Long-Term Steroid Use

While most drugs have some adverse effects, steroids have
more than their fair share of problems.  Warning:  Heavy Science
Content, but required reading for anyone who is considering
putting their pet on long-term steroids.

To quote Dr. Keith Hnilica, DVM, MS, DACVD, a dermatology expert from the University of Tennessee, "Steroids are like cigarettes: one cigarette will not kill you; social smoking is probably OK, but at some point smoking becomes detrimental. One in five smokers get lung cancer; nicotine has some benefits - a sensation of well-being, memory improvement, energy booster. Likewise steroids have benefits but with chronic use and more importantly, repetitive use - at some point problems develop."


The most common side effects we see with steroid use are increased thirst, increased urination, and increased appetite.  Almost all patients experience these side effects, so plan on them.  In particular, housebreaking can be compromised in some individuals because of the increased urination.  You may need to make plans to prevent accidents.

The anti-inflammatory and immunosuppressive actions of steroids, though desired for their therapeutic effects, may facilitate the establishment or spread of other infectious or parasitic diseases. As a result, dogs treated with steroids have a tendency to develop secondary bacterial infections of the skin, urinary tract or respiratory tract.  Urinary tract infections have been ocumented in 18 to 39% of dogs who are treated with 0.28 to 0.8 mg/kg of steropids for more than 6 months.  

The most serious side effects of steroids are related to prolonged use of large doses which may suppress the pituitary and adrenal glands. The effects of chronic elevations in steroid levels are readily seen with naturally occurring Cushing's Disease.  Unfortunately those same problems can be created by overuse of steroids by the veterinarian and / or owner, even when administered on an alternate-day basis. These high levels of  steroids can result in hyperglycemia, fat redistribution, decreased skin elasticity, atrophy of the skin, poor wound healing, a pendulous abdomen secondary to a redistribution of body fat, poor quality coarse hair, baldness (e.g. hair loss from breakage and failure to regrow), comedones (e.g. follicular plugs or blackheads), a variety of bacterial infections (especially of the bladder and skin) and even calcinosis cutis (e.g. mineral deposits in the skin).  Localized dermal and adnexal atrophy following subcutaneous and occasional intramuscular steroid injections have also been reported. If the steroid used also has mineralocorticoid effects then polyuria (e.g. production of an increased amount of urine) and polydipsia (e.g. drinking an excessive amount) may also be present.  Secondary adrenocortical insufficiency is a side effect that can be seen after withdrawal of the steroid therapy.


The list goes on (and on and on and on...)