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5 Indication for Prescribing

Dr. Abhishek Shukla, a geriatrician at Aastha - Centre for Geriatric Medicine, Palliative Care Hospital & Hospice in Lucknow, explained to the student that corticosteroids are synthetic drugs mimicking cortisol, the natural hormone that curbs inflammation, swelling, pain, and excessive immune activity. These medications alter gene transcription to dampen immune responses, providing rapid symptom relief in various conditions though they do not address underlying causes and demand cautious use owing to side effects like osteoporosis, hyperglycemia, hypertension, and infection risk—especially heightened in the elderly. He outlined five common indications. First, allergic conditions and anaphylaxis: steroids treat severe reactions like anaphylaxis, acute asthma attacks, urticaria (hives), and allergic rhinitis by swiftly reducing airway swelling and hypersensitivity. Second, autoimmune diseases: they manage chronic inflammation in rheumatoid arthritis, systemic lupus erythematosus (SLE), vasculitis, and multiple sclerosis flares, helping induce remission without curing the disorder. Third, respiratory diseases: in exacerbations of chronic obstructive pulmonary disease (COPD) and asthma, steroids lessen airway inflammation, improving breathing when bronchodilators alone fail. Fourth, inflammatory skin conditions: topical or systemic forms alleviate eczema, contact dermatitis, and psoriasis by suppressing local immune overactivity, often via creams for targeted relief. Fifth, inflammatory bowel disease (IBD): during flare-ups of Crohn’s disease or ulcerative colitis, they control gut inflammation, bridging to maintenance therapies. Dr. Shukla stressed short-term, lowest-effective doses in geriatrics, preferring topical/inhaled forms and monitoring for complications like fractures or infections prevalent in older patients