Side effects are the actions of drugs that you do not want to get; however, in many cases, you can’t avoid them. Medications are prescribed for special purposes, for example, to treat eczema. All other effects of the medicine are side effects. Some side effects are mild, for example a headache. Others, such as liver damage or long-term fever, can be severe.

Side effects of steroids may be very severe, because these drugs are hormonal in nature. Breaking the hormonal balance in the body can lead to serious consequences. Below we describe the side effects of Cortisone, a drug belonging to the group of corticosteroids.

Cortisone shot side effects (from injections in elbow, back, knee, etc.)

Systemic side effects in case of local (intra-articular) cortisone injections are rare and, as a rule, insignificant. Most of the negative reactions of the body are observed with oral administration of steroids, but if cortisone is injected directly into the inflamed area (for example, the joint), only a small quantity of the drug is carried throughout the body with the blood flow. Here are some examples of cortisone shot side effects depending on the site of injection:

• Side effects from shot in elbow. These may include pain & swelling around the injection site, as well as hives.
• Side effects from shot in knee. They also include possible swelling and pain.
• Side effects from shot in wrist. These imply pain, swelling, and nerve damage (rarely).

In addition, some patients may notice that the skin around the shot site becomes lighter.

Spinal cortisone injection side effects

Epidural steroid injection in spine also may cause some side effects. Thus, spinal injection side effects include all above-mentioned adverse possibilities, as well as a pounding headache that is only relieved while lying down. Another example of side effects from shot in back is fluctuating blood sugar, but it is insignificant. In addition, other side effects may be as follows:

• Facial flushing.
• Anxiety.
• Sleeplessness.
• Local pain increase
• Fever.

Cortisone cream & lotion side effects

Cortisone cream side effects may include:

• itching;
• skin irritation;
• hirsutism;
• cutaneous atrophy;
• local infection;
• contact dermatitis;
• maceration of the skin;
• miliaria (skin changes due to clogged duct of sweat gland);
• systemic action (the risk increases with prolonged treatment, when applied to a large surface, to damaged skin, or under a tight bandage).

The same holds true for lotions. According to a female patient, during adolescence she used a face cream with cortisone for several years. As a result, her skin became noticeably thinner and blood vessels began to be visible.

Side effects of cortisone pills & systemic injections

The main drawback of tablets and general injections is that they can have a systemic effect on the body. As a result, side effects can also be systemic. The same holds true for systemic cortisone injection side effects.

Inreased blood sugar level is the most typical systemic response, which is more common in patients suffering from diabetes. Therefore, during the therapy with cortisone injections, persons suffering from diabetes should carefully monitor the sugar level in the blood, since cortisone can cause its temporary increase. Individuals administering insulin need to check the sugar levels in the blood even more often and, depending on the indicators, adjust the dose of insulin, if necessary.

In addition, patients may have acne, dry skin, and excessive hairiness or hirsutism (hirsutism is also a common side effect of prednisolone). These reactions are more common in female persons and occur in 15 percent of patients. The skin reaction may occur several hours after the shot, and last for several days. Also, administration of cortisone may lead to deterioration of the process of natural hormone secretion by the adrenal glands.

There are suspicions that corticosteroids can cause a stomach ulcer or duodenal ulcer. Some scientists of the mid-20th century described some cases of ulceration as a result of cortisone therapy. Is it true? What does science say about this now? If we look at modern studies, for example the article “Steroid ulcers: Any news?” by Italian scientist Mario Guslandi, we will see that most likely cortisone is not a direct cause of ulceration.

According to experimental studies, corticosteroids do not appear to cause ulcer directly, but prevent the process of healing ulcer caused by other medications, namely nonsteroidal anti-inflammatory drugs, like aspirin, ibuprofen, and naproxen.

Nevertheless, as Mario Guslandi points out, due to a lack of interest on the part of modern scientists, the myth of steroid ulcers is still preserved, despite the fact that it is based on very weak clinical data (for example, on studies that have described cases of ulcers only in small groups of patients).

How to avoid or minimize side effects of cortisone?

For effective and safe cortisone treatment, it is important to observe the following rules:

• Do not change the dose of the drug yourself, and strictly follow the doctor’s instructions.
• In case of prolonged use of cortisone, do not stop treatment suddenly. If you have been taking the medicine for more than two weeks, it is desirable to lower the dosage gradually until the complete discontinuation of cortisone administration. This will allow the natural production of hormones in the body to recover.
• Never start cortisone treatment again without consulting a healthcare professional.

To reduce the risk of side effects, it is recommended to take cortisone-based preparations with or after meals to avoid stomach irritation (although, as we have already mentioned, cortisone is not a visible direct cause of ulcer development). The risk of developing a stomach ulcer is increased if you take any anti-inflammatory drugs or aspirin in parallel with cortisone, or consume alcohol. Perhaps, the attending physician will prescribe you additional medications that protect the stomach mucosa, to prevent the development of ulcer and gastritis.

People who are treated with cortisone are more likely to develop infections, because the drug suppresses immunity. If you are aware of having any chronic infection (for example, herpes), tell your doctor about it. As we have written above, prolonged administration of cortisone can disrupt the process of natural hormone secretion by the adrenal glands. Taking medication in the mornings, and not in the evening, can lower the risk of this complication.

It is important to consult a doctor about diet during taking cortisone, because the drug causes a feeling of hunger and can lead to gaining excess weight. Throughout the period of taking the drug it is important to periodically take a blood test and monitor the level of glucose. And finally, it is important to see an ophthalmologist once a year, as long-term administration of large doses of cortisone can lead to the development of cataracts or glaucoma.

For children taking cortisone drugs, it is important to see a specialist for early detection of a possible delay in development, growth, or puberty.

The bottom line on cortisone side effects

Local shots of cortisone are typically relatively safe. Adverse effects are most often manifested when using drugs in the form of tablets or systemic body steroid injections. If a patient experiences a negative reaction in a wide extent, there is always the possibility of replacing cortisone with other medicines, both corticosteroid ones and non-steroidal anti-inflammatory drugs. Currently, in the pharmaceutical market, cortisone is gradually replaced by hydrocortisone (a substance with a chemical structure similar to cortisone), which has the same side effects, but is stronger with respect to suppressing the inflammatory response.