3 Points to Know About Steroids

“Steroids and KIDS? What the what. Can the world get any weirder?”

No, not THAT kind of steroids.

I say that phrase a fair amount, and most people seem to know what I mean. Ok, so what DO I mean?

Many folks immediately call up images of either illegal substances used to enhance performance by high level athletes, or drugs that make bodybuilders bulk up to superhuman size with anatomical definition akin to a medical school textbook illustration. But that’s only one class of steroids. There are different categories of steroid medicines, many of which are used for children, and I want to make sure that you know the difference.

The word “steroid” simply refers to the chemical structure of four rings joined together: for all you organic chemistry fans out there, the base structure is 3 cyclohexane rings plus a cyclopentane ring. As different chemical groups attach to the base structure, the various forms of steroids emerge.

Let’s get the performance enhancing group out of the way first.

Anabolic steroids are generally thought of as being in the “hormone” category.  As in reproductive hormones- like testosterone, estrogen and various derivatives. These natural and synthetic agents interact with androgen (producing male characteristics) receptors to stimulate bone and muscle growth. Take enough of those and you’ll be the incredible HULK before you know it. Unfortunately, other than the fact that many of these substances are illegal, there are also some real downsides to taking them: mood changes, hair differences, & cataracts.

Alright, POINT #1: Not all steroids are performance-enhancing steroids.

So what other kinds of steroids are there? One steroid formulation that is used very commonly in kids who have reactive airway disease or wheezing is the anti-inflammatory kind of steroid. We call this class of steroids corticosteroids. Dexamethasone, Prednisolone, and others are given to treat the inflammatory component of asthma. (The other component is bronchospasm.) Usually this is only given for a few days during an acute asthma exacerbation. Same thing for severe croup. Another example of how an anti-inflammatory steroid is used is in the setting of eczema or atopic dermatitis. This is an inflammatory skin disorder that causes red, itchy rashes. Steroid creams are the mainstay of keeping the skin of patients with eczema as rash-free as possible. Anti-inflammatory steroids are also given for other less common and more severe medical situations like autoimmune disorders and even spinal cord trauma, but it’s important to note that these particular medicines don’t have any stimulatory effect on bones or muscles. We give anti-inflammatory corticosteroids judiciously, as they can have some long term negative effects on growth if given repeatedly and for long courses.

POINT #2: Steroids are crucial in the management of inflammatory disease processes for many kids with illnesses such as eczema or asthma.

Not all steroids are given by mouth or as a topical cream either. A very common steroid preparation is a nasal spray, like fluticasone. This is an over the counter nose spray that is used for people with allergies or other types of rhinitis. Anti-inflammatory steroids can be inhaled as well through a controller inhaler.  Controller inhalers are an everyday medicine for people with asthma and other chronic lung conditions. What’s nice about these preparations is that they are absorbed locally in the targeted tissues and do not have systemic effects.

So, POINT #3: Steroids can be given many different ways: orally, intravenously (IV), as a shot in the muscle, inhaled, and as a nose spray.

I wanted to write this entry because I think the word “steroid” gets a bad rap, when in reality, it is a bit of an unsung hero for many. Not to be taken lightly, when managed and dispensed carefully, these medicines are the cornerstone of health maintenance for people with certain chronic illnesses, and in a few emergent situations can even be life saving. I hope that going forward when you hear the word “steroid” you’ll remember this “image update” and think of something else besides bodybuilding! I know I do.