Cortisone as tablet

Cortisone is always prescribed or used as a tablet when the effect is not limited to one (external) area, but when the effect should be more systemic, i.e. occur in the whole body. If cortisone is taken in tablet form, it is absorbed in the gastrointestinal tract and enters the bloodstream, so that it is distributed throughout the body via the circulation and bloodstream and acts in places that cannot be reached from the outside. If cortisone is used to treat a rash, local treatment in the form of an ointment is often started first, depending on the severity of the rash and the response of the medication, but can be switched to a systemic tablet form at the outset or afterwards. The likelihood of cortisone side effects is higher when taking tablets than with the limited local application of ointments on the skin or inhalation sprays, as cortisone reaches the whole body via the bloodstream. However, whether and when side effects occur varies from person to person and depends on the dosage of cortisone.

What to do if cortisone does not help?

If there is no improvement under local or systemic therapy with cortisone, either the dose of cortisone should be increased or the therapy should either be supplemented by other drugs or the cortisone should be replaced by another drug. If, for example, cortisone has been used on the skin mainly because of its anti-inflammatory effect in eczema without improvement, a possible infection of the skin with bacteria or fungi must be considered, so that additional use of (local or systemic) antibiotics or anti-fungal (antifungal) agents may be appropriate.If the cortisone has been prescribed for its immunosuppressive effect, for example in autoimmune diseases, and no satisfactory effect occurs, the cortisone can be supplemented or replaced by other drugs that block or reduce the body’s defence system (e.g. methotrexate, azathioprine, cyclosporine, etc. ).

Side effects of cortisone on the skin

Short-term application of ointments or creams containing cortisone on the skin, or short-term or low-dose intake of cortisone as tablets for systemic effect, does not usually lead to changes in the skin. If an ointment containing cortisone is applied to the skin over a longer period of time or if cortisone is taken in a dose above the so-called Cushing’s threshold (threshold above which possible side effects may occur) over a longer period of time, side effects on the skin may sometimes occur. Long-term use can lead to parchment skin, for example.

This is a very sensitive, thin skin that can tear and bleed even under slight mechanical stress. The skin may also have an increased tendency to bleed, as the small skin vessels become more brittle and protrude more strongly as a result of long-term application of cortisone. Furthermore, a so-called steroid acne can develop. This is the occurrence of pimples and blackheads preferably on the back, shoulders and face. Hyperpigmentation (the skin assumes a slightly darker color) can also be noticeable, but this usually disappears after the ointment is discontinued.