Cortisone Treatment Guide

October 17th, 2018        Written by a Staff Member of Hair Loss in Women

What is Cortisone?

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.  

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.

Cortisone Treatments

There are three main ways cortisone can be administered.

1. Creams and lotions that go on the surface of the skin.
2. Injections
3. Pills that are taken orally.

Injections directly in the scalp to treat alopecia is the most common and most affected form of treatment. It involves using tiny needles to inject corticosteroids into bare patches of skin.  The Mayo Clinic suggests not to get cortisone injections more often than once every six weeks. Rounds of injections should be done more than three to four times per year. 

The injections are given by the name of Kenalog®®. Most people who receive Cortisone know it by this name, Kenalog®. The number of injections ranges from 2 to 50 injections per session depending on the size of the area that is being addressed.  For example, a small quarter-sized area of alopecia areata may be treated with 4 injections and a full eyebrow may be treated with 5-6 injections.

Does Cortisone Work?

It is important to know that cortisone does work for some hair loss, not all.

Types of hair loss that it works for:

• central centrifugal cicatricial alopecia
• pseudopelade
• folliculitis decalvans
• some types of traction alopecia

Types of hair loss that it does not work for:

Cortisone treatment does not seem to work as well for hair diseases that do not have much inflammation under the scalp such as:

• androgenetic alopecia (male and female genetic balding)
• telogen effluvium (hair shedding problems)
• tinea capitis (fungal infections)

Cortisone’s effectiveness seems to depend on how it manifests and evolves over time. One study did not show any real significant benefit of treatment with patients that had less than 40% scalp involvement. Natural remissions (return of hair growth on it’s own) also makes it difficult to clearly assess whether or not the treatment was effective. It could be that the condition had naturally reversed rather than the treatment actually working. 

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 or return rate is higher.

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

In conclusion, it is difficult to determine if 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.

Is it safe?

The most common side effect that people experience from injections is some discomfort during the injection itself. Most people would rate this discomfort about 3 out of 10 and it lasts only for a few seconds.

Cortisone injections can cause temporary depressions in the skin may result from the injections. These depressions, known as dells, usually go away over time.

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 severe 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

Cost?

Prices range from $25 to $100 per shot.

MDsave.com provides a healthcare locator for your cortisone shots needs. They can also help you get the service at the lowest possible price. You may also call them at (855) 946-6566 for more details.

Your insurance provider may or may not cover your course of treatment.

Where to get the treatment?

A medical professional can administer the injections.

Before you seek treatment, it is important to speak with your doctor about all options and understand if cortisone is the best plan of action. Cortisone injections often times are just PART of a treatment plan.

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
• https://www.webmd.com/drugs/2/drug-8641/cortisone-oral/details
• https://www.webmd.com/arthritis/what-are-cortisone-shots
• https://rarediseases.info.nih.gov/diseases/4536/pseudopelade-of-brocq
• https://www.dermnetnz.org/topics/folliculitis-decalvans/
• https://www.mayoclinic.org/diseases-conditions/hair-loss/multimedia/traction-alopecia/img-20006442