What are the effects of cortisone on eczema?

Theeczema is an inflammatory skin disease that evolves in flare-ups. It is very common, especially in children and infants, and represents the second reason for dermatological consultation, behind acne. Although considered a benign disease, eczema is associated with many troublesome symptoms and has an impact on the daily lives of those who suffer from it.

• Lesions : Red and inflammatory, eczema lesions appear during flare-ups. They are often accompanied by small vesicles filled with clear fluid that become weeping, naturally or due to scratching. The skin then thickens, a process referred to as lichenification.

• Itching : during flare-ups, eczema causes significant itching that impacts the life of the affected individual. Irritability, sleep disturbances, fatigue... are all consequences of the pruritus.

• Skin dryness : Atopic skin is constantly very dry, due to its inability to retain water. This is referred to as xerosis. The skin feels tight and uncomfortable, even outside of flare-ups. Certain external factors such as prolonged contact with water or the use of unsuitable products exacerbate xerosis.

Cortisone is a molecule whose chemical structure is very similar to cortisol, a hormone naturally produced in the body by the adrenal glands. Cortisol plays a predominant role in the regulation of sugar and carbohydrate metabolism and the release of energy. Cortisone is considered a medication and is dispensed on prescription. It is taken orally in cases of adrenal insufficiency, injected into joints to treat rheumatic issues, and applied topically to combat skin inflammation... Its uses are numerous. In terms of eczema, cortisone has various effects:

• Cortisone is anti-inflammatory.

  Cortisone works by binding to glucocorticoid receptors, which belong to the steroid receptor family. This binding results in the inhibition of the production of certain pro-inflammatory cytokines, such as interleukins-1 and 6 (IL-1 and IL-6) and the tumour necrosis factor (TNF-α). This helps to reduce the inflammatory symptoms of eczema such as the redness of patches and itching.

• Cortisone is immunosuppressive.

  Cortisone also possesses immunosuppressive properties, meaning it is capable of reducing the body's immune response. Individuals suffering from eczema often secrete significant amounts of Immunoglobulin E (IgE) in response to environmental allergens. The topical application of corticosteroids can help mitigate this phenomenon. Notably, cortisone inhibits the activation of T lymphocytes, which play a major role in the adaptive immune response and trigger the release of pro-inflammatory cytokines. It thus reduces the body's inflammatory response when the skin comes into contact with allergens causing an eczematous reaction.

Creams based on cortisone, known as topical corticosteroids, are one of the most frequently prescribed treatments by dermatologists in cases of eczema. They have recognised effects against this condition and alleviate its symptoms. Topical corticosteroids can be used from the age of one year. There are several types of topical corticosteroids, the use of which depends on the location of the eczema patches and the age of the patient.

In terms of their use, cortisone creams are applied once a day and only during periods of eczema flare-ups. Dermatologists, however, advise not to wait until the flare-up reaches its peak to start using them, but rather to apply them at the onset of the flare-up. The most important thing is to follow your dermatologist's recommendations to avoid side effects. Between eczema flare-ups, it is recommended to hydrate and nourish your skin with a standard emollient to restore its hydrolipidic film and combat xerosis.

• FONACIER L. & al. Treatment of Eczema: Corticosteroids and Beyond. Clinical reviews in allergy and immunology (2016).

• GUTTMAN-YASKY E. & al. Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement. The British journal of dermatology (2018).