Sarcoidosis is a rare inflammatory disease that can affect any part of the body. It is characterized by an overactive immune system that leads to the build-up of clusters of immune cells, called granulomas in different organs and tissues. These granulomas can prevent the normal function of organs and cause additional inflammation, leading to organ damage.

There is currently no cure for sarcoidosis, but there are therapies that can help manage the condition. The most commonly used medications for sarcoidosis are corticosteroids.

How corticosteroids work

Corticosteroids are a type of naturally or synthetically produced hormone that resembles cortisol, a steroid hormone normally produced by the human adrenal glands. They may also be referred to as glucocorticoids.

Cortisol has many different roles in the body, including the regulation of the immune system and the reduction of inflammation.

Corticosteroids can mimic these two functions. They quickly reduce inflammation, preventing further damage to tissues and reducing the swelling, redness, and heat associated with inflammation. They also act to reduce the rate of production of some immune cells, which build up and cause inflammation in sarcoidosis.

Types of corticosteroids

There are many different types of corticosteroid therapies available. However, for most types of sarcoidosis, the most commonly used corticosteroid is prednisone. It is often taken by mouth as a tablet and has an effect on the entire body. It is therefore known as a systemic treatment.

If possible, corticosteroid treatment will be restricted to a specific area to reduce side effects on the rest of the body. For example, inhaled corticosteroids may be used to treat pulmonary sarcoidosis, when the lungs are affected, although it is uncertain how effective these are.

If there are skin lesions, a corticosteroid cream may be directly applied to the affected area. In many cases of ocular sarcoidosis, where the eyes are affected, the first-line treatment will be a topical corticosteroid, in the form of eye drops.

Side effects of corticosteroids

There are known risks associated with corticosteroids, so they are generally not recommended for patients with mild sarcoidosis. They will also not be prescribed long-term unless necessary. Where possible, the patient will be given an initially high dose for a short time followed by a much lower dose for a longer period of time.

Patients should be monitored regularly by their doctor during treatment to identify any side effects early. These include weight gain and increased appetite, insomnia, acne, high blood pressure, an eye disease called glaucoma, cataracts, fragile bones or osteoporosis, depression, skin bruising, increased risk of infections, indigestion, and heartburn.

Corticosteroid treatment can also increase the risk of diabetes in susceptible people.

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