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"

  • Shirley M
    01/12/2024 (3:28 pm)

    I took a steroid shot for my knee before I knew about lyme. I had a lot of neurological symptons cone back an d more. This was a big shot. I am all updet and feel I will never be well again. Anyone else see this or have kept unwell.

  • Catherine
    12/18/2023 (8:23 pm)

    If I was treated for Bells Palsy with prednisone before I was diagnosed with Lyme two weeks later, and I have subsequently gone through several rounds of oral and IV antibiotics without resolution of cognitive symptoms over the last 3 years, is there a high likelihood that I will just never feel better? I would love to stop spending thousands and thousands of dollars on treatment if it is ultimately pointless.

  • Karen Luciani
    05/02/2023 (9:02 pm)

    How do you know if your Lyme is cured?

    • Dr. Daniel Cameron
      05/03/2023 (7:13 am)

      Some patients remain well but are reluctant to used cured as there is always a chance there will be a recurrence. Some patients improve but have a difficult time resolving their illness.

  • Cheryl Stouffer
    11/05/2022 (12:15 am)

    In the past I have had a recurrence of Lyme disease brought on by epdiural steroid applicaton 3x for treatment of bulging disks which is now in remission. I have breast cancer and it is being recommended that I get 4 cycles of CheomTherapy – 20 Mg of Decadron (steroid) will be administered intravenously at the beginning of each cycle. Will a prophalactic medicine mitigate the recurrence of Lyme due to the steroid and the Chemo Therapy itself? If so how likely is it to mitigate? If so what is the recommended medication? Would be happy to have a tele-health appointment to discuss ASAP if warranted.

    • Dr. Daniel Cameron
      11/06/2022 (12:57 pm)

      I have patients who have been ill with Lyme disease when they are diagnosed with a tick borne illness. I have had some Lyme disease patients who found out they also had cancer during their tick borne infection. I have treated these patients as they prepare for their cancer treatment. I have not administered prophylactic treatment for Lyme disease as they prepare for cancer treatment if their tick borne infection has resolved.

  • Kathy Osborn
    03/02/2022 (10:50 am)

    I live in Iowa, drs do not know about lyme. I have cronic lyme, arthritus and my back dr wants me to get steroid injections in my back, I heard steroids are a no no with lyme. What do I do? It is getting really hard to continue working and without llmd anywhere close, how do I continue? I need help or disability and I dont think either are posible🥺

    • Tracy Pilger
      06/10/2022 (8:52 am)

      Find an herbalist that treats lyme or a practitioner that uses frequency or rife machines. Both can be life savers. You may need to do telehealth with an out of state practitioner. CA has some that do this. Wishing you a return to optimal health.

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