Steroid use can lead to long-term treatment failure for Lyme disease patients

Several studies have documented the consequences steroids pose to patients with Lyme disease. Most recently, researchers from Massachusetts Eye and Ear and Harvard Medical School published a retrospective study which described an "association between corticosteroid use in acute LDFP [Lyme disease-associated facial palsy] and worse long-term facial function outcomes." [1]

Physicians are warned of the importance in distinguishing between viral or idiopathic facial paralysis (e.g., Bell’s palsy) from Lyme disease-associated facial palsy. Authors of the study, “Steroid Use in Lyme Disease-Associated Facial Palsy Is Associated With Worse Long-Term Outcomes,” used the term Lyme disease-associated facial palsy (LDFP) rather than Bell’s palsy to highlight the differences in pathophysiologies between viral and idiopathic facial palsy.

LDFP was presumed to be the consequence of a humoral immune neuropathy rather than cell-mediated autoimmunity or edematous compressive neuropathy as seen with viral-induced Bell’s palsy. [1] “If LDFP is a humoral immune neuropathy, corticosteroid therapy may be ill-advised,” states Jowett and colleagues. [1]

Man with Bell’s palsy paralysis of the facial nerve.

The authors expressed concern that two-thirds of the 51 study participants had been prescribed corticosteroids.

“Because corticosteroids are the standard of care for acute viral facial paralysis, it is not surprising that they were prescribed to nearly all patients who were initially misdiagnosed as having such.” [1]

Other studies have described long-term treatment failures for Lyme disease (LD) patients following use of steroids. [2,3] Treatment failures were found in Lyme arthritic patients who were treated with intramuscular (IM) benzathine penicillin following steroids. [3]

In another study, two patients were ill for 3 years and one patient for 6 years despite receiving intravenous (IV) ceftriaxone. The authors explained, “Patients unresponsive to ceftriaxone were more likely to have received corticosteroid treatment.” Dattwyler et al. from Stony Brook Medical Center found an “association of steroid use with an increased failure rate or worsening of disease is understandable in view of the well-known effects of these agents on the inflammatory and immune responses.”

Dattwyler advised against the use of steroids in Lyme disease patients based on these two studies. “In view of the strong association between the use of steroids and the lack of response to antibiotic therapy, we believe that glucocorticoids should not be used in the treatment of Lyme borreliosis.” [2]

Treatment failures following steroids were also reported in a case series of recurrent Lyme disease by Cameron. [4] In the series, a 75-year-old man was prescribed diuretics for edema followed by steroid injections for a swollen knee. An 18-year-old woman with a 4″ x 4″ rash followed by pericarditis was treated with steroids instead of antibiotics. A 37-year-old man with disseminated early Lyme disease (LD) rashes and asthmatic bronchitis was treated initially with steroids instead of antibiotics.

Complications have also been reported in canine-infected Borrelia burgdorferi. [5] Dogs succumbed to arthritis after prednisone use. Straubinger found “corticosteroids inhibit the regulation of cytokines at the DNA level, thus handicapping leukocyte communication during treatment.” [6]

An association of steroid use with an increased failure rate or worsening of disease is understandable in view of the well-known effects of these agents on the inflammatory and immune responses. [2]

A study of Post-Treatment Lyme Disease Syndrome (PTLDS) supports concerns that the pathophysiology of LD is partly a consequence of a humoral immune response. The T-cell chemokine CCL19 remained high in 14% of Lyme disease patients despite a 3-week course of antibiotics. The level of the T-cell chemokine CCL19 for these patients was 12 times higher than for LD patients who were successfully treated with 3 weeks of antibiotics alone. [7]

“Individuals with ideally treated early Lyme disease have a greater than 12-fold higher risk of developing PTLDS by six or twelve months post-treatment if their CCL19 level is higher than 111.67 pg/ml at one month post-treatment,” writes Aucott and colleagues.

These studies remind us of the need to avoid steroids in patients who may have Lyme disease to avoid long-term treatment failure.



  1. Jowett N, Gaudin RA, Banks CA, Hadlock TA. Steroid use in Lyme disease-associated facial palsy is associated with worse long-term outcomes. Laryngoscope, (2016).
  2. Dattwyler RJ, Halperin JJ, Volkman DJ, Luft BJ. Treatment of late Lyme borreliosis–randomised comparison of ceftriaxone and penicillin. Lancet, 1(8596), 1191-1194 (1988).
  3. Steere AC, Green J, Schoen RT et al. Successful parenteral penicillin therapy of established Lyme arthritis. N Engl J Med, 312(14), 869-874 (1985).
  4. Cameron DJ. Consequences of treatment delay in Lyme disease. J Eval Clin Pract, 13(3), 470-472 (2007).
  5. Straubinger RK, Straubinger AF, Summers BA, Jacobson RH. Status of Borrelia burgdorferi infection after antibiotic treatment and the effects of corticosteroids: An experimental study. J Infect Dis, 181(3), 1069-1081 (2000).
  6. Straubinger RK, Straubinger AF, Summers BA, Jacobson RH, Erb HN. Clinical manifestations, pathogenesis, and effect of antibiotic treatment on Lyme borreliosis in dogs. Wien Klin Wochenschr, 110(24), 874-881 (1998).
  7. Aucott JN, Soloski MJ, Rebman AW et al. CCL19 as a Chemokine Risk Factor for Post-Treatment Lyme Disease Syndrome: A Prospective Clinical Cohort Study. Clin Vaccine Immunol, (2016).


43 Replies to "Steroid use can lead to long-term treatment failure for Lyme disease patients"

  • Katie
    10/12/2021 (1:09 pm)

    How long will lyme symptoms last after using steroids?? Cortisteroids triggered my chronic lyme and I’m now in agony. My Dr did mention this could be a side effect knowing full well i had chronic lyme. Will symptoms subside fairly quick after starting doxy and herbs? Its been 3wks since i was injected. How long do i have to live like this??

    • Dr. Daniel Cameron
      10/12/2021 (8:30 pm)

      I have patients who quickly resolve a flare-up and some that do not. I have also had to change antibiotics in some of my patients.

  • Dianne Stewart
    06/28/2021 (11:03 pm)

    I’m a 74yo grandmother, diagnosed thru Igenex in 2019 and had bullseye rash. Met with Opthamologist today to discuss cataract surgery. He, like the 3 other Opthamologists I’ve seen know nothing about Lyme and say I’ll have to have steroids for the inflammation/swelling after surgery. I also have Macular Degeneration and am really concerned about the steroid drops they say are needed. Is there somethingelse they might use? Early on I took several different antibiotics for several months and then went on Dr. Rawls herbal supplements for last year and a half and have improved greatly; I don’t want to go backwards with steroids, but my eyesight is getting worse. Do you or perhaps a Lyme-literate opthamologist you might recommend, have an alternative to steroids? Thank you so much.

  • M S
    06/14/2021 (2:11 pm)

    Dr. Cameron or anyone. I have not been diagnosed w Lyme, but I have CFS. I had horrible response to Prednisone. EXTREME fatigue, Mod Dizzyness and Mod nausea, could hardly walk. Happened every single time I took a pill within 10 Min and waned a bit before taking the next pill where cycle would start all over again with the severe symptoms above. Any answers as to why this would happen?? Detail, medical and physiological reasons, mechanisms would be appreciated. TY!

    • Dr. Daniel Cameron
      06/14/2021 (3:31 pm)

      I have patients in my practice who find steroids helpful and others that do not. I advise my Lyme disease patients to avoid steroids if they can to avoid interfering with the body’s immune function. I find Lyme disease, COVID-19 long hauler, fibromyalgia and chronic fatigue look alike. I don’t think we know enough about the mechanism.

  • Tyler
    04/22/2021 (2:44 pm)

    I’ve not been diagnosed with Lyme disease (but I swear I have it). I can’t remember if the two occasions lined up, but I’ve received two steroid injections (a stronger one earlier this week) in my foot in the past 3 weeks (arthritis in addition to a toe surgery–and another fracture in the same toe!) and now I’m reading here and wondering if that has anything to do with my “Lyme” symptoms’ return.

    • Dr. Daniel Cameron
      04/22/2021 (6:59 pm)

      I have some Lyme disease patients in my practice who have felt better during their steroid only get worse later. I suspect that the steroids led to a temporary effect on the immune system. I typically advise consulting a doctor with experience treating Lyme disease.

    03/08/2021 (6:08 am)

    I have Lyme disease chronic and also have had terrible sciatic pain for over 5 months. I thought it would eventually clear up but so far hasn’t. WHAT!!! CAN I DO TO GET RELIEF? Do not want steroid because of making lyme worse. Most doctors do not understand so I have just been suffering in silence so to say!! Cannot find a good Lyme doctor.

    • Dr. Daniel Cameron
      03/08/2021 (8:20 am)

      I have patients where their presumed sciatica was from sacroiliitis due to Lyme disease. In those cases treating Lyme disease and co-infections has been helpful.

1 2 3 4

Join the Lyme Conversation
(Note: comments are moderated. You will see your comment after it has been reviewed.)

Some html is OK