If you have inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, you may be prescribed corticosteroids (or steroids) to help control a flare-up. These steroids can reduce inflammation and can help you go into remission — a period when the disease is no longer active.
However, steroids also have a wide range of side effects, including moon face (also called moon facies). This refers to when a person’s face becomes rounder and more full, resembling a full moon.
Here are 10 things you should know about taking steroids and their side effects.
1. Steroids Decrease Your Body’s Production of Inflammatory Chemicals
Steroids are human-made drugs that work the same way as cortisol, a hormone your body produces naturally. Cortisol is made by your adrenal glands, which are endocrine glands (glands that produce hormones) located above your kidneys.
Steroid medications are anti-inflammatory. They decrease the number of inflammatory chemicals your body makes, reducing the immune system’s activity.
Steroids can be used to treat autoimmune disorders like Crohn’s disease and ulcerative colitis by reducing overactive immune systems. An autoimmune disorder is when your immune system attacks healthy cells in your body by mistake.
When steroids are taken orally (by mouth) or by injection into a vein, they work throughout the body and are called systemic steroids. Common systemic steroids are:
- Prednisolone (Orapred)
- Prednisone (Deltasone)
- Methylprednisolone (Medrol)
Steroids can also be applied rectally (via the rectum) by an enema. Rectal steroids are typically not absorbed systemically. Common rectal steroids include hydrocortisone (Cortifoam) and Budesonide (Uceris).
Budesonide is also available as a tablet. It is designed to target only the intestines and doesn’t have much systemic absorption.
2. Steroids Can Have Serious Side Effects
Steroids are very effective at treating IBD flare-ups, but they can have serious side effects, especially if you take them for a long time.
Some of the possible common side effects of steroids include:
- Osteoporosis (weak and brittle bones) and bone fractures
- Increased blood sugar
- Heart disease
- High blood pressure
- Stomach ulcers
- Cushing syndrome
- Moon face
- Mood swings
- Nervousness or anxiety
- Immunosuppression (increased risk of infection)
- Blurred vision
- Hair growth
- Muscle weakness
- Insomnia (difficulty sleeping)
- Fluid retention and swelling
3. Lower Doses for Shorter Amounts of Time Can Reduce Side Effects Risks
Your risk of side effects is increased if you take a high dose of steroid medication for a longer period of time. The dose and duration of steroid use needed to cause side effects is different for everyone.
Although side effects are possible at any dose, they are more likely with higher doses. Low doses of steroids — such as doses less than 5 milligrams (mg) per day of prednisone — are associated with fewer side effects. Additionally, as the amount of time you take steroids increases, so does your risk of side effects.
Steroids can be very helpful in inducing remission of an IBD flare-up, but there’s not enough evidence that steroids can maintain remission. You may take steroids for a short time to calm down a flare-up before you start a long-term treatment for IBD that is more effective for maintaining remission with fewer side effects.
Budesonide has less systemic activity than prednisone, prednisolone, and methylprednisolone and therefore leads to much less side effects.
4. Moon Face Can Be a Side Effect of Taking Steroids
Moon face is caused by the redistribution of fat around the face and jaw, causing the face to look rounder. The appearance of a round face can be exaggerated by other side effects of steroids, such as weight gain and water retention.
5. Moon Face Is More Common in Long-Term, High-Dose Steroid Use
Moon face may appear within the first two months of steroid therapy, though the risk of developing it depends on dosage and length of treatment. One study looked at the effects of taking 20 mg or more of corticosteroids over a prolonged period of time. Among the 88 participants, 61 percent developed what are called Cushingoid features — which can include moon face — at three months. After 12 months of treatment, almost 70 percent of people had developed such features.
Another study found that the rate of Cushingoid features in people taking prednisone was:
- 4.3 percent at doses under 5 mg per day
- 15.8 percent at doses of 5 mg to 7.5 mg per day
- 24.6 percent for those taking more than 7.5 mg per day
People taking systemic steroids like prednisone are more likely to experience moon face because, compared with rectal steroids such as budesonide, more of the medication is absorbed into the body. Although some medication can be absorbed into the body when applied by an enema, the dose will not be as high as if it were taken by mouth. Additionally, budesonide is quickly broken down by the liver when it is absorbed into the body.
However, if rectal steroids are used for a long time or if they’re absorbed into the body at high doses, they can cause moon face.
6. Moon Face Isn’t Dangerous
Moon face can cause facial swelling that changes your appearance and may be upsetting. However, it is not dangerous by itself and does not need to be treated in most people.
Sometimes, moon face can be a symptom of Cushing’s syndrome. Cushing’s syndrome can happen when the body produces too much cortisol, caused by pituitary gland tumors or adrenal disease. If your moon face is caused by something other than corticosteroid use, your health care provider will treat the underlying cause.
7. Certain Groups Have an Increased Risk of Moon Face
Studies have found that moon face is more common in certain groups of people. According to one study published in the Journal of the American Academy of Dermatology, people at higher risk of developing moon face include:
- People under 50
- People with a high initial body mass index (BMI)
- People with a high-calorie intake
8. Moon Face Is Associated With Other Chronic Conditions
A study looked at the incidence of steroid side effects in people taking oral steroids for three months or more and found that those with symptoms of moon face were more likely to develop:
- High blood pressure
- High blood glucose (sugar)
- High cholesterol and triglycerides (a kind of fat found in your blood)
Talk to your doctor about your risk of chronic (ongoing) conditions while taking steroids.
9. Healthy Diet and Water Intake Can Reduce the Appearance of Moon Face
Although you can’t prevent the development of moon face, there are some things you can do to reduce facial swelling.
Steroids can cause water retention (fluid buildup). Eating high amounts of salt can worsen water retention, and reducing the amount of salt you eat can decrease it. Drinking more water can also help reduce water retention and decrease facial swelling.
Increased appetite and weight gain are also side effects of steroids. Maintain a healthy diet to prevent weight gain while taking steroids.
10. Stopping Steroids Suddenly Can Cause Withdrawal Symptoms
The appearance of moon face can start to fade when you stop taking steroids, but it may take several weeks or even months for your face to return to normal.
To prevent steroid withdrawal, do not suddenly stop taking them. If you are experiencing side effects from long-term steroid use, seek medical advice about how to stop taking steroids.
If you’ve been taking steroids for more than a few days, your doctor may need to gradually reduce the amount of medication you take over time — this is called a steroid taper.
Talk With Others Who Understand
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Have you experienced moon face as a side effect of steroids? Have you tried anything that worked to reduce the swelling? Share your experience in the comments below, or start a conversation by posting on your Activities page.
- Corticosteroids — Cleveland Clinic
- Corticosteroid (Rectal Route) — Mayo Clinic
- A Practical Guide to the Monitoring and Management of the Complications of Systemic Corticosteroid Therapy — Allergy, Asthma & Clinical Immunology
- Using Corticosteroids Appropriately in Inflammatory Bowel Disease: A Guide for Primary Care — British Journal of General Practice
- Cushing Syndrome — Mayo Clinic
- Dose-Related Patterns of Glucocorticoid-Induced Side Effects — Annals of the Rheumatic Diseases
- Budesonide for Maintenance of Remission in Crohn’s Disease — Cochrane
- Incidence and Risk Factors for Corticosteroid-Induced Lipodystrophy: A Prospective Study — Journal of the American Academy of Dermatology
- Corticosteroid-Induced Lipodystrophy Is Associated With Features of the Metabolic Syndrome — Rheumatology
- Relationship Between Sodium Intake and Water Intake: The False and the True — Annals of Nutrition and Metabolism
- Prednisone Withdrawal: Why Taper Down Slowly? — Mayo Clinic