Cortisone: Indications, Types & Side Effects

Cortisone is a synthetic corticosteroid similar to the cortisol hormone produced by the adrenal glands. It acts as an anti-inflammatory and immunosuppressant and is commonly used in the treatment of chronic conditions like asthma, allergies, rheumatoid arthritis, lupus, and skin problems, as well as post-transplant to prevent rejection.

Different types of corticosteroids include betamethasone, dexamethasone, fluticasone, prednisolone, and methylprednisolone, which come in the form of injections, pills, eye drops, nasal sprays, inhalers, or topicals.

These medications should only be used as prescribed by your healthcare provider. Regular follow up is necessary to evaluate treatment response and identify any side effects. Do not stop taking these medications without first talking with your healthcare provider, as doses should be gradually decreased over time when taken at high doses or for extended periods of time. 

Indications for use

Cortisone is indicated for the treatment of:

• Rheumatic disease, like rheumatoid arthritis, ankylosing spondylitis, multiple sclerosis, bursitis, tenosynovitis, acute gouty arthritis, osteoarthritis, synovitis, and epicondylitis;
• Skin conditions, like pemphigus, dermatitis, eczema, impetigo, severe psoriasis, and lichen planus;
• Connective tissue diseases, like dermatomyositis, acute rheumatic heart disease, polymyalgia rheumatica, temporal arteritis, and granulomatosis with polyangiitis;
• Blood disorders, like thrombocytopenic purpura, thrombocytopenia, autoimmune hemolytic anemia, erythrocytic anemia, and erythroid anemia;
• Allergies, like allergic rhinitis, contact dermatitis, atopic dermatitis, and urticaria; 
• Allergic or anaphylactic reactions to medications, foods, and insect bites, or serum sickness;
• Eye conditions, like corneal ulcers, keratitis, herpes zoster ophthalmicus, anterior uveitis, ophthalmia, allergic conjunctivitis, chorioretinitis, optic neuritis, iritis, and iridocyclitis; 
• Respiratory diseases, like sarcoidosis, Löffler's syndrome, berylliosis, pulmonary tuberculosis, pulmonary fibrosis, aspiration pneumonia, asthma, bronchitis, and sinusitis;
• Gastrointestinal diseases, like ulcerative colitis, Crohn's disease, and chronic hepatitis;
• Endocrine disorders, like adrenal insufficiency, congenital adrenal hyperplasia, thyroiditis, and hypercalcemia related to cancer;
• Cancer, for palliative treatment of leukemia, lymphoma, mycosis fungoides, and multiple myeloma.

In addition, cortisone-based medications may be indicated for the treatment of cerebral edema, nephrotic syndrome, severe COVID-19, organ transplants, and Stevens-Johnson syndrome, for example.

Types and formulations

Various types of corticosteroids exist that are prescribed based on the condition being treated. Some examples include: 

1. Topical corticosteroids

Topical corticosteroids can be found in the form of creams, ointments, gels, and lotions, and are generally used to treat allergic reactions or skin conditions like seborrheic dermatitis, urticaria, or eczema.

Medication names: some examples of topical corticosteroids are hydrocortisone, betamethasone, mometasone, or dexamethasone.

2. Oral corticosteroids

Oral corticosteroids (taken by mouth) are used to treat various conditions, including endocrine disorders, musculoskeletal disorders, rheumatic diseases, collagen disorders, skin conditions, allergies, eye diseases, respiratory diseases, blood disorders, neoplastic diseases, and others.

Medication names: some examples of oral corticosteroids are prednisone, prednisolone, and deflazacort.

3. Injectable corticosteroids

Injectable corticosteroids are indicated for the treatment of musculoskeletal disorders, allergies, skin conditions, collagen disorders, and for palliative treatment of malignant (cancerous) tumors.

Medication names: some examples of injectable corticosteroids are hydrocortisone, dexamethasone, and betamethasone. 

4. Inhaled corticosteroids

Inhaled corticosteroids are used to treat asthma, chronic obstructive pulmonary disease (COPD), and respiratory allergies.

Medication names: some examples of inhaled corticosteroids are fluticasone and budesonide.

5. Nasal corticosteroid sprays

Steroid nasal sprays are used to treat rhinitis and severe nasal congestion.

Medication names: some examples of steroid nasal sprays are fluticasone and mometasone.

6. Corticosteroid eye drops

Corticosteroid eye drops are used to treat eye conditions like conjunctivitis or uveitis, reducing inflammation, irritation, and redness. 

Medication names: some examples of steroid eye drops include prednisolone and dexamethasone.

Side effects

Side effects from corticosteroids are more common with prolonged use, and may include:

• Tiredness or insomnia;
• Increased blood sugar levels;
• Immune system issues, decreasing the body's ability to fight infection;
• Agitation and nervousness;
• Increased appetite;
• Indigestion;
• Stomach ulcers;
• Pancreatic and esophageal inflammation;
• Localized allergic reactions.

In addition, corticosteroids may lead to eye problems like cataracts, ocular hypertension, and bulging eyes.

Contraindications to use

Use of corticosteroids is contraindicated in people with hypersensitivity to any substance or component found in their formulas, as well as people with uncontrolled infections or systemic fungal infections.

In addition, corticosteroids should be used with caution in people with high blood pressure, heart failure, kidney disease, osteoporosis, epilepsy, peptic ulcer disease, diabetes, glaucoma, obesity, or psychosis, and only if approved by a doctor or other healthcare provider.