Cortisone is a steroid medication used to reduce inflammation and suppress overactive immune responses. It treats a wide range of conditions, from minor skin rashes you can manage at home with an over-the-counter cream to serious autoimmune diseases that require prescription-strength pills or injections. The form you use and how long you use it depend entirely on what’s being treated.
How Cortisone Works in Your Body
Cortisone belongs to a class of drugs called corticosteroids, which mimic a hormone your adrenal glands naturally produce. When your body detects an injury or threat, immune cells rush to the area and release signaling molecules that trigger swelling, redness, heat, and pain. Cortisone interrupts this process at multiple points: it dials down the production of those inflammatory signals, and it slows the activation and movement of immune cells so fewer of them pile into the affected tissue.
This is why cortisone works for such different problems. Whether the inflammation is in a swollen knee joint, an itchy patch of eczema, or an inflamed colon, the underlying mechanism is the same. Cortisone dampens the immune activity driving the problem.
Common Uses for Cortisone
Joint and Muscle Pain
Cortisone injections are one of the most familiar uses. Doctors inject cortisone directly into inflamed joints (shoulders, knees, hips, hands, feet, and spine) as well as into tendons and bursae, the small fluid-filled sacs that cushion the spaces around your joints. Conditions treated this way include bursitis, tendonitis, tennis elbow, gout flares, and osteoarthritis that isn’t responding to other treatments. The injection delivers medication right where it’s needed, which means a lower overall dose and faster relief compared to taking a pill.
Skin Conditions
Topical cortisone creams are the form most people encounter first. Over-the-counter hydrocortisone at 1% or 2.5% concentration is the least potent steroid cream available, sitting at the bottom of a seven-tier potency scale. It’s used for mild eczema, contact dermatitis, insect bites, and minor rashes. Prescription-strength creams and ointments climb that potency ladder and are used for more stubborn conditions like severe psoriasis, seborrheic dermatitis, and certain blistering skin diseases.
Allergies and Asthma
When severe allergic reactions don’t respond to antihistamines, cortisone can bring them under control. This includes seasonal allergies, drug reactions, contact dermatitis, and asthma flares. In these cases, cortisone is typically taken as a short oral course or delivered through an inhaler for ongoing asthma management.
Autoimmune and Inflammatory Diseases
Oral cortisone (usually as hydrocortisone or a related steroid) is a cornerstone treatment for conditions where the immune system attacks the body’s own tissues. The FDA-approved list includes lupus, rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, inflammatory bowel diseases like ulcerative colitis and Crohn’s disease, and certain muscle-wasting conditions. In most of these cases, cortisone is used to get a flare under control quickly, then tapered down or replaced with other medications for long-term management.
Hormone Replacement
Because cortisone closely resembles the hormone cortisol, it’s also used to replace what the body can’t make on its own. People with adrenal insufficiency (including Addison’s disease) and congenital adrenal hyperplasia take hydrocortisone daily as a lifelong replacement therapy. This is a fundamentally different use from its anti-inflammatory applications, since the goal is simply restoring normal hormone levels.
Over-the-Counter vs. Prescription Strength
The hydrocortisone cream you buy at a pharmacy without a prescription contains 1% concentration, which is the weakest topical steroid available. Some pharmacies also carry 2.5% hydrocortisone. These low-potency creams are appropriate for mild, short-lived skin irritation. If you’re using an OTC hydrocortisone cream and don’t see improvement within 7 days, it’s time to stop and talk to a doctor.
Prescription topical steroids range from medium to super-high potency. They use different chemical formulations that penetrate the skin more effectively or resist being broken down as quickly. A doctor chooses the potency based on the severity of your condition and where on your body it is. Thicker skin on your palms and feet needs a stronger preparation, while thin skin on your face, armpits, and groin calls for the mildest option available.
Side Effects of Topical Cortisone
Skin thinning is the most common side effect of topical cortisone creams, and it can begin surprisingly fast. Microscopic changes in the outer layer of skin are detectable within 3 to 14 days of continuous use. With prolonged application, the skin becomes visibly thinner, more fragile, and somewhat transparent, with underlying veins showing through. Stretch marks, easy bruising, lightened skin color, and broken blood vessels near the surface can also develop.
Another issue with long-term use is tachyphylaxis, where your skin gradually stops responding to the same cream. This is especially common in people treating psoriasis. The temptation is to switch to a stronger product, but that only increases the risk of more serious side effects. This is one reason doctors typically recommend using topical cortisone only during active flares, not as continuous daily treatment.
Side Effects of Injections and Oral Cortisone
Cortisone injections can cause a temporary spike in blood sugar, which matters most for people with diabetes. In one study of diabetic patients receiving a shoulder injection, blood sugar levels jumped by more than 80 mg/dL in the first 3 to 4 days. For people with well-controlled diabetes, levels returned to normal around day 8. For those with poorly controlled diabetes, levels remained elevated for more than 10 days. If you have diabetes and are getting a cortisone shot, plan to monitor your blood sugar more closely for at least a week afterward.
Other common injection side effects include temporary pain at the injection site, a brief facial flushing, and occasionally a “cortisone flare” where the joint feels worse for a day or two before improving. Most doctors limit cortisone injections to three or four per year in the same joint, because repeated shots can weaken cartilage and tendons over time.
Long-term oral cortisone carries the most significant risks. Extended use can lead to weight gain, elevated blood pressure, weakened bones, cataracts, mood changes, and a higher vulnerability to infections. The infection risk is dose-dependent: the more cortisone you take and the longer you take it, the greater the chance of picking up infections that a healthy immune system would normally fend off. This includes reactivation of dormant infections like shingles or tuberculosis.
Using Cortisone Safely on Children
Children, especially infants, absorb more topical cortisone relative to their body size than adults do, which makes them more vulnerable to side effects. The American Academy of Pediatrics recommends using only low-potency preparations like 1% or 2.5% hydrocortisone on infants, and reserving those for flare-ups rather than daily maintenance. On sensitive areas like the face, armpits, groin, and diaper area, low-potency creams are the safest choice regardless of age.
Older children and teenagers with conditions like eczema often need medium-potency prescription steroids to see results, particularly on thicker-skinned areas like the hands and feet. The key principle for all ages is the same: use the lowest potency that works, apply it only when the skin is actively inflamed, and stop when things clear up.