Adverse Effects of Cortisone on Vitiligo

Cortisone and Vitiligo

Cortisone (corticosteroids) or steroids have been in use for the treatment of various diseases, administered either locally (on the skin) or oral tablets or through injections. Judicial use of cortisone is life-saving; however, its routine use may not be indicated as often as it has been prescribed. Cortisone, when used for vitiligo, either as a topical cream or oral medicine, has some major disadvantages of leading to the relapse or an increase of vitiligo on stopping its use eventually. 

Some of the major conditions where cortisone is routinely used in conventional medicines whereby the patients may end up with adverse effects are:

a Skin diseases: Psoriasis, Eczema, Vitiligo, Urticaria, Lichen planus, etc.

b Autoimmune diseases: Polymyositis, Rheumatoid arthritis, etc

c Asthma

d Ulcerative colitis, Nephrotic syndrome

Major adverse effects could be listed in brief as under:

Moon-face is a common side effect of cortisone: Typical swollen face with excessive hair growth on forehead due to cortisone use. The second photo shows a normal face on stopping cortisone while on homeopathic treatment.

(click here for more photos of the moon-face effect.)

A 4-year-old child suffering from Nephrotic Syndrome developed "moon face," i.e., swelling on the face, due to cortisone.

1 year, 4 months old child suffering from Nephrotic Syndrome who developed "moon face" due to cortisone.

• Decreased resistance to infections such as coughs and colds
• An increase in appetite may lead to a rapid increase in weight
• Flushed, swollen cheeks and stretch marks on the skin; acne (pimples)
• The rise in blood pressure
• Behavioral problems, e.g. temper tantrums, mood changes, and/or depression
• Steroids in very high doses can cause an increase in blood sugar and fat
• Atherosclerosis, i.e. "hardening of the arteries."
• Slowing of growth rate producing shunted growth
• Osteoporosis (bones becoming hollow due to a lessening of calcium)
• Cataract development
• Diabetes
• Some of the adverse effects of cortisone may be described in detail as under:

  Long-term effects:

  Some adverse effects of cortisone develop over a period of time in people receiving long-term treatment. Cortisone or cortisone acetate taken on a long-term basis can cause many health problems. Some of them are:

  • Dependency: One of the most important problems with the use of cortisone is that it produces drug dependency. Once cortisone is used, it is likely that you may have to use it again, as the disease is likely to relapse on stopping it.
  • Rebound effect: Another hurdle with the use of cortisone in any form is the rebound effect after stopping its use. In most diseases such as psoriasis (local and oral cortisone), vitiligo (local and oral cortisone), urticaria (oral cortisone), ulcerative colitis (oral cortisone), nephrotic syndrome (local cortisone), lichen planus (local, injectible and oral cortisone), etc., it has been observed that patients receiving cortisone respond well initially. However, either on stopping it or on long-term use, there is either a severe relapse or a flare-up in the form of a rebound effect. Such a flare-up is often difficult to handle with mild medicines, as it might require a probably higher dose of cortisone. This leads to a vicious cycle.
  • Suppresses immunity: Cortisone is an immunosuppressive medicine. It suppresses and alters the immunity, making one prone to having a relapse of the same disease with more intensity.
  • Changes in appetite: An increase in appetite and weight gain is seen in many long-term receivers of corticosteroid therapy.
  • Generalized swelling in the body: Corticosteroids can cause excess water retention within the body, thus making it swell. Salt and water retention can also lead to high blood pressure and reduced levels of potassium in the blood.
  • Faulty fat deposition: There may be excess fat deposition in the back, face, chest, and abdomen.
  • Skin changes: The skin becomes very delicate and bruises easily. It may appear very thin in certain areas with patchy discoloration. Wound healing may also take a longer time than usual. Acne and dry skin are other skin conditions commonly seen.
  • Repeated infections: Corticosteroids can depress your immune system, thus lowering your body's natural defenses against illnesses. Hence, repeated infections are very common in long-term corticosteroid therapy.
  • Sleep problems: Difficulty falling asleep (insomnia) is a common side effect.
  • Mood changes: A person can either become very irritable, very euphoric, or depressed for no understandable reason.
  • Eye disorders: Cataract, glaucoma, and exophthalmos are known to occur in long-term corticosteroid treatment.
  • Muscle weakness
  • Giddiness, Headaches, vertigo
  • Gastrointestinal upsets: Stomach ulcers and inflammation of the pancreas (pancreatitis) are common conditions arising from long-term treatment.
  • Adrenal suppression: Long-term treatment with corticosteroids can suppress the natural production of these hormones from the adrenal glands. This particularly occurs when these medications are suddenly stopped or not tapered off properly.
  • Diabetes: Long-term use of corticosteroids can result in increased blood sugar levels.
  Critical adverse effects: Adverse reactions to cortisone can call for emergency care. Seek immediate medical advice if you experience any of the following when on cortisone therapy.
  • Sudden onset of visual disturbances.
  • A severe headache, giddiness, imbalance, weakness, and rapid heartbeat, with or without excessive sweating.
  • Any sudden skin eruptions like hives or urticaria. Sudden swelling of the face, lips or hands, and feet.
  • Difficulty in breathing.
  • Black or bloody stools.

  More about cortisone:

  It is very easy for any physician to get you started on treatment with cortisone. However, it is not easy to stop cortisone! Abuse of cortisone is often a bigger medical issue than the basic disease itself. Ask your doctor the following questions before you start with the prescription of cortisone:

  a Is this cortisone therapy really essential at this time?

  b Is it going to cure my disease?

  c How long will I have to take it?

  d What will happen when I will stop it?

  e What are the likely adverse effects?

  f On discontinuing the use of cortisone, will my disease relapse? If yes, will I need to use cortisone once again, or will I be able to manage with milder medicine at that time?

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Written & Approved by-

Dr. Rajesh Shah

M.D. (Hom.)