Cortisone – Questions & Answers

Cortisone is a type of medication that is used to treat a wide variety of conditions, mainly by suppressing inflammation. Its name often generates concern because of the risk of complications and possible side effects arising from its use. However, over the last century, it has become one of the most effective drugs used to treat even the most severe forms of rheumatic diseases.

Professor Bianca Marasini, Head of the Operating Unit of Rheumatology at Humanitas Gavazzeni, provides us with some insight into the use and side effects of cortisone.

1. Is cortisone bad for the skin?

In young individuals, frequent use of cortisone can worsen acne. In elderly individuals, it can cause fragile skin. It is important to avoid prolonged exposure to the sun as cortisone injections can make an individual more susceptible to sun burns and infections (especially individuals with rheumatic diseases).

2. Should cortisone be discontinued for patients undergoing surgery?

Cortisone should not be discontinued in patients undergoing surgery. In fact, cortisone dosages may need to be increased during hospitalization.

3. Should cortisone be discontinued for patients who are scheduled for a vaccination?

For cases such as the flu, cortisone does not need to be discontinued. However, some vaccinations are contraindicated. Ask your doctor.

4. Can cortisone weaken the immune system?

Cortisone, like all other immunosuppressants, can weaken the immune system. It can worsen an existing infection or make an individual more susceptible to viral or microbial infection. Although the risk of contracting an infection is small and can be controlled with antibiotics, it generally depends on the presence of other possible risk factors. The recommended dosages of cortisone will depend on a wide range of factors. These include an individual’s overall health status and the disease or condition for which cortisone is prescribed.

5. Can cortisone cause hyperactivity?

It is possible for cortisone to cause hyperactivity. In such cases, it is essential to consult with a doctor about lowering dosages. If necessary, mild sedatives may be given to help induce sleep.

6. Can cortisone injections cause weight gain?

Cortisone can cause weight gain due to increased appetite and water retention. A “moon face” can result, meaning a large forehead and a large chin appear during treatment, accompanied by larger cheeks. Other gains occur in the neck and around the waist. These anomalies are due to redistribution of fat cells in the body.  The limbs on the other hand, tend to dwindle because of a decrease in muscle mass. In order to reduce these effects, a calorie-controlled diet is recommended. Doctors believe that a limitation of carbohydrate intake may be beneficial in decreasing the weight gain associated with cortisone use.

7. Is there an alternative treatment to cortisone?

In cases where extremely high dosages are required or intolerable side effects appear, cortisone dosages should be decreased or suspended. Immunosuppressive drugs may be used as an alternative treatment, though cortisone has a more rapid effect and side effects substantially lower than those of other immunosuppressants.

All in all, cortisone is used to treat severe allergies, arthritis, asthma, multiple sclerosis and skin conditions. It may also be used for other conditions as determined by a doctor. Cortisone works by decreasing or preventing tissues from responding to inflammation. It also modifies the body’s response to certain immune stimulation.