Cortisone (Glucocorticoids) • Use & Side Effects

The term cortisone (glucocorticoids) is a colloquial term for various active substances. Cortisone supplements have been available on the market for over 50 years. However, at first the side effects were not clear and the preparations with cortisone were used accordingly carelessly. Too high a dose and too long use resulted in a number of undesirable side effects, which is why cortisone still has a bad reputation today. However, this is usually unfounded if preparations containing cortisone are correctly dosed and only used to a limited extent. It also depends on the form in which the cortisone is used.

At a glance:

How cortisone works

Cortisone is produced by the body itself as the stress hormone cortisol in the adrenal cortex. Synthetic glucocorticoids are used in pharmaceuticals. Their name is derived from their function in the sugar metabolism, where they promote the conversion of protein into glucose and glycogen. Cortisone has different effects on the body, the most important for treatment are:

• anti-inflammatory

• antiallergic

• immunosuppressive

• stabilizing the circulation

Use of cortisone: from over-the-counter to powerful

The glucocorticoids include over 30 active ingredients in different strengths. They are divided into four groups:

• weak glucocorticoids like hydrocortisone and prednisolone

• moderate glucocorticoids such as prednicarbate and methylprednisolone aceponate

• starke Glucocorticoids such as betamethasone valerate and mometasone furoate

• very strong glucocorticoids like Clobetasol

Cortisone medication usually requires a prescription. The weak glucocorticoids are an exception: ointments, gels and creams with hydrocortisone and nasal spray with beclometasone dipropionate in low doses and small packaging sizes are available from pharmacies without a prescription. However, they may only be used for a short time and not in children under six years of age.

Indications for cortisone

Cortisone can be used both externally (locally) and internally (systemically). The external application is given in case of inflammation of the skin, as it occurs with neurodermatitis, psoriasis or allergies with itching.

Systemic treatment with glucocorticoids encompasses many disease areas, as it can be used as a therapy for almost all inflammatory diseases. These include:

Side effects of cortisone

When used correctly, the risk of side effects is low. The side effects of cortisone differ between different types of drugs. In the case of external use, side effects of skin thinning (parchment skin), hair root inflammation, slight pigmentation disorders of the skin (white spots) and the formation of stretch marks (stretch marks) can occur with excessive use.

With cortisone injections, side effects are very rare if there is an interval of four to twelve weeks between injections. There may be swelling and pain at the puncture site, and the skin there may become a little lighter. Joint infections, tendon tears (especially at the shoulder joint) and nerve damage can occur very rarely, for example in carpal tunnel syndrome.

With cortisone sprays that are inhaled or given as a nasal spray, the cortisone can cause coughing and hoarseness. A fungal infection in the mouth can occur as a side effect in immunocompromised people. To avoid this side effect, we recommend rinsing your mouth thoroughly, having a drink or brushing your teeth after using cortisone inhalations. In very rare cases, especially in children, allergic reactions in the mouth and face can occur.

Cortisone tablets are mainly used for chronic inflammatory diseases that no longer respond 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 from the cortisone are to be expected here either. However, if systemic treatment with cortisone takes place more frequently or for a longer period, the risk increases.

Possible side effects of cortisone are:

Avoid side effects as best as possible

Safe application to avoid side effects means that when applied topically, the amount of cortisone applied is adjusted to the sensitivity and thickness of the skin. Because cortisone has a stronger effect on thin, sensitive areas of skin such as the elbows, the eyes or the genital organs, so that weak or medium-strength preparations are sufficient for treatment.

Glucocorticoids are many different active ingredients, but not all of the side effects mentioned. It also depends on the dose, duration of use and other illnesses whether side effects occur from the use of cortisone. Many side effects are also temporary. Blood pressure, blood sugar and bone density should be checked regularly during systemic therapy with cortisone.

The risk of stomach ulcers caused by cortisone can be reduced, for example, by taking additional stomach protection. In order to prevent osteoporosis, drug measures to prevent adverse effects on bone strength should be started with the start of glucocorticoid therapy and continued for up to one year after the end of therapy. One way to slow down the harmful effects of cortisone is to give infusions with bisphosphonates, combined with vitamin D and calcium. Another approved substance is teriparatide, which promotes bone formation and which the patient has to inject himself under the skin on a daily basis. Another alternative is treatment with denosumab, which is applied twice a year. It is also important that the medication is continued for up to one year after the end of the glucocorticoid therapy, as the risk of bone fractures is still increased after discontinuation.

The increased susceptibility to infection can be counteracted by taking distance from sick people and discussing with the doctor before a vaccination whether it makes sense at the time of taking cortisone. In addition, before starting cortisone therapy, you should discuss with your doctor which other medications you can take in order to avoid interactions.

Regardless of whether cortisone is used internally or externally, direct sun should be avoided as UV rays can cause skin irritation.