Cortisone Treatment Guide

May 18th, 2017          Written by a Staff Member of Hair Loss in Women

What is Cortisone?

Cortisone is a corticosteroid hormone (glucocorticoid). Cortisone is a steroid that prevents the release of substances in the body that cause inflammation. The medication works by suppressing the immune system’s natural defense against infection and illness.  This is useful for treating alopecia areata because the condition is believed to be caused by the immune system attacking hair follicles.  Cortisone is used to treat many different conditions such as allergic disorders, skin conditions (alopecia), ulcerative colitis, arthritis, lupus, psoriasis, or breathing disorders. Intralesional corticosteroid injections are the most common form of treatment for alopecia areata. The treatment involves using tiny needles to inject corticosteroids into bare patches of skin.  The Mayo Clinic suggests that one should not get cortisone injections more often than once every six weeks.  Rounds of injections should be done more than three to four times per year.

Cortisone Treatments

Cortisone is injected, applied as a cream, or taken orally. Injections tend to be most effective when used to treat small patches of alopecia on the scalp. Cortisone is typically injected as a shot at the site of hair loss being used to treat alopecia areata. If the treatments are effective new hair growth is usually apparent within four weeks.  Doctors widely prescribe topical corticosteroids to treat alopecia but long term success rates are not fully understood. Examples of include betamethasone, hydrocortisone and mometasone. These can be found as lotions, gels or foam. Alos, it is important to note that they cannot be used on your face. Corticosteroid pills aren’t recommended because of the seriousness of the risk of side effects.

Does Cortisone Work?

Judgment of the effectiveness of cortisone and its variants should be carefully measured because the alopecia is exceedingly erratic in how it manifests, evolves over time, and responses to treatment. Little data exist regarding the natural evolution of the condition. One study showed that in cases where patients have less than 40% scalp involvement there was no statistically significant benefit with treatment (minoxidil 1% and topical immunotherapy) over placebo. Many alopecia patients experience natural remissions.  Natural remissions make it difficult to clearly assess whether or not the treatment was effective. It could be that the condition had naturally reversed. The true effectiveness of a treatment is difficult to measure unless appropriate control groups with placebo treatments are under observation.

Very little data exists on the natural progression of for patients with widespread alopecia areata (>40% hair loss). In patients with less than 40% hair loss, the rate of natural remission appears to be lower. One study observed 50 patients with extensive alopecia areata. During the observation period of 3-3.5 years, twenty four percent of the patients experienced natural complete or nearly complete regrowth at some point. Among patients with widespread alopecia areata the relapse rate is high.

Patients with alopecia totalis or alopecia universalis typically have a poorer prognosis.   In most patients treatment failure is typical outcome with any therapy. Therefore, patients must enter treatment with realistic expectations.

Cortisone Side Effects

Corticosteroid injections can cause temporary depressions in the skin may result from the injections. These depressions, known as dells, usually go away over time. Also, it is very common to experience slight discomfort at the point of injection from the needle pricks and tingling from the medication. By the time a patient is leaving the dermatologists office usually there is no other pain or discomfort.

Get emergency medical help if you have any of these signs of an allergic reaction:hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Less serious side effects may include:

  • sleep problems (insomnia),
  • mood changes
  • acne, dry skin, thinning skin, bruising or discoloration
  • slow wound healing;
  • increased sweating;
  • headache, dizziness, spinning sensation;
  • nausea, stomach pain, bloating; or

Serious side effects may include:

  • vision problems
  • swelling, rapid weight gain
  • feeling short of breath
  • severe depression, unusual thoughts or behavior,
  • seizure (convulsions)
  • bloody or tarry stools, coughing up blood
  • pancreatitis (severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate)
  • low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling)
  • dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure).

Most controversial side effects may include:

  • Thinning skin – such that it tears easily
  • Bone loss near the site of treatment
  • Bone death near the site of treatment

 

Cortisone Conclusion

In conclusion, it is difficult to condone or condemn cortisone as a viable treatment for hair loss in women. Each case is different and and unique. Ultimately, the decision is between you and your dermatologist. Our hope is that you make the most informed decision possible.

REFERENCES

  • https://www.drugs.com/mtm/cortisone.html
  • https://www.naaf.org/alopecia-areata/alopecia-areata-treatments
  • http://www.mayoclinic.org/tests-procedures/cortisone-shots/home/ovc-20206814
  • http://www.nhs.uk/Conditions/Hair-loss/Pages/Treatment.aspx
  • http://emedicine.medscape.com/article/1069931-treatment

 

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