticosteroids were created by synthesizing derivatives of the hydrocortisone molecule - halogenation (chlorine and fluorine atoms), esterification, hydroxylation, and addition of side chains. A real revolution in dermatology was made by fluorinated topical glucocorticosteroids, and among them triamcinolone (triamcinolone acetonide) is the first strong glucocorticosteroid. 1960s-1970s - the period of the triumph of topical glucocorticosteroids, they successfully treated all inflammatory skin diseases. But in the same years, side effects of drugs of this series began to be detected. Enthusiasm began to give way to disappointment and refusal to use them, a return to the old methods of treatment tested by many years of practical experience.

In recent decades, much attention has been paid to the creation of glucocorticosteroid drugs with improved pharmacological properties and, accordingly, with fewer side effects.

As a result, non-halogenated preparations containing chlorine instead of fluorine were created. Such improved drugs, if the rules for the use of topical glucocorticosteroids are observed, practically do not give side effects.

Drugs with a high degree of safety in combination with high efficiency in recent years are winning back the good reputation once lost by external glucocorticosteroids.

Topical or external glucocorticosteroids are the main drugs that eliminate skin inflammation. They are divided into four groups depending on the strength of the action - weak, moderate, strong and very strong. The therapeutic effect is maximum with early and developing inflammation, therefore, the sooner they are applied in developing inflammation, the sooner it will be possible to extinguish it and the less the possibility of spreading rashes. Accordingly, with short-term use of glucocorticosteroids, side effects can be avoided.

In pediatric practice, it is recommended to use the safest drugs that do not contain fluorine:
advantan (methylprednisolone aceponate) (emulsion, cream, fat cream and ointment) - from 4 months;
locoid (hydrocortisone * 17-butyrate) (cream, lipocream and ointment), latikort (hydrocortisone) (cream, ointment and solution) - from 6 months;
elokom (lotion, cream and ointment), momat (cream and ointment), uniderm (cream), mometasone - from 6 months.

Mechanism of action of glucocorticosteroids
Glucocorticosteroids have three main effects - vasoconstrictor, anti-inflammatory and antiproliferative.

According to the first effect, as the most noticeable, the strength of the drugs is ranked, although its nature has been little studied.

The molecular basis of the anti-inflammatory action is the interaction of glucocorticosteroids with specific receptors (intracellular glucocorticoid receptors) in target cells - granulocytes, lymphocytes, mast cells involved in inflammatory reactions.

It is known that glucocorticosteroids reduce the number of T-lymphocytes in the peripheral blood, the phagocytic activity of macrophages, and inhibit the release of mediators such as IL-1 and IL-2 from macrophages and T-lymphocytes. Inside cells, through glucocorticosteroid receptors, they affect the synthesis of lipocortin and vasocortin proteins. Lipocortin inhibits the synthesis of pro-inflammatory cytokines (anti-inflammatory effect), and vasocortin inhibits the release of histamine (anti-allergic effect).

The antiproliferative effect is carried out by inhibiting mitoses in the basal layer of the epidermis and fibroblasts (cessation of the synthesis of type I and III collagen by fibroblasts). This causes the most serious skin side effect of glucocorticosteroids - skin atrophy.

Side effects
The main side effects of topical glucocorticosteroids are local in nature, they can be divided into groups according to the object of exposure.

Effects on the proliferation of keratinocytes and fibroblasts:
skin atrophy;
stretch marks;
purpura and ecchymosis;
telangiectasia;
slowing down the healing of wounds PI reparative processes in the skin;
dryness and peeling.

Effects on skin appendages:
acne;
increased hair growth;
perioral dermatitis.

Impact on the immune system, exacerbation or occurrence of infectious (bacterial, viral, fungal) skin diseases:
pyoderma;
folliculitis;
simple herpes;
mycoses (candidiasis).

Other side effects:
violation of pigmentation;
allergic reactions;
addiction (tachyphylaxis);
withdrawal syndrome.

Patients who have developed an allergic reaction to a certain glucocorticosteroid drug may have similar reactions to other drugs in this group, as well as other groups with a similar structure of the active substance (cardiac glycosides, androgens, vitamin D). However, an allergic reaction may occur in response to exposure to other active substances in combined preparations (such as antibiotics, antimycotics), as well as excipients.

Systemic side effects associated with resorption and entry into the bloodstream of topical glucocorticosteroids are rare. The risk of systemic effects is higher in very young children and in severely impaired skin barrier function. Absorption also depends on the area on which the drug is applied, the concentration and strength of glucocorticosteroids. Absorption is higher on the face, in the perineum, when applied under an occlusive dressing. Systemic effects include Cushing's syndrome (hypercorticism), adrenal insufficiency.

In order to avoid side effects, short-term use of drugs (no more than 14 days in children), the correct selection of glucocorticosteroids according to the strength of action, and adherence to the daily dose (the "fingertip" rule) are important. The appointment of glucocorticosteroids of any strength under dressings, including wet-drying, occlusive and wet, is possible only for a very short period. In children, occlusive dressings are practically not used.

The fingertip rule allows you to control the dose of the drug. On the tip of the index finger of an adult, counting from the last interphalangeal fold to the very tip, fits a strip of medicine squeezed out of a standard tube (hole diameter - 0.5 cm) weighing about 0.5 g. Usually this amount is enough to cover two adult palms (2% of body surface area).

The following monthly consumption of strong glucocorticosteroids is safe:
for a small child - 15 g;
for a student - 30 g;
for an adult - 60-90 g.

The risk of side effects is low if topical glucocorticosteroids are used correctly.

Basic rules for the use of external glucocorticosteroids.
The strength of the drug should correspond to the severity of inflammation.
Short-term use of a strong drug is more effective than long-term use of a weak one.
Weak glucocorticosteroids are prescribed for the face and neck; in case of acute inflammation, it is possible to prescribe moderate and strong ones for a period of
3-5 days.
In places where the skin is delicate and thin (in the face, folds and perineum), strong drugs should not be used, and moderate and weak ones should not be used under an occlusive dressing.
Topical glucocorticosteroids are preferably used early in the morning (before 8 hours) in accordance with the daily rhythms of cell division.
The dosage form of the drug should correspond to the severity and nature of the process, as well as the area of rashes.
Consideration should be given to increased absorption with the combined use of glucocorticosteroids with salicylic acid and urea.
It is necessary to frequently evaluate the patient's condition and cancel topical glucocorticosteroids as soon as they are no longer needed.
Very strong glucocorticosteroids are used only in adults and only under the supervision of a dermatologist.
The area on which the drug is applied should be minimal.
Glucocorticosteroids are applied no more than 1-2 times a day, regardless of the strength of inflammation.
In children with frequent outbreaks of inflammation (2-4 per month), glucocorticosteroids can be used only 2 consecutive days per week for 3-6 months to prevent an exacerbation.
A combination of glucocorticosteroids with nonsteroidal drugs is preferred.
Among the drugs of the same strength, choose the most inexpensive.
The patient or his parents should be informed that the prescribed drug contains glucocorticosteroids.
Topical glucocorticosteroids are best discontinued gradually to avoid a withdrawal syndrome.
If addiction to the drug has developed, it should be replaced by another from the same group (of equal strength) with another active substance.

withdrawal syndrome
A particular problem is the withdrawal syndrome faced by a patient using topical glucocorticosteroids for chronic diseases. After discontinuation of the drug, after a short time, the rash reappears in the same places and, over time, responds worse and worse to the resumption of treatment with the same drug. There are four ways to overcome withdrawal symptoms.

1. Gradually reduce the strength of the drug, moving from strong to weaker, and then cancel the weak. There are some inconveniences here:
- you need to purchase several modern drugs of different strengths, and this can be a financial burden on a low-income family;
- drugs can have different dosage forms, which means that their action will be different; in practical terms, this means that each time you will need to consult a doctor, which is difficult;
- the use of drugs of different composition increases the risk of allergic reactions.

2. Reduce the concentration of the same drug, using it more rarely, but so far there is no uniform approach to the rate of such a decrease.

3. Apply the so-called intermittent, or anti-relapse, therapy - lubricate the areas where the rash has already resolved with the same preparation, 2 times a week for several months; this approach appears to be promising in patients with frequent exacerbations of atopic dermatitis.

4. When the activity of the process decreases, replace glucocorticosteroids with anti-inflammatory drugs that do not contain steroids. Topical glucocorticosteroids can be combined with these drugs in the active phase of inflammation, and then switched to them after the severity of the process decreases.

With any approach, first of all, care should be taken to eliminate provoking factors.

corticophobia
A consequence of the somewhat exaggerated possibility of undesirable effects in the population is corticophobia. Currently, parents of sick children often categorically refuse treatment with glucocorticosteroids in any form, despite the development of safe compounds and a number of rules for the use of glucocorticosteroids that ensure this safety. Physicians themselves are often poorly oriented in a wide range of
topical glucocorticosteroids and cannot offer the best option for both the dosage form and the compound itself, focusing on the stage, prevalence and activity of manifestations of atopic dermatitis.

And patients who are not sufficiently informed about the exact name of the drug and the reasons why the doctor chose this particular drug in the pharmacy buy cheaper drugs of past generations.

In addition, many doctors, supporters of alternative medicine (homeopathy, oriental medicine), are categorically against the use of topical glucocorticosteroids.
Reasonable use of modern topical glucocorticosteroids allows you to completely avoid possible side effects.

The human body is a complex, continuously functioning system capable of producing active substances to independently eliminate the symptoms of diseases and protect against negative factors of the external and internal environment. These active substances are called hormones and, in addition to their protective function, they also help regulate many processes in the body.

What are glucocorticosteroids

Glucocorticosteroids (glucocorticoids) are corticosteroid hormones produced by the adrenal cortex. The pituitary gland, which produces a special substance, corticotropin, is responsible for the release of these steroid hormones. It stimulates the adrenal cortex to secrete large amounts of glucocorticoids.

Specialist doctors believe that inside human cells there are special mediators responsible for the reaction of the cell to the chemicals acting on it. This is how they explain the mechanism of action of any hormones.

Glucocorticosteroids have a very extensive effect on the body:

have anti-stress and anti-shock effects;
accelerate the activity of the human adaptation mechanism;
stimulate the production of blood cells in the bone marrow;
increase the sensitivity of the myocardium and blood vessels, provoke an increase in blood pressure;
increase and have a positive effect on gluconeogenesis occurring in the liver. The body can stop an attack of hypoglycemia on its own, provoking the release of steroid hormones into the blood;
increase the anabolism of fats, accelerate the exchange of beneficial electrolytes in the body;
have a powerful immunoregulatory effect;
reduce the release of mediators, providing an antihistamine effect;
have a powerful anti-inflammatory effect, reducing the activity of enzymes that cause destructive processes in cells and tissues. Suppression of inflammatory mediators leads to a decrease in the exchange of fluids between healthy and affected cells, as a result of which inflammation does not grow and does not progress. In addition, GCS is not allowed to produce lipocortin proteins from arachidonic acid - catalysts for the inflammatory process;

All these abilities of the steroid hormones of the adrenal cortex were discovered by scientists in the laboratory, due to which there was a successful introduction of glucocorticosteroids into the pharmacological field. Later, the antipruritic effect of hormones was noted when applied externally.

The artificial addition of glucocorticoids to the human body, internally or externally, helps the body deal with a large number of problems faster.

Despite the high efficiency and benefits of these hormones, modern pharmacological industries use exclusively their synthetic counterparts, since conticosteroid hormones used in their pure form can provoke a large number of negative side effects.

Indications for taking glucocorticosteroids

Glucocorticosteroids are prescribed by doctors in cases where the body requires additional supportive therapy. These drugs are rarely prescribed as monotherapy, they are mainly included in the treatment of a specific disease.

The most common indications for the use of synthetic glucocorticoid hormones include the following conditions:

body, including vasomotor rhinitis;
and pre-asthma states, ;
skin inflammations of various etiologies. Glucocorticosteroids are used even for infectious skin lesions, in combination with drugs that can cope with the microorganism that provoked the disease;
any origin, including traumatic, caused by blood loss;
, and other manifestations of connective tissue pathologies;
a significant decrease due to internal pathologies;
long-term recovery after organ and tissue transplants, blood transfusions. Steroid hormones of this type help the body to quickly adapt to foreign bodies and cells, significantly increasing tolerance;
glucocorticosteroids are included in the complex of recovery after and radiation therapy of oncology;
, a reduced ability of their cortex to provoke a physiological amount of hormones and other endocrine diseases in the acute and chronic stages;
some diseases of the gastrointestinal tract:,;
autoimmune liver diseases;
swelling of the brain;
eye diseases: keratitis, cornea¸ iritis.

It is necessary to take glucocorticosteroids only after a doctor's prescription, because if taken incorrectly and in an inaccurately calculated dose, these drugs can quickly provoke dangerous side effects.

Synthetic steroid hormones can cause withdrawal syndrome- deterioration of the patient's well-being after stopping the medication, up to glucocorticoid insufficiency. To prevent this from happening, the doctor calculates not only the therapeutic dose of drugs with glucocorticoids. He also needs to build a treatment regimen with a gradual increase in the amount of the drug to stop the acute stage of the pathology, and lower the dose to the minimum after the transition of the peak of the disease.

Classification of glucocorticoids

The duration of action of glucocorticosteroids was artificially measured by experts, according to the ability of a single dose of a particular drug to inhibit adrenocorticotropic hormone, which is activated in almost all of the above pathological conditions. This classification divides steroid hormones of this type into the following types:

short range - suppress ACTH activity for a period of just over a day (Cortisol, Hydrocortisone, Cortisone, Prednisolone, Metipred);
medium duration - period of validity is approximately 2 days (Traimcinolone, Polkortolone);
Long acting drugs - the effect lasts longer than 48 hours (Batmethasone, Dexamethasone).

In addition, there is a classical classification of drugs according to the method of their introduction into the patient's body:

Oral (in tablets and capsules);
nasal drops and sprays;
inhalation forms of the drug (most often used by asthmatics);
ointments and creams for external use.

Depending on the state of the body and the type of pathology, both 1 and several forms of drugs containing glucocorticosteroids can be prescribed.

List of popular glucocorticosteroid drugs

Among the many drugs containing glucocorticosteroids in their composition, doctors and pharmacologists distinguish several drugs of various groups that are highly effective and have a low risk of provoking side effects:

note

Depending on the patient's condition and the stage of development of the disease, the form of the drug, the dose and duration of use are selected. The use of glucocorticosteroids necessarily occurs under the constant supervision of a physician to monitor any changes in the patient's condition.

Side effects of glucocorticosteroids

Despite the fact that modern pharmacological centers are working to improve the safety of drugs containing hormones, with a high sensitivity of the patient's body, the following side effects may occur:

increased nervous excitability;
insomnia;
causing discomfort;
, thromboembolism;
and intestines, inflammation of the gallbladder;
weight gain;
with prolonged use;