Introduction
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 transformation process with the formation of cortisol first takes place in the organism. 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 are distributed throughout the body via the bloodstream. For very interested laypersons: “Cortisone itself is the form of the glucocorticoid cortisol that is inactivated by an oxidation process; it has no biological effectiveness whatsoever. This is because it is not able to bind to a glucocorticoid or mineral corticoid receptor due to its chemical structure.
Within the organism, cortisol is formed in the zona fasciculata of the adrenal cortex. The release of the hormone is controlled by a stimulating hormone of the anterior pituitary gland. Like all other steroid hormones, cortisol is formed from cholesterol.
After administration of drugs containing cortisone (cortisone ointment), the biomolecule is enzymatically converted and can only develop its effect afterwards. “The active hormone cortisol is responsible for the control of degrading (catabolic) metabolic pathways, thus it is significantly involved in the provision of energy for the body. In addition, it has an inhibitory effect on the normal processes of the immune system and is therefore able to contain excessive reactions and inflammatory processes. This is the effect that is particularly desired with cortisone ointments.
Effect
Cortisol, known as the “stress hormone”, has numerous regulatory functions within the organism. However, its main effect is the regulation of the sugar metabolism and thus the provision of energy-rich compounds. Cortisol promotes the production of glucose (gluconeogenesis) in the cells of the liver (hepatocytes), which means that it stimulates the formation of sugar molecules when energy is lacking.
In addition, it has a stimulating effect on the breakdown of fat and the entire protein metabolism of the body. In the course of long-term stress 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 creamsSince cortisone (actually its active form cortisol) has an inhibitory effect on inflammatory processes and immune reactions, it is often prescribed in the course of a deliberate containment of the immune system. It can be administered orally, through the vein or as an ointment. In addition, patients suffering from joint inflammation can be injected directly into the affected joint.
Cortisone ointment is used to alleviate inflammatory processes in the skin. By inhibiting the immune system and thus having an anti-inflammatory effect, pain, swelling, redness and itching quickly subside after application. Cortisone ointment also helps to reduce allergic reactions of the skin.
A further effect of cortisone ointment is the accelerated removal of scales and cornifications. Application areas are therefore:
- Neurodermatitis
- Contact eczema
- Psoriasis
- Insect bites
- Sunburn
- Other inflammatory and allergic skin diseases
The use of cortisone ointments for neurodermatitis is controversially discussed. Up to now, however, cortisone is the first choice for acute, external skin inflammations in the context of neurodermatitis.
In the treatment concept there are 4 different classes of active agent concentrations of cortisone. There are different preparations for each concentration. In each class there are different but similar preparations in terms of concentration strength.
Derivatives of cortisone that are used are for example dexamethasone, fluocortolone, hydrocortisone, prednisone, prednisolone, prednicarbate and triamcinolone. The class of active substances from which a preparation is selected depends on the severity of the neurodermatitis. In cases of permanent, light skin inflammations, low-dose cortisone ointments are recommended.
For acute, more severe skin problems, cortisone ointments with a higher concentration of active agents are used. However, the application of high-dose cortisone preparations is kept as short as possible. As soon as the situation improves, the concentration will slowly be reduced.
Neurodermatitis is a chronic skin disease with scaly skin accompanied by redness and itching. Typically, neurodermatitis occurs in relapses, during which the symptoms are many times more pronounced and cover a larger area. The causes are not yet fully understood, but the focus is on an 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 which cause itching, especially histamine.
This property is beneficial in two respects as on the one hand the itching itself is suppressed and on the other hand a further injury of the skin by scratching is counteracted. When applied systemically and over a longer period of time the active agent sometimes causes considerable side effects which do not occur when applied locally as cortisone ointment. However, over a longer period of time, the skin changes described above also occur in adults.
Therefore, the application on the face or other sensitive areas is only conditionally recommended. With old preparations some of the active agent also passes through the skin into the organism. In the population there are many prejudices against cortisone ointments, however, it has to be said that they represent one of the most successful treatment options for neurodermatitis and if used properly, no or only well controllable side effects are to be expected.
Eczema is a non-infectious skin inflammation. They are characterized by itching or they express themselves as weeping inflammation. The treatment of eczema depends on various factors, such as the stage of the disease, the skin type and the cause.
Only under certain circumstances is treatment with a (over-the-counter) cortisone ointment useful. If, for example, there is a moderately strong acute inflammatory flare, cortisone ointments with an active substance concentration between 0.25 % – 0.5 % can be used. As a rule, it is advisable to apply a thin layer to the affected area 1 – 2 times a day.
Care should be taken to rub the ointment into as small an area as possible. In addition, the hands should always be washed thoroughly after application. This prevents any of the active ingredient from getting into the eye.
If the skin area regenerates, the application can be slowly reduced. Abrupt discontinuation 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 adapted to the individual skin type can help to prevent the recurrence of eczema. Skin rashes can have different causes. It can occur in different forms.
Both play a major role in the treatment. All skin rashes have one thing in common. They are all characterized by a reddening of the skin.
This in turn indicates that an inflammatory process is taking place in the body. However, the cause of the inflammation can be manifold. Expert opinions differ on the question of whether cortisone should be used and at what point in time.
The application of cortisone ointment can temporarily be an effective treatment against pimples. In this case, however, care should be taken to use the ointment as sparingly as possible. This means only applying the pimple itself and not the surrounding healthy skin areas.
Furthermore, the cortisone ointment should never be used permanently. Prolonged use of cortisone ointments for pimples can lead to permanent damage to the skin. Cortisone ointment for the face can have a soothing and healing effect in certain cases and under certain conditions.
However, greater caution is required here compared to other skin areas. The uppermost skin layer, the horny layer, represents a barrier for the penetration of the cortisone ointment. It usually takes 15 minutes to 2 hours, depending on the skin region, until the active agents have passed this barrier.
The horny layer of the face is thinner than in other areas of the body. This means that the corticoids are absorbed faster and more strongly by the skin. Accordingly, the concentration must be lower.
Preparations with an active agent concentration of 0.25% are suitable for the face. The upper layers of the horny layer store the ingredients and successively release them to deeper skin layers. Therefore a thin application of the cortisone ointment on the face 1 – 2 times a day is sufficient.
As soon as the complexion improves, the application of the ointment can be reduced. In order to prevent a so-called rebound phenomenon (“rebound phenomenon”), it is important that the cortisone ointment is applied slowly. Cortisone ointments have a wide range of applications.
As with various skin diseases, cortisone is also used locally as an ingredient of ointments for diseases of the eye. The ingredient is usually hydrocortisone or dexamethasone, a somewhat more potent derivative of cortisone. Cortisone ointments applied to the eye are only available on prescription.
They are used for inflammatory diseases of the eye that are not caused by bacteria, viruses or fungi, as well as for allergic conditions. Various areas of the eye can be treated. These include, for example, the conjunctiva, the cornea of the eye or the edges of the eyelids.
The ointment has a local anti-inflammatory and anti-allergic effect. It is important that the cortisone ointment should not be used on the eye if a pathogen is responsible for the disease. This can cause the inflammation to progress because the immune system, which is reduced by the cortisone, can no longer fight the pathogens.
A cortisone ointment must also not be applied to the eye if the cornea is damaged or if an increased intraocular pressure (glaucoma) is known. Side effects may include allergic reactions to the active substance or other ingredients of the ointment, such as wool wax. Cortisone preparations are contraindicated in children under the age of 6 months.
Up to this age the baby does not have a fully developed horny layer. Consequently, it cannot yet form a protective barrier, for example against corticoids. Caution should also be exercised when using cortisone ointments in the further infancy and childhood.
The reason for this is the larger body surface area in relation to the weight of the child compared to the adult. This increases the risk of systemic effects when the ointment is applied over a large area. However, this medication can also be used in babies, of course with more care and caution than in adults.
Cortisone has a general anti-inflammatory effect and keeps allergic reactions in check. It is also often and successfully used in babies to treat allergic redness of the skin, itching and insect bites. One of the main areas of application in babies is neurodermatitis, which can be treated well with cortisone ointments in light and medium form.
The advantage of local application is the fact that there are no known side effects of prolonged tablet use such as susceptibility to infections, 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 reduction in skin thickness can be observed in creamed areas after prolonged application. Therefore, the baby should only be treated with cortisone ointments if necessary and not for too long. The use of a cortisone ointment for babies should always be discussed with a doctor.
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