🔷 Introduction:
Steroids are a group of hormones produced naturally in the body.
The adrenal cortex consists of 3 zones:

- Zona Glomerulosa synthesizes Aldosterone, the most potent Mineralocorticoid in humans.
- Zona Fasciculata – produces hydrocortisone (a glucocorticoid)
- Zona Reticularis produces Adrenal Androgens
• Glucocorticoid secretion is regulated by ACTH produced in the anterior pituitary. Cortisol has a -ve feedback on ACTH production.
• In Addison diseases, Glucocorticoid secretion impaired & ACTH is ⬆️
🔷 Corticosteroid Action & its regulation
- Glucocorticoid – Hepatic Glycogen deposition
- Mineralocorticoid – Sodium, electrolyte-fluid balance.
- Glucocorticoid play critical role in body’s response to stress.
Stress
⬇️
Release of cytokines (IL-1)
⬇️
⬆️ cortisol levels
🔷 Classification:

🔷 Steroid synthesis:
The substrate for steroid production is cholesterol. It is mobilized from the outer to the inner mitochondrial membrane by the steroidogenic acute regulatory (StAR) protein.
🔷 Glucocorticoids:
1) Hydrocortisone
• Action: Anti-allergy, anti-inflammatory
• Therapeutic Uses:
- intralesional injection in dose of 20-50 mg/mL
- Topical application
- Tablet in dose of 100mg/day can be given systemically to relieve burning sensation.
- Tab. Cortisol(25mg) combined with dexamethasone(90mg) can be given at biweekly interval.*
Action: Fibrinolytic,Anti-allergic, anti-inflammatory*
It causes ⬇️ fibroblastic production & deposition of collagen*
- Topical application with orabase
- Intralesional injection of hydrocortisone acetate (25mg/ml)
- Topical application (0.25-0.5%) to the affected area
- Intra-articular injection (25mg/ml)
- 20-30mg/day in divided doses
• Trade Name: CORTEF, ORABASE-HCA
• Preparation:
- Oral: 5 – 20 mg tab.
- Topical – 1% eye drop solution; 0.025 nasal drops, 0.25-2.5% skin creams
• Hydrocortisone acetate 25-50 mg/mL for soft tissue suspensions
• Hydrocortisone sodium phosphate: 50mg/mL IV, IM, SC
2) Cortisone:
• Uses:
- OSMF
- Addison disease
- Hodgkin lymphoma
3) Prednisolone:
• Action: Anti-allergic, anti-inflammatory, immunosuppressive
• Uses:
- Rheumatoid arthritis: 10mg/day in divided doses
- Collagen disease: 1mg/kg
- SLE: IM/IV; Topical application 2-3 times daily
- Leukemia: ALL as maintenance dose
- Erythema multiforme, pemphigus, bullous pemphigoid, behchet’s syndrome
- Bronchial asthma: 40-60 mg
- Post-herpetic neuralgia
- Amyloidosis, cyclic neutropenia, purpura
• Trade name: DELTA-CORTEF, PRELONE
4) Triamcinolone:
• Uses:
- Lichen planus: Topical application 3-4 times daily
- Erythema multiforme: 40-100 mg/day or inhalation doses
- Recurrent aphthae: Oral (2-4 mg/day)
- Desquamative gingivitis, OSMF, contact chelitis – intralesional (2-3 mL/day)
• Trade name: Kenolog cream
5) Dexamethasone:
• Uses:
👉🏻Mainly used for adrenal cortical suppression
- Allergic diseases, serum sickness, urticaria, hay fever, angioneurotic edema: IV; topically 2-4 times a day
- Benign migratory glossitis: Topical application
- Shock, cerebral edema, occular diseases.
• Trade name: DECADRON
6) Betamethasone:
• Action: Anti-allergy, anti-inflammatory
• Uses: Lichen planus, pemphigus, Aphthae ulcer
Dr. Mehnaz Memon🖊
References: Self Notes, Image chart source: Classification of Drugs with DOC by Vikas Seth (Third Edition)