Systemic Cortisone Injections for Alopecia Areata and My Experience with Body Fat Gain and Muscle Loss

Cortisone injections and body fat gain
Body fat or weight gain is a common side effect of taking systemic cortisone. I want to share with you my experience with taking intramuscular corticosteroid injections and the negative effects it has on body composition. I did have other unpleasant side effects, but nothing alarming where I needed additional medical attention.

I began taking the injections as treatment for Alopecia Areata on my beard. This is an autoimmune disease which causes bald spots in a particular region. My doctor gave me 40mg monthly intramuscular injections of a corticosteroid for 4 months. A few months after treatment, I did some research and as expected I found many health networks saying it to be an aggressive and uncommon treatment due to possible severe side effects. He also gave me a topical cream to be used daily.

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Gain fat and lose muscle
It is almost certain to have side effects when taking any kind of systemic cortisone. After 4 months of injections, I lost 6 lbs. and gained 4% body fat!! Doing the math, I gained 6lbs of fat and worst of all I lost 12 lbs. of LBM (lean body mass or muscle)! Now it was not like I was sitting on the couch all day and eating a dozen Krispe Kreme donuts every day. I was lifting intensely, doing moderate amounts of cardio, and eating very clean. Oh, and I was a part of a fat loss competition with fellow trainers so my motivation for results was high. The first two months I was doing great on my workouts and nutrition, but gained a percent of body fat and lost 4 lbs. of body weight. The next two months I let up a little to give my body adequate recovery and ended up gaining another 3 percent body fat and lost another 2 lbs. of bodyweight! As expected with systemic corticosteroid treatments, most of the body fat was gained in the midsection. This was shown by weekly to bi-monthly body fat measurement with calipers done by a seasoned fitness professional.

Under normal conditions I would have maintained my muscle mass and lost 3-4% body fat over the four month course. I have lost 20-30 lbs. of body fat a number of times and know how my body reacts to various exercise and nutrition. I was very unhappy to say the least.

Side Effects
Possible side effects from systemic intramuscular corticosteroid injections (from Dermnetnz(2)):

Other systemic side-effects are not likely to follow intralesional injection of localized skin disease because the dose used is very small.

• However, the following potentially serious conditions have been reported from intramuscular injection of large doses of triamcinolone acetonide.
• Heart: congestive heart failure in susceptible patients, fluid retention, hypertension, cardiac arrhythmias.
• Hormones: decreased glucose tolerance, Cushing syndrome, hirsutism, hypertrichosis, manifestations of latent diabetes mellitus, menstrual irregularities, adrenocortical and pituitary unresponsiveness, suppression of growth in children.
• Musculoskeletal: aseptic necrosis of hip or shoulder bones, calcinosis, osteoporosis and pathological fractures, muscle weakness, tendon rupture.
• Neurologic/psychiatric: convulsions, depression, euphoria, swelling of the brain, insomnia, mood swings.
• Eyes: glaucoma, cataracts, rare instances of blindness associated with periocular injections.

My experience with intramuscular corticosteroid injections:
Initially I felt better and had more energy. This is likely due to my recent history of having clinically low cortisol levels. After 3 weeks of the first injection I experienced major fatigue and lack of motivation until my next cortisone shot. This pattern of increased energy after the injection and a sharp drop a few weeks later makes sense. According to the nurse it was common as the cortisone will artificially increase energy and your body will down regulate the natural production of cortisol. Once the injection wears off, the body feels a “lag” in energy as it now naturally produces less cortisol and does not have the artificial cortisone in the body. I would start to feel better as my body began to produce more cortisol once the injections wore off, but soon after I would get another cortisone injection. This pattern occurred for the 4 months I received treatment.

Throughout the course of treatment I many times felt shaky and fatigued as my body could not produce adequate cortisol during times of heightened stress like intense exercise or stressful situations. In the last 1-2 months the side effects became worse with having a severe lack of motivation to work or complete projects. Instead of spending time on hobbies, learning, or chores, I used my spare time to watch TV, play video games, or mindlessly surf the internet.  

Recovering
About 6 weeks after my last injection I started to feel an increased in energy, well being, and motivation. After 10 weeks I felt about 80% of normal and at 12 weeks (at the time I am writing this) I felt close to 100%. My weight is now up 8 lbs. and my body fat is down 3.5%. I have added back about 11 of my 12 original pounds of LBM and dropped 4 lbs. of body fat. Although the experience was not so great, my body composition is almost back to normal and looks like it will soon be in another few weeks.

Summary
Systemic corticosteroid injections for Alopecia Areata are an aggressive approach for treatment. Most common treatments are topical creams or local corticosteroid injections. Unless systemic injections are now the common method for treatment for this autoimmune disease, I would not recommend going this route due to the unpleasant side effects. On the other hand, hair re-growth started within a week of the first injection and after 6 months I gained back about 70% of the lost hair. Lastly, I would like to add that during the four months of treatment I was working hard to either lose body fat or maintain my body composition and gained 4% body fat. A sedentary individual would have likely gained much more body fat. The good news (at least in my case) is that after treatment your body composition should go back to normal.

References:
1) Clinical Policy Bulletin: Alopecia Areata. Aetna. 2008 No: 0432
2) Dr. Chin-Yun Lin. Intralesional Steroid Injections. dermnetnz.org/treatments
3) Alopecia Areata, Those Round Bare Patches. Retrieved from: http://www.normangoldsteinmd.com/ALOPECIA.HTML

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