With the successful treatment of the young American woman, cortisone was quickly established as a drug. In the 1950s, the new drug was used primarily internally to treat rheumatism with great success. And cortisone also quickly established itself in dermatology. Until that time, in fact, there was no drug for the treatment of inflammatory skin diseases that was so fast and so effective.
The effect of cortisone as an active ingredient
It is now known that cortisone has various effects and can be used in different ways accordingly, because it:
- Inhibits inflammation
- Suppresses immunological/allergic reactions
- Slows down accelerated cell division
- Can reduce brain edema
- Prevents vomiting after taking certain anticancer drugs
These effects are due to the fact that the hormone triggers the formation of certain proteins in the cell nucleus, which in turn produce reactions. Therefore, the effect of the drug occurs at the earliest after 30 minutes. However, this effect is only achieved if the hormone is administered in a higher dosage than is present in the body. At extremely high dosages, the hormone deposits directly into the cell walls and can then take effect immediately. Physicians take advantage of this mechanism when, for example, swelling conditions in the tissues impede breathing or shock conditions acutely threaten the patient’s life.
Variety of cortisone preparations
The original cortisone is still used in patients with impaired adrenal cortex. For other therapeutic purposes, various cortisone preparations have been developed through chemical modifications, all of which have the same effect in the body but differ in the strength of their action and their behavior in the organism. In particular, cortisone-containing ointments used for skin diseases have benefited from drug research in recent years. Today, there are a number of ointments and creams that have no effect on the organism as a whole, even when used on the skin for a longer period of time, but exert their effect only locally on the skin. Patients with inflammatory bowel diseases, asthma or inflammatory rheumatic diseases have also benefited from this development.
Derivatives of cortisone
There are now numerous synthetically produced derivatives of cortisone, such as betamethasone, triamcinolone, dexamethasone, prednisolone, prednisone, mometasone, and fluticasone. The active ingredient is used in:
- Asthma and nasal sprays
- Eye drops
- Liquid for injection (injections)
- Ointments
- Creams
- Suppositories
- Tablets
For the long-term treatment of chronic diseases, they can be used in very low doses or targeted and therefore cause few problems.
Internal use of cortisone
Inflammatory reactions are symptoms of many diseases, such as asthma, chronic obstructive pulmonary disease (COPD), rheumatism, or kidney disease. Cortisone and its derivatives are indispensable for therapy, as they remain the most effective anti-inflammatory agents known to medicine. Allergic diseases are also frequently accompanied by inflammation of the affected organs. Here, corticoids are also used to curb the inflammatory reactions. The symptoms can be reduced with this therapy or sometimes disappear completely. Cortisone preparations can also prevent a so-called floor change from hay fever to chronic asthma. Here are 3 rules when using cortisone internally:
- Since the adrenal cortex releases the most cortisone in the morning, one should take the entire daily dose before 8 am. This way, you mimic the body’s natural daily rhythm.
- In order to prevent symptoms from intensifying in the event of a sudden discontinuation of the medication (rebound effect), corticosteroids must be discontinued gradually. One speaks then of a Ausschleichen of the therapy.
- The systemic, i.e. the internal use of corticoids must not take place without medical supervision over a long period of time (longer than 3 to 4 weeks) and in high doses (more than 10 milligrams/day), otherwise there is indeed a risk of the known side effects such as weight gain, water retention in the tissues, osteoporosis or a disturbance of the sugar metabolism.
External use of cortisone
Against inflammatory skin diseases, corticosteroids work particularly well – the typical signs such as redness, swelling, heating and pain pass quickly. In particular, itching, the classic symptom of atopic dermatitis, for example, can be quickly controlled with cortisone therapy. However, if cortisone ointments are used incorrectly (for example, over a long period of time), they can make the skin thinner and ultimately lead to the skin becoming more prone to infection more quickly. Therefore, the following rules should be followed:
- As long as the disease is acute, apply the drug as often as necessary.
- When the symptoms subside, apply as little as necessary.
- In the chronic phase, use as rarely as possible.
