This post is also available in: Svenska
There is no drug that worries parents more than cortisone. When I ask why parents are so reluctant to give their child cortisone, fears of side effects often arise – thinning of the skin, poor growth, diabetes… So, let’s set things straight. In this blog, we’ll discuss a little bit about cortisone, different types of cortisone treatments and its side effects.
What is cortisone?
Cortisone, or steroids, is the collective name for a group of different molecules that have the same effect as the vital hormone we produce in our body, called cortisol. Cortisol is formed by the adrenal gland and has a variety of effects on the body. To understand how important it is, I will tell you what problems arise for those who do not produce any cortisol. A child who does not produce cortisol (a very unusual disease, but does occur) becomes tired, listless, nauseous, vomits, has poor growth, has low blood pressure and may have very low blood sugar without feeling it. Their salt level is also out of balance. Additionally, if a child who cannot produce cortisol gets a stomach ache or fever, they can die within a few hours. This is because cortisol is absolutely necessary for the body’s defense against infection, and necessary to trigger the body’s defenses against fluid loss and low blood pressure.
Therefore, cortisol is both natural and vital!
Cortisone is a type of anti-inflammatory. Some diseases trigger inflammation in your body. Therefore, to treat these disease, you need to use cortisone.
Long term treatment of high dose cortisone causes severe side effects
Children with severe inflammation sometimes receive high doses of cortisone, in tablet form or intravenously, for a short or long period of time. These children get high doses of cortisone in the blood and consequently side effects.
The three side effects that commonly occur on the first day of treatment are:
1. Wakefulness. Children often have difficulty sleeping.
2. Mood swings. Children often become more rowdy, sometimes depressed, and sometimes upset. In my experiences, children commonly become more noisy.
3. Increase in appetite. Children want to eat a lot of food, and often.
If the treatment is to continue for longer than a few weeks, the increase in appetite often results in weight gain. I always advise parents to give children the same portion size as before the cortisone treatment. And if children want extra snacks and evening meals, then give carrot and cucumber sticks.
If the treatment lasts longer, the weight gain often settles on the abdomen and cheeks. At the same time, the muscles are broken down, which makes the legs appear smaller and stick-like.
Children can also have acid reflux, and develop diabetes and stomach ulcers that can affect their growth.
After a while, the body thinks that the adrenal glands no longer need to produce cortisol because so much comes from the medicine. Therefore, you must never stop a high-dose cortisone treatment abruptly. Cortisone needs to be tapered down slowly. A sudden drop in cortisone can cause life-threatening symptoms similar to the diseases caused by cortisol deficiency. Follow the doctor’s prescription!
Lower doses of cortisone tablets have fewer side effects
Doctors who treat children with high-dose cortisone, always try to reduce the dose as soon as possible while effectively treating the disease. Many children can stay on a low dose for a long time to prevent the disease from returning.
Single high doses of cortisone do not cause long-term side effects
Children with croup, asthma or severe allergic reactions, often receive a single high dose of cortisone in the pediatric emergency room. Children can have difficulty sleeping, and they can also have mood side effects for a few days. However, receiving single such doses does not cause long-term side effects. Height can probably be affected for a short time, but if the child does not receive repeated doses often, then they will make up for their growth loss later.
Cortisone nasal spray is safe to give to children
Nasal sprays with cortisone (Nasonex, mometasone, Mommox, Orimox and more) are safe to give to children as it acts locally in the nasal passages. Cortisone nasal spray is good for allergic nasal congestion. It is often given as a trial, even for chronic nasal congestion where it is not known if any allergy is behind it.
Some children find the nasal spray stings and some get nosebleeds as a side effect. However, Nasonex and similar nasal sprays are not absorbed into the bloodstream and do not cause systemic cortisone side effects.
Nasal spray with cortisone is good for pollen allergy.
Cortisone inhalers to treat asthma has few side effects
Inhaled cortisone for asthma treatment (Pulmicort, Flutide, Giona Easyhaler, Symbicort in the several orange or brown spray cannisters) is absorbed into the blood to a very small extent. Therefore, treatment with asthma inhalers never gives the side effects that high-dose cortisone treatment in tablets or IV gives.
Untreated asthma results in poor growth and poor quality of life in children. It also results in poorer muscle development as children with untreated asthma do not move as much as other children. In order for children with asthma to grow optimally, their asthma should be treated optimally. This often means inhaling cortisone every day.
If your child has asthma and you want to minimize possible cortisone side effects, you should give the cortisone inhalations correctly via a spacer. Cortisone inhalations reduce the risk of admittance to the pediatric emergency room. If your child is admitted with an asthma attack, they will immediately receive a large dose of cortisone tablets with a greater risk of side effects.
Cortisone creams are an effective treatment against eczema
Cortisone creams are effective against eczema. They are available in four different strengths: weak, medium, strong and extra strong. Their side effects differ between groups.
Weak cortisone creams are not absorbed into the bloodstream
Most over-the-counter cortisone creams belong to the weak cortisone creams. Hydrocortisone 1%, Mildison lipid are weak cortisone creams. They are not absorbed into the bloodstream at all and the only side effect we sometimes see is contact allergy to the drug itself. The side effect is rare, but worth considering if the child’s eczema gets worse and not better from the cortisone treatment.
I treat my own children with weak cortisone cream as soon as they get eczema. When the eczema is gone, they receive treatment every other day for a while and then stop. Then moisturizer is applied until the ezcema reappears. When the eczema reoccurs, I use hydrocortisone again, for as much and as long as needed.
Medium-strength cortisone creams can be absorbed into the bloodstream
Medium-strength cortisone creams, such as Locoid 0.1% or Emovat 0.05%, are usually prescription-only. They are used when weak cortisone creams fail to treat the eczema. Unlike weak cortisone creams, they can be absorbed into the bloodstream. The more you apply, the more it absorbs. However, you won’t see the side effects you see with high-dose tablet treatment. Not even during long treatment periods. When the eczema is clearly better, try switching to a weak cortisone cream. Follow the instructions given to you by your child’s doctor!
Strong cortisone creams often cause skin side effects
Strong cortisone creams, such as Elocon 0.1% and Betnovat 0.1%, I use less often on children. With long-term use (months), they can cause skin thinning, stretch marks and they are definitely absorbed into the bloodstream. However, strong cortisone creams also do not cause the side effects that high-dose tablet cortisone does. When the eczema has clearly improved with strong cortisone cream, you switch to medium-strong cortisone cream. If the eczema is stubborn, however, you may need to continue applying the strong cortisone cream once a week to prevent relapse. Follow the instructions given to you by your child’s doctor!
Extra strong cortisone creams
Extra strong cortisone creams such as Dermovat 0.05% are not used on children.
The percentage says nothing about the strength of cortisone creams!
Notice in the examples above. The strongest cream has a much lower percentage than the weakest. I included the percentages to demonstrate. Make sure you know which cortisone creams are weak, medium or strong.