Side effects of steroid injection
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Side Effects of Steroid Injections
Steroid injections are commonly used to treat a variety of medical conditions, but they can come with a range of side effects. This article synthesizes findings from multiple studies to provide a comprehensive overview of the potential adverse effects associated with steroid injections.
Systemic Side Effects of Steroid Injections
Common Systemic Side Effects
Steroid injections can lead to several systemic side effects. A study on intralesional steroid injections for idiopathic subglottic stenosis (iSGS) found that 55% of patients reported side effects such as menstrual irregularities, feelings of joy, and sleeping difficulties. These side effects were generally mild and resolved after treatment completion . Another study on epidural steroid injections highlighted systemic effects like hyperglycemia, hypothalamic-pituitary-adrenal axis suppression, and decreased bone mineral density . Additionally, systemic absorption of glucocorticoids can lead to complications such as Cushing syndrome, infection, and hyperglycemia, especially in high-risk patients like postmenopausal women and diabetics .
Immediate and Acute Adverse Effects
Transforaminal epidural steroid injections (TFESI) with dexamethasone have been associated with immediate adverse effects such as numbness, tingling, perineal pruritus, headaches, insomnia, hiccups, flushing, and increased radicular pain. These effects were generally minor and self-limited . Similarly, another study reported central steroid responses like sleeplessness, flushing, and non-positional headaches following epidural steroid injections .
Local Complications of Steroid Injections
Injection Site Reactions
Local complications can also occur at the injection site. For instance, anabolic steroid injections have been linked to severe local complications such as knee joint sepsis and radial nerve palsy . In bodybuilders, anabolic steroid use has resulted in tissue necrosis and soft tissue infections, as well as the development of painful inflammatory masses .
Dermatological Reactions
Intralesional steroid injections can cause dermatological side effects like pain, granulomatous reactions, allergic reactions, and changes in skin pigmentation. Rarely, they can lead to linear hypopigmentation and atrophy, likely due to the lymphatic spread of corticosteroid crystals . Perilymphatic atrophy, characterized by atrophy of dermal structures and depigmentation along lymphatic vessels, has also been reported .
Specific Case Studies and Observations
Idiopathic Subglottic Stenosis
In patients with idiopathic subglottic stenosis, office-based steroid injections have shown promise in reducing airway stenosis and improving symptoms like dyspnea. However, side effects such as temporary airway restriction, cough, and nasal pain were noted, though these were generally mild and transient .
Tendonitis Treatment
Steroid injections for shoulder and elbow tendonitis have been found to be effective in the short term but come with side effects like transient pain and skin modifications. These injections were not significantly better than NSAIDs in the short term and showed no long-term benefits .
Conclusion
Steroid injections, while effective for various conditions, can lead to a range of systemic and local side effects. These can include hormonal imbalances, skin reactions, and immediate adverse effects like numbness and headaches. Clinicians should inform patients about these potential side effects and consider individual risk factors when recommending steroid injections. Further research is needed to better understand and mitigate these risks.
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