Where does the fear of cortisone come from?
The first cortisone preparations that came onto the market for medical treatment were very heavily dosed and led to considerable side effects. Even the first ointments contained amounts that were effective throughout the body in many patients. Today’s preparations, however, are much smaller and more specific doses and therefore have fewer side effects.
Especially the local application today also has almost only local side effects. A further reason for the fear of cortisone is the extreme pattern of long-term use. Parents fear side effects such as truncal obesity and high blood pressure, but these are only to be feared if cortisone is taken in high doses over a long period.
Hypercortisolism (too high cortisol levels in the body) leads to the so-called Cushing’s syndrome. Since cortisone is a hormone produced naturally in the body, its effect is also easier to control than chemical drugs, to which the body often reacts unspecifically. This means that the side effects are based on the natural action of cortisone and are well known, whereas other drugs can cause more unexpected side effects. In addition to the fear of cortisone, there is often a lack of information about the preparations. Parents should not be afraid to ask the treating paediatrician if anything is unclear.
What can I do to alleviate the side effects?
The most important way to alleviate side effects is to closely monitor and adjust the dose of cortisone as soon as side effects occur. Furthermore, the timing of the intake is also important, as this allows an appropriate level of cortisone to be maintained in the body. The concentration of cortisone varies depending on the time of day.
When using nasal sprays containing cortisone, children should rinse their mouths after use to prevent fungal infection in the mouth. Cortisone ointment should only ever be applied in a thin layer to the affected skin areas. In the case of open skin, additional antibiotic therapy may be advisable so that the weakened immune system is not overburdened with possibly invading pathogens. In the case of long-term therapy with cortisone, discontinuation should take place slowly and gradually so that the body can adjust its own cortisone production. The entire therapy with cortisone should always be closely monitored by the parents and the paediatrician, even in slightly older children.
What are the options if cortisone does not help?
The main effect of cortisone is based on its inhibition of the immune system and thus the weakening of defensive reactions. There is a whole range of different immune-regulating drugs. In organ transplants or autoimmune diseases, for example, calcineurin inhibitors such as ciclosporin can be used to reduce the formation of pro-inflammatory cytokines.
Another group of drugs are mTor inhibitors, which slow down the development of immune cells. These include the drugs Sirolimus and Everolimus. Cytostatic drugs are also known from cancer therapy, which prevent cell growth and cell division.
Besides the cancer cells, these act on all rapidly dividing cells and thus also on many cells of the immune system, which leads to an inhibition of inflammation. Monoclonal antibodies represent a therapeutically still very young alternative. These can be used very specifically against one cell type and are therefore also suitable for the treatment of many autoimmune diseases.
All these alternatives have a very strong influence on the body and are possibilities to further intervene in severe autoimmune diseases. Here, very close monitoring by pediatricians and other specialists is necessary. The drugs do not cover the full spectrum of action of cortisone, but are usually more specific for certain diseases.
Cytostatic drugs are also known from cancer therapy, which prevent cell growth and cell division. In addition to cancer cells, these act on all rapidly dividing cells and thus also on many cells of the immune system, which leads to inflammation inhibition. Monoclonal antibodies represent a therapeutically still very young alternative.
These can be used very specifically against one cell type and are therefore also suitable for the treatment of many autoimmune diseases. All these alternatives have a very strong influence on the body and are possibilities to further intervene in severe autoimmune diseases. Here, very close monitoring by pediatricians and other specialists is necessary. The drugs do not cover the full spectrum of action of cortisone, but are usually more specific for certain diseases.
