The hormonal drug known as cortisone does not always contain the actually inactive cortisone, but also its active form cortisol (Hydrocortisone).
In the case of drugs with cortisone as an indirect active ingredient, a chemical conversion process takes place in the organism with the formation of cortisol.
Both cortisone and its active form belong to the group of steroid hormones.
Steroid hormones are primarily produced in the adrenal cortex and from there distributed in the body via the bloodstream.
For very interested laypeople: "Cortisone itself is the inactivated form of the glucocorticoid cortisol through an oxidation process; it itself has no biological effectiveness. This is because, due to its chemical structure, it is not able to bind to a glucocorticoid or mineralcorticoid receptor.
Within the organism, cortisol is produced in the zona fasciculata of the adrenal cortex.
The release of the hormone is controlled by a stimulating hormone from the anterior pituitary gland.
Like all other steroid hormones, cortisol is also made from cholesterol educated.
After the administration of drugs containing cortisone (Cortisone ointment) the biomolecule is converted enzymatically and can only then develop its effect.'
The active one hormone Cortisol is used to control degrading (catabolic) Metabolic pathways responsible, so it's up to the Providing energy to the body essentially involved.
In addition, it has an inhibitory effect on the normal processes of the Immune system and is therefore capable of excessive reactions and Curb inflammatory processes.
This is the one that is particularly desirable for cortisone ointments effect.
Cortisol, known as the “stress hormone”, has numerous regulatory tasks within the organism.
Its main effect, however, is the regulation of the sugar metabolism and thus the provision of high-energy compounds.
Cortisol promotes glucose production (Gluconeogenesis) in the cells of the liver (Hepatocyten), which means that when there is a lack of energy it stimulates the formation of sugar molecules.
It also has a beneficial effect on fat loss and the overall protein metabolism of the body.
In the course of long-term stressful situations, cortisol is increasingly produced and released into the bloodstream. In this context, it has a similar effect to the hormones adrenaline and noradrenaline.
An overview of the most important creams and ointments and their areas of application can be found here: Ointments and creams
Since cortisone (actually its active form cortisol) inhibits inflammatory processes and immune reactions works, it is often prescribed as part of an intentional containment of the immune system.
It can do both orally, about the vein or as ointment administered. Also, it is in patients who are on Joint inflammation suffer, possible that drug directly into the affected joint to squirt.
Cortisone ointment becomes Relief of inflammatory processes of the skin used. By inhibiting the immune system and the resulting anti-inflammatory effect, pain, swelling, redness and itching quickly subside after application.
Also allergic reactions of the skin are made to subside by cortisone ointment.
Another effect of cortisone ointment is that accelerated detachment of scales and cornifications.
Areas of application are therefore:
- Contact eczema
- psoriasis (psoriasis)
- Insect bites
- other inflammatory and allergic skin diseases
Cortisone ointment for neurodermatitis
The use of cortisone ointments for neurodermatitis is controversial. So far, however, cortisone has been the first choice for acute, external skin inflammation in the context of neurodermatitis. There are 4 different classes of active ingredient concentrations of cortisone in the treatment concept. There are different preparations for each concentration. In each class there are different preparations that are similar in concentration. Derivatives of cortisone that are used are for example dexamethasone, fluocortolone, hydrocortisone, prednisone, prednisolone, prednicarbate and triamcinolone. The class of active ingredients from which a preparation is selected depends on the severity of the neurodermatitis. For permanent, mild skin inflammation, low-dose cortisone ointments are recommended. For acute, more severe skin problems, cortisone ointments are used in a higher concentration of active ingredients. However, the use of high-dose cortisone preparations is kept as short as possible. As soon as improvement occurs, a change to a lower concentration occurs slowly.
Neurodermatitis is a chronic skin disease with flaky skin, accompanied by redness and itching. Typically, atopic dermatitis runs in episodes, during which the symptoms appear many times more pronounced and over a large area. The causes are not yet fully understood, but the focus is on excessive activation of the immune system.
Thus, cortisone ointments are of great importance in the treatment of neurodermatitis. Cortisone has an inhibitory effect on the immune system. It inhibits inflammatory processes in the skin and prevents the release of substances that cause itching, especially Histamine, before. This property is beneficial in two respects because, on the one hand, the itching itself is relieved and further damage to the skin through scratching is counteracted.
When administered systemically and over long periods of time, the active ingredient sometimes causes considerable side effects, which, however, do not occur when administered locally as a cortisone ointment. However, the skin changes described above also occur in adults over a longer period of time. Therefore, use on the face or other sensitive areas is only recommended to a limited extent. In the case of old preparations, some active ingredient also passes through the skin into the organism. There are many prejudices against cortisone ointments among the population, but it must be said that they represent one of the most successful treatment options for neurodermatitis and that, if used properly, no or only easily controllable side effects are to be expected.
Read more at: Treatment of atopic dermatitis
Cortisone ointment for eczema
Eczema is a non-contagious skin inflammation. They are characterized by itching or they express themselves as oozing inflammation. The therapy for eczema depends on various factors, such as the stage of the disease, the skin type and the cause. Treatment with a (non-prescription) cortisone ointment only makes sense under certain conditions.
For example, if there is a moderate acute inflammatory flare-up, cortisone ointments can be used in an active ingredient concentration between 0.25% - 0.5%. It is usually advisable to apply a thin layer to the affected area once or twice a day. Care should be taken to rub the ointment as small as possible. In addition, hands should always be washed thoroughly after use. This can prevent any of the active ingredient from getting into the eye. If the area of skin regenerates, the application can be slowly reduced.
Abrupt termination of the use of the cortisone ointment should be avoided at all costs. Overall, the cortisone ointment should not be used for more than 4 weeks. Skin care that is tailored to the individual skin type can help prevent eczema from coming back.
Read more on the topic: Eczema - cause, treatment, and more
Cortisone ointment for skin rashes
Skin rashes can have different causes. It can occur in different forms. Both play a major role in treatment. All rashes have one thing in common. They are all characterized by reddening of the skin. This in turn indicates that an inflammatory process is taking place in the body. The cause of the inflammation can be varied. When it comes to the question of whether and from what point in time cortisone should be used, the technical opinions differ.
Read more on the subject at: When does a rash need cortisone?
Cortisone ointment for pimples
Applying cortisone ointment can be an effective treatment for pimples temporarily. However, it is important to ensure that you use the ointment as sparingly as possible. That means, only apply cream to the pimple itself and not the surrounding healthy areas of skin. Furthermore, the cortisone ointment should never be used permanently. Prolonged use of cortisone ointments on pimples can cause permanent damage to the skin.
Cortisone ointment for the face
Cortisone ointment for the face can in certain cases, under certain conditions, have a soothing and healing effect. However, greater caution is required here compared to other areas of the skin. The top layer of skin, the horny layer, represents a barrier for the penetration of the cortisone ointment. Depending on the skin region, it usually takes 15 minutes to 2 hours for the active ingredients to pass through this barrier. The horny layer of the face is thinner than in other parts of the body. As a result, the corticoids are absorbed faster and more strongly by the skin. The concentration must be correspondingly lower. Preparations with an active ingredient concentration of 0.25% are suitable for the face. The upper layers of the horny layer store the ingredients and gradually release them to deeper skin layers. That is why it is sufficient to apply the cortisone ointment thinly and as small as possible to the face once or twice a day. As soon as the complexion improves, the application of the ointment can be reduced. In order to prevent a so-called rebound phenomenon ("recoil phenomenon"), it is important that the cortisone ointment slowly taper off.
Cortisone ointment on the eye
Cortisone ointments have a wide range of applications. As with various skin diseases, cortisone is used locally as an ingredient in ointments for diseases of the eye. The ingredient is usually hydrocortisone or dexamethasone, a somewhat more effective derivative of cortisone.
Cortisone ointments applied to the eye require a prescription. They are used for inflammatory diseases of the eye that are not caused by bacteria, viruses or fungi, as well as for allergic events. A wide variety of parts of the eye can be treated. These include e.g. the conjunctiva, the cornea of the eye or the edges of the eyelids. The ointment has local anti-inflammatory and anti-allergic effects.
It is important that the cortisone ointment must not be used on the eye if a pathogen is responsible for the disease. This allows the inflammation to progress because the immune system, which has been reduced by the cortisone, can no longer fight the pathogens. A cortisone ointment must also not be used on the eye if the cornea is damaged or if you have known increased pressure in the eye (glaucoma). Side effects may include allergic reactions to the active ingredient or other ingredients in the ointment, such as Wool wax, occur.
Read more on the topic: Eye ointment with cortisone
Use in babies
Cortisone preparations are contraindicated for children under the age of 6 months. Up to this age the baby does not have a fully developed horny layer. As a result, it cannot yet form a protective barrier, for example against corticoids. Caution should also be exercised in the use of cortisone ointments in later childhood and childhood. The reason is the larger body surface area in relation to the weight in the child compared to the adult. This increases the risk of a systemic effect when the ointment is applied over a large area.
However, this drug can also be used in babies, of course with more care and caution than in adults.
Cortisone has general anti-inflammatory effects and keeps allergic reactions at bay. It is also often and successfully used in babies for allergic reddening of the skin, itching and insect bites. One of the main areas of application in babies is atopic dermatitis, which can be treated easily with cortisone ointments in mild and moderate forms. The advantage of topical application is the fact that there are no known side effects of prolonged tablet intake such as Susceptibility to infection, high blood pressure, weight gain. However, especially in babies who have a softer skin than adults, changes in the skin in the form of tears and a decrease in skin thickness can be observed after prolonged use of the cream.
Therefore, you should only treat the baby with cortisone ointments when necessary and not for too long and the use of a cortisone ointment on the baby should always be discussed with a doctor.
Read more about this: Cortisone in babies
Are there any cortisone ointments available without a prescription?
It is possible to buy cortisone ointments without a prescription. However, these are low in concentration. This means that there are only over-the-counter cortisone ointments that are prepared with an active ingredient concentration of less than 0.5%. However, even with low-dose cortisone ointments there is a risk of side effects and damage if used incorrectly or permanently. It is therefore advisable to discuss cortisone treatment with a doctor if possible. In addition, all children under 6 years of age, including these low-concentration cortisone ointments, require a prescription.
Most cortisone-containing preparations require a prescription due to possible side effects. Now there are some ointments that can be bought in pharmacies without a prescription. Here the active ingredient, hydrocortisone, is dosed in a lower dose than with the prescription preparations. A concentration of 0.5% was set as the limit for over-the-counter sales.
The effectiveness of such a cortisone ointment is weaker, but any side effects do not occur or only very weakly because of the lower amount of active ingredient. An over-the-counter cortisone ointment is suitable for the treatment of inflammatory or allergic superficial skin diseases with mild to moderate symptoms. The hydrocortisone helps to dampen the immune system and thus to prevent an excessive reaction. Typical areas of application are, for example, skin affected by itching or insect bites. The use of an over-the-counter cortisone ointment is also useful for other allergic reactions with reddening and wheals of the skin. If the symptoms are not severe, it can be helpful for atopic dermatitis. Cortisone ointments should not be used on open wounds or acne.
Likewise, after 14 days at the latest, over-the-counter use should be discontinued and a doctor should be consulted, as after this period of time, even with local application, side effects such as thin and chapped skin that tears easily can occur.
Cortisone ointment and pill taking
The use of cortisone ointments does not generally endanger the effectiveness of the birth control pill. This means that the contraceptive protection is not influenced by the cortisone ointment itself. It doesn't matter what type of birth control pill is used. Nevertheless, it should always be indicated to the gynecologist if cortisone preparations are used. At best, you should consult your gynecologist before starting the application. Especially if there are uncertainties or the ointment is to be used in the genital area.
There are many different hormones in the body, some of which interact with one another and can inhibit or release one another. The active ingredient contained in cortisone ointments is structurally similar to the hormones that are used in what is known as the pill, oral contraception: the progestins and estrogens.
As a result, the question often arises whether cortisone ointments impair the effect of the pill or vice versa. It has been observed in studies that estrogens can increase the levels of cortisone in the blood. To reassure you, it must be said that the use of a cortisone ointment has no influence on the effect of the pill. When used as an ointment, the cortisone collects in certain layers of the skin and is released evenly from there (depot effect). However, virtually no active ingredient enters the circulation and thus passes through the entire body. When applied locally, the measurable amount of cortisone is far too small, if present at all, to interact with the hormones in the pill.
For systemic treatment with cortisone e.g. in the form of tablets, however, clarification with a gynecologist is extremely advisable, as large amounts of cortisone act in the entire body. If in doubt, it is always advisable to read the package leaflet for both drugs carefully for this question.
Cortisone ointment during pregnancy
One of the contraindications to cortisone ointments is pregnancy. Since it cannot be completely ruled out that some of the active ingredient gets into the organism, cortisone preparations of any kind should be avoided during pregnancy. If the corticoids penetrate the organism, the unborn child could be harmed. The newer preparations have a lower risk of the active ingredients entering the body. But this cannot be completely ruled out. It is safer to consider alternatives together with the doctor.
Read more on the topic: Cortisone in Pregnancy
Cortisone ointment and breastfeeding - is that possible?
Cortisone ointments are contraindicated during breastfeeding. The corticoids can pass into breast milk. Even if there is no evidence of damage to the infant, cortisone preparations should be avoided if possible. Consultations from the midwife and the gynecologist can offer support and solutions.
Duration of application
The duration of the application of cortisone ointments should be as long as necessary and as short as possible. It is important to taper off the treatment if the treatment lasts longer than 10 days. The longer the duration and the higher the concentration of the application, the higher the risk of side effects. The size and region of the skin area also play an important role in terms of duration of use and side effects. The skin on the face and genital area is very thin and sensitive. As a result, side effects can arise even with a short application of cortisone ointments.
Read more on the topic: Taper off cortisone
Many patients fear taking cortisone and applying cortisone ointment because of some side effects. However, side effects are usually not to be expected with treatment with low-dose cortisone.
The external application of cortisone is to be regarded as safe, systemic side effects, which affect the whole body, are very unlikely.
Nevertheless, to be on the safe side, the cortisone ointment should not be applied for too long and if possible only on smaller areas of the skin.
Side effects that may occur with prolonged use of cortisone ointments are thinning of the skin, hyperpigmentation and the emergence of small blood vessels.
The thinning and hyperpigmentation disappear by themselves after stopping the cortisone ointment; the blood vessels may have to be removed with the laser.
However, in the event of systemic overdose from oral or intravenous administration of cortisone, serious problems can arise.
Some patients report symptoms of a condition called Cushing's syndrome after prolonged use of cortisol.
Due to the increased cortisol level, they suffer from hypoglycaemia and a serious immune deficiency with many, sometimes serious infections. In addition, muscle wasting in the arms and legs can occur with simultaneous fat accumulation on the trunk of the body (trunk obesity).
Osteoporosis, wound healing disorders, punctiform skin bleeding and an increase in intraocular pressure are also possible.
In addition, some patients have reported having stomach problems caused by an inhibition of the production of mucus by the stomach cells.
A general disadvantage of preparations containing cortisone is that they can only be tapered off slowly. If the patient is stopped suddenly, symptoms may reappear.
Therefore, you should gradually apply less cortisone ointment until you finally leave it off completely.
Read a lot more information on this topic at: Side effects of cortisone
Cortisone ointment and sun
When using cortisone ointment, the sun should be avoided as far as possible. Together with UV radiation, the active ingredient can cause irritation and pigmentation of the skin. In some cases of sunburn, cortisone preparations are also recommended. Especially means that contain hydrocortisone. These have an anti-inflammatory effect. The sunburn heals faster and the active ingredient has a cooling effect. However, cortisone ointments should be avoided as they block the skin and lead to a kind of heat build-up. In cases of sunburn, gel or cream preparations with cortisone may be recommended.
Cortisone ointment after tattoo
After a tattoo, ointments containing cortisone are generally not recommended. Because these inhibit the healing process. Usually antiseptic substances like the active ingredient chlorhexidine are recommended. This can be found, for example, in the commercial preparation Bepanthen®. In individual cases it may be that the use of certain cortisone ointments makes sense in the short term. If there is inflammation, allergies, swelling of the lymph nodes or nodules on the skin, a doctor should be consulted.
Please also read our topic: Post treatment of a tattoo