Dr.Mahreen Shahzad
MSc (London),B.D.S, R.D.S
Head of Department & Associate Professor
Oral Medicine & Diagnostic Department
Sir Syed College of Medical Sciences (Sir Syed Dental Hospital)
Corticosteroids, since their beginning in the 1940s, have turn out to be one of the most broadly prescribed class of drugs. They belong to a class of chemicals that includes steroid hormones that are produced naturally in the adrenal cortex of vertebrates and analogous to those that are synthesized in laboratories.
Steroids have been used widely in treating several oral diseases, due to their outstanding anti-inflammatory and immuno-modulatory effects. Nevertheless, corticosteroids have significant side-effects, hence it is recommended to use in patients with careful management strategies.
Their successful use depends upon the knowledge of the disease progression. This includes a correct diagnosis, a clear view of the advantageous treatment outcome and understanding of whether the treatment is planned for the management of a chronic disease or better resolution of a short-term condition. The likely positive effects of systemic corticosteroids must be weighed next to possible risks. This article is intended to review the use of corticosteroids in the treatment of various oral conditions and lesions.
How systemic corticosteroids work?
Corticosteroids are steroid hormones that are also produced by the body or are artificial.
Corticosteroids are available in topical, tablet or injectable forms. Systemic corticosteroids refer to corticosteroids that are given orally (tablets) or by injection and distribute all over the body. It does not consist of corticosteroids used in the eyes, ears, or nose, on the skin or that are inhaled, although small amounts of these corticosteroids can be absorbed into the body.
Natural corticosteroids, hydrocortisone and cortisone, are produced by the outer portion of the adrenal gland identified as the cortex (hence the called as corticosteroid). Corticosteroids are classified into:
- Glucocorticoids (anti-inflammatory) which reduces inflammation and suppress immunity and help out in the breakdown of fats, carbohydrates, and proteins, or as
- Mineral corticoids (salt retaining) that regulate the balance of salt and water in the body.
Synthetic corticosteroids are similar in the action of naturally occurring corticosteroids and might be used as substitute corticosteroids in patients with adrenal glands that are incapable to produce sufficient amounts of corticosteroids, nevertheless, they are more frequently used in higher than replacement doses to treat diseases of immunity, inflammation or salt and water balance.
Examples of synthetic topical and systemic corticosteroids include:
Topical Corticosteroids
Class I
Very potent: up to 600 times stronger than hydrocortisone
- Clobetasol propionate05% (Dermovate)
- Betamethasone dipropionate25% (Diprolene)
- Halobetasolpropionate 0.05% (Ultravate, Halox)
- Diflorasone diacetate05% (Psorcon)
Class II
- Fluocinonide05% (Lidex)
- Halcinonide05% (Halog)
- Amcinonide05% (Cyclocort)
- Desoximetasone25% (Topicort)
Class III
- Triamcinolone acetonide5% (Kenalog, Aristocort cream)
- Mometasone furoate1% (Elocon, Elocom ointment)
- Fluticasone propionate005% (Cutivate)
- Betamethasone dipropionate05% (Diprosone)
- Halometasone05%
Class IV
- Fluocinolone acetonide01-0.2% (Synalar, Synemol, Fluonid)
- Hydrocortisone valerate2% (Westcort)
- Hydrocortisone butyrate1% (Locoid)
- Flurandrenolide05% (Cordran)
- Triamcinolone acetonide1% (Kenalog, Aristocort A ointment)
- Mometasone furoate1% (Elocon cream, lotion)
Class V
- Fluticasone propionate05% (Cutivate cream)
- Desonide05% (Tridesilon, DesOwen ointment)
- Fluocinolone acetonide025% (Synalar, Synemol cream)
- Hydrocortisone valerate2% (Westcort cream)
Class VI
- Alclometasone dipropionate05% (Aclovate cream, ointment)
- Triamcinolone acetonide025% (Aristocort A cream, Kenalog lotion)
- Fluocinolone acetonide01% (Capex shampoo, Dermasmooth)
- Desonide05% (DesOwen cream, lotion)
Class VII
The weakest class of topical steroids. Has poor lipid permeability, and can not penetrate mucous membranes well.
- Hydrocortisone5% (Hytone cream, lotion, ointment)
- Hydrocortisone1% (Many over-the-counter brands)
Systemic Corticosteroids
- Bethamethasone, (Celestone)
- Prednisone (Prednisone Intensol)
- Prednisolone (Orapred, Prelone)
- Triamcinolone (Aristospan Intra-Articular, Aristospan Intralesional, Kenalog)
- Methylprednisolone (Medrol, Depo-Medrol, Solu-Medrol)
- Dexamethasone (Dexamethasone Intensol, Dexpak 10 Day, Dexpak 13 Day, Dexpak 6 Day).
Side Effects of Systemic Corticosteroids
Corticosteroids have various side effects that can be mild or serious. These side effects are more obvious when corticosteroids are used at higher doses or for long periods of time.
Corticosteroids can:
- Cause sodium (salt) and fluid to be retained in the body and cause weight gain or swelling of the legs (edema)
- High blood pressure
- Loss of diabetes control
- Loss of potassium
- Headache
- Muscle weakness
- Puffiness of the face (moon face)
- "Buffalo hump," a condition described as a rounding of the upper back
- Facial hair growth
- Thinning and easy bruising of the skin
- Slow wound healing
- Glaucoma
- Cataracts
- Ulcers in the stomach and duodenum
- Menstrual irregularity
- Osteoporosiswhich can result in bone
- growth retardation in children
- Psychiatric disturbances include depression, euphoria, insomnia, mood swings, psychotic behaviors and personality changes.
- Increase in the rate of infections and reduce the effectiveness of vaccines and antibiotics.
Shrinking (atrophy) of the adrenal glands can be caused by the long term use of corticosteroids resulting in the body's inability to produce cortisol, the body's natural corticosteroid, when the systemic corticosteroids are discontinued.
Corticosteroids should not be stopped suddenly after prolonged use as this can result in adrenal crisis because of the body's inability to secrete enough cortisol to make up for the withdrawal. Nausea, vomiting, and shock are the reported side effects of adrenal crisis.
Indications of Corticosteroids in Dentistry
- Recurrent Apthous Stomatitis
- Behcet’s Disease
- Lichen Planus
- Lupus Erythematosis
- Pemphigus
- Pemphigoid
- Erythema Multiforme
- Steven Johnson Disease
- Orofacial Granulomatosis
- Oral Submucous Fibrosis
- Dermatititis Herpetiform
- Linear IgA Disease
