Cortisone is an active substance in the group of glucocorticoids (also glucocorticosteroids). What medicines are available with cortisone, when it can be used, how it works and what side effects there are.
The term cortisone (glucocorticoids) is colloquially summarized various drugs. For over 50 years, cortisone supplements are available on the market. However, one was initially not aware of the side effects and used the preparations with cortisone accordingly thoughtless. By too high a dosage and too long an application, there were a number of unwanted side effects, which is why cortisone today still has a bad reputation. However, this is usually unfounded when cortisone preparations are dosed correctly and used only to a limited extent. It also depends on the form in which the cortisone is used.
Mode of action of cortisone
Cortisone is produced by the body itself as a stress hormone cortisol in the adrenal cortex. In medicines, synthetic glucocorticoids are used. Its name derives from its function in sugar metabolism, where it promotes the conversion of protein into glucose and glycogen. Cortisone has different effects on the body, the most important for the treatment are:
- anti-inflammatory
- antiallergic
- immunosuppressive
- circulation stabilizing
Use of cortisone: from over-the-counter to strong-acting
The glucocorticoids include more than 30 active ingredients in different strengths. They are divided into four groups:
- weak glucocorticoids such as hydrocortisone and prednisolone
- moderate glucocorticoids such as prednicarbate and methylprednisolone aceponate
- strong glucocorticoids such as betamethasone valerate and mometasone furoate
- very strong glucocorticoids such as clobetasol
Medications with cortisone are usually prescription. The weak glucocorticoids are an exception: ointments, gels and creams with hydrocortisone and nasal spray with beclomethasone dipropionate in low doses and small packaging sizes are available over the counter from the pharmacy. However, they may only be used for a short time and not for children under the age of six.
Indications for cortisone
Cortisone can be used both externally (locally) and internally (systemically). External use is given for inflammations of the skin, as they occur in atopic dermatitis , psoriasis or allergies with itching .
Systemic treatment with glucocorticosteroids covers many disease areas as it is considered as a treatment in almost all inflammatory diseases. These include, among others:
- Pulmonary diseases such as bronchial asthma and COPD
- hay fever
- Rheumatism and other joint diseases
- Carpal Tunnel Syndrome
- tinnitus
- chronic inflammatory bowel disease
- Liver and kidney inflammation
- multiple sclerosis
- vasculitis
- Cerebral edema as a side effect of cancer treatment
Side effects of cortisone
When used correctly, the risk of side effects is low. The side effects of cortisone differ in the different types of remedies. When used externally, side effects may include skin thinning (parchment skin), hair root inflammation, mild pigmentation of the skin (white spots) and the formation of stretch marks (stretch marks).
In cortisone injections, side effects are very rare if there is a gap of four to twelve weeks between injections. There may be swelling and pain at the injection site and the skin may get lighter. Very rarely, joint infections, tendon tears (especially at the shoulder joint) and nerve damage can occur, for example in carpal tunnel syndrome.
In cortisone sprays that are for inhalation or nasal spray, cortisone may cause coughing and hoarseness . In immunocompromised people can occur as a side effect, a fungal infection in the mouth. To avoid this side effect, we recommend rinsing your mouth thoroughly after drinking cortisone inhalations, drinking something or brushing your teeth. In very rare cases, especially in children allergic reactions in the mouth and face may occur.
Cortisone tablets are mainly used in chronic inflammatory diseases that are not (anymore) responsive to other treatments. With a short-term treatment up to a maximum of three weeks with a dose adapted to the symptoms, no side effects due to cortisone are to be expected here either. However, if systemic treatment with cortisone is more frequent or longer term, the risk increases.
Possible side effects of cortisone are then:
- increase in weight
- Cushing’s syndrome
- osteoporosis
- high blood sugar and lipid levels, increased blood pressure
- sleep disorders
- emotional disorders such as mild irritability or depression
- increased risk of thrombosis and infection
- stomach ulcers
- in children: temporary growth disorders
Avoid side effects as best as possible
Safe use to avoid side effects means that when applied externally, the amount of cortisone applied will be adjusted to the sensitivity and thickness of the skin. Because cortisone acts on thin, sensitive skin areas such as elbows, the eyes or the genital organs stronger, so that weak treatment with hydrocortisone or moderate enough for treatment.
Glucocorticoids are many different agents that do not trigger all the side effects mentioned. It also depends on the dose, duration of use and other medical conditions, whether side effects from the use of cortisone occur. Many side effects are also temporary. During systemic therapy with cortisone, blood pressure, blood sugar and bone density should be monitored regularly.
The risk of gastric ulcers due to cortisone can be reduced by, for example, taking additional stomach protection. To prevent osteoporosis, the onset of glucocorticoid therapy should initiate drug treatments to prevent unfavorable effects on bone strength and continue until one year beyond the end of treatment. One way to slow down the harmful effects of cortisone is by administering bisphosphonate infusions combined with vitamin D and calcium, Another approved substance is teriparatide, which promotes bone formation and requires the patient to inject themselves under the skin every day. Another alternative is the therapy with denosumab, which is applied twice a year. It is also important that the medication is continued until one year after the end of the glucocorticoid therapy, since the bone fracture risk is still increased after weaning.
The increased susceptibility to infection can be counteracted by removing distance from sick people and discussing with a doctor before vaccination, whether this is useful at the time of cortisone intake. In addition, it is important to discuss with the doctor before initiating therapy with cortisone which other medicines can be taken to avoid interactions.
Regardless of whether cortisone is used internally or externally, direct sun should be avoided, since UV rays can cause skin irritation.