Cortisone cream is not available over-the-counter in pharmacies, and must be prescribed by a doctor. While its anti-inflammatory and antiproliferative properties are undeniable, it also has potential adverse effects and contraindications. Cortisone cream is more or less powerful depending on the class to which it belongs (1 to 4), and the risks of side effects are all the greater as the potency of the cream is high. Find out what are the indications for cortisone cream, but also what are its prescription methods and its potential side effects.
1. Indications and mode of action of cortisone cream
Cortisone cream is a topical corticosteroid, in other words, a skin cream that belongs to the anti-inflammatory family. For sixty years, it is commonly used against certain skin conditions. It can be prescribed by the attending physician or dermatologist, for babies, children, or adults. According to the Swiss Medical Journal, the main benefits of cortisone cream are its anti-inflammatory (reduction of edema and redness), anti-proliferative, cytotoxic (anti-cancer) and immunosuppressive actions. There are various corticosteroids, divided into 4 classes according to their potency, class 4 being that of the most powerful topical corticosteroids. The main indications for the topical form of cortisone are skin pathologies of an inflammatory nature.
Still according to the Swiss Medical Review, cortisone cream is particularly effective, provided that its use is well supervised, in the event of inflammatory dermatosis (atopic dermatitis, seborrheic dermatitis), psoriasis, nodular prurigo (very painful chronic inflammatory skin disease ), cutaneous lupus, lichen planus (skin lesions induced by persistent and recurrent scratching) or allergic contact eczema in particular. Cortisone cream may likewise be prescribed by dermatologists for the medical treatment of hemorrhoids. In such cases, the treatment must be powerful and short in duration. It is essential to follow the medical prescription carefully (duration, method of administration). It should not be used for self-medication: do not reuse cortisone cream previously prescribed for another skin condition, and do not give your topical corticosteroid to another person. If necessary, the person is exposed to adverse effects and contraindications; even if, in the case of this topical corticosteroid, the risk of adverse effects is lower than in the context of oral administration of cortisone. The potential side effects here are essentially local.
2. Prescription cortisone cream
The prescription of cortisone cream must take into account various parameters, to limit the risk of side effects, even if these are relatively infrequent. The physician should seek the minimum effective dose. Indeed, even if these side effects are limited compared to oral cortisone prescription, and rarely systemic (i.e. generalized to the whole body), it should not be forgotten that a part cortisone enters the blood through the skin. If a cortisone cream is prescribed, the doctor will therefore take the following parameters into account:
- The age of the person: both children and the elderly have thinner and more fragile skin than the rest of the population. And therefore a skin that is all the more permeable to cortisone.
- The dose, duration and potency of cortisone cream: cortisone cream is divided into 4 classes, from class 1 (least potent) to class 4 (most potent). That of class 4 must have a brief and very supervised use. Thus, the recommended prescription duration for a class 4 topical corticosteroid is a maximum of 4 weeks, according to the Public Drug Database. Indeed, the higher the potency of the cortisone cream, the greater the risk of local side effects.
- The location of the skin problem to be treated: the thickness of the skin varies according to its location on the body. Thus, the soles of the feet like the palms of the hands or the scalp benefit from a much greater thickness of skin than the contour of the eyes, the armpits, the groin, the face, the underside of the breasts or the genitals. . This must be taken into account, because the rate of absorption of the active principles of cortisone by the blood is all the higher as the skin is thin at the place of application.
- The extent of the skin problem: the larger the surface of the skin on which to apply cortisone cream, the greater the quantity of cortisone to pass into the blood.
3. Local cutaneous side effects of topical corticosteroids
The potential side effects of cortisone cream are infrequent if the prescription is well respected (duration, dosage). These side effects of topical corticosteroids are mainly local, that is to say located at the level of the lesions and the area of the skin which has received the application of cortisone cream. Among the side effects of cortisone cream, the French Eczema Association evokes a reversible epidermal atrophy (superficial part of the skin that covers the dermis). This epidermal atrophy results in a thinning of the skin, a loss of skin elasticity, a smooth and pearly appearance of the skin, a slight depigmentation, and a delay in the healing of wounds. A partially irreversible dermal atrophy can also be observed. It causes the appearance of stretch marks, increased hairiness (we speak of hypertrichosis) or star-shaped white marks. A possible worsening of acne rosacea has also been noted after the application of cortisone cream.
Finally, insofar as one of the actions of cortisone cream is immunosuppression, that is to say the limitation of the action of the immune system, there is the risk of a cutaneous superinfection in people treated. Among the serious forms of cutaneous superinfections induced by cortisone cream, the Swiss medical journal evokes herpetic superinfection of atopic dermatitis or Kaposi’s angiosarcoma. There are also possible bacterial infections (impetigo, etc.), fungal infections (mycobacteria, etc.) or even parasitic infections (scabies). Finally, with a very low prevalence, in 0.2 to 6 out of 100 cases, cortisone cream can cause allergic reactions in the form of allergic contact eczema.
4. Systemic side effects of cortisone cream
Systemic side effects, that is to say generalized to the whole body, are rare in the case of treatment with topical corticosteroids, specifies the Cortisone-info site. They occur mainly in the case of a class 4 cortisone cream prescription, that is to say a powerful topical corticosteroid and/or in the case of a topical corticosteroid prescription over a relatively long period. These side effects are mainly:
- The appearance of glaucoma: cortisone cream, applied to the eyelids in particular, leads in some cases to an increase in intraocular pressure and therefore a risk of glaucoma. This risk varies among people, depending on their corticosteroid sensitivity. It is essential that there are regular checks of intraocular pressure throughout treatment with cortisone cream. Glaucoma is indeed silent, and must be detected at the earliest.
- High blood pressure.
- Growth retardation in children.
- Cushing’s syndrome (chronic hypercorticism): it is manifested by an accumulation of fat mainly in the neck and face.
- Glycemic disorders: hyperglycemia, diabetes (in people with prediabetes or suffering from masked diabetes), glucose intolerance. The risk of diabetes would be correlated with the duration of treatment (it would increase with the latter) and not with the potency of the topical corticosteroid.
5. Contraindications to cortisone cream
There are cases in which cortisone cream is contraindicated. According to the Reference Center for Teratogens (CRAT), pregnancy and breastfeeding are not among these contraindications: there is no risk of premature delivery, miscarriage or malformation of the fetus in the event of treatment with a topical corticosteroid. Contraindications concern the following situations:
- A known allergy to the active ingredient (hydrocortisone) contained in cortisone cream or to one of the components of the topical corticosteroid.
- The presence of acne or rosacea (damage to the small blood vessels of the face) under penalty of aggravation of these dermatological conditions.
- In application to the eyelids: cortisone cream may cause an increase in intraocular pressure. Treatment with a topical corticosteroid should therefore be brief, and subject to monitoring of intraocular pressure. If, before topical corticosteroid treatment, the person suffers from primary open-angle glaucoma, then this risk is increased.
- An infectious skin disease of viral origin: chicken pox, shingles, herpes…
- An infectious skin disease of fungal or parasitic origin.
- An infectious skin disease of bacterial origin: impetigo…
- Ulcerated lesions: presence of wounds on the skin that have not healed for at least a month and form a hole.
Sources:
Cortisone-info, The Swiss medical journal, Public Drug Database, Reference center on teratogens, Pastor Institute
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