What Is The Difference Between Cortisone And Hydrocortisone

Corticosteroids are a class of medications that include cortisone and hydrocortisone, both vital for their anti-inflammatory and immune system suppression capabilities. These compounds have been used extensively in the medical field to treat a variety of conditions, from skin disorders to severe allergies. Their importance cannot be overstated, as they often provide relief where other treatments may fail.

Cortisone and hydrocortisone are closely related but have distinct applications and effects on the body. Cortisone is typically used in its inactive form, which the body then converts into an active form, while hydrocortisone is active upon administration and often preferred for conditions that require immediate corticosteroid action. This essential difference influences their use in medical treatments and dictates the conditions under which each is prescribed.

These steroids, while chemically similar, differ significantly in their pharmacological potency and the scope of their usage. Their applications range from topical creams for eczema to systemic treatments for autoimmune diseases, showcasing their versatility and critical role in modern medicine. Understanding their differences not only aids in appropriate application but also minimizes potential risks associated with their use.

Cortisone Overview

Definition and Chemical Nature

Cortisone is a steroidal hormone produced naturally by the human body’s adrenal cortex. It falls under the class of glucocorticoids, which are essential for managing carbohydrate metabolism and immune response. Chemically, cortisone is known as 17-hydroxy-11-dehydrocorticosterone. It is slightly less active than cortisol, its hydroxylated counterpart, which the liver converts into cortisone.

History and Development

The discovery of cortisone can be traced back to the early 20th century when researchers first isolated the compound from the adrenal glands. Its therapeutic potential was realized in the 1940s, notably by Dr. Philip S. Hench, who along with his colleagues at the Mayo Clinic, demonstrated its effectiveness in treating rheumatoid arthritis. This breakthrough led to Hench receiving the Nobel Prize in Medicine in 1950. The development of cortisone marked a significant milestone in medicine, providing relief for patients with severe inflammatory and autoimmune conditions.

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Hydrocortisone Overview

Definition and Chemical Nature

Hydrocortisone, also known as cortisol, is a steroid hormone produced by the adrenal glands. It is the bioactive form of cortisone and plays a crucial role in the body’s response to stress. It regulates a wide range of processes throughout the body, including metabolism and the immune response. Hydrocortisone’s chemical structure allows it to act swiftly at the site of inflammation, providing quick relief from symptoms.

History and Discovery

Hydrocortisone was discovered shortly after the identification of cortisone, with scientists noting its presence as a naturally occurring compound in the human body. It was first synthesized in 1944 by Edward Calvin Kendall, Tadeusz Reichstein, and Philip S. Hench, who later shared the Nobel Prize for their work on adrenal hormones. The ability to synthesize hydrocortisone marked a significant advancement in endocrinology and pharmacology, facilitating its widespread use in treating a variety of disorders.

Production and Synthesis

How Cortisone is Synthesized

The production of cortisone in the laboratory typically involves the synthesis from simpler starting materials:

  • Start with progesterone: This is a readily available steroid which undergoes a series of chemical reactions.
  • Modify the steroid backbone: Specific enzymes are used to introduce oxygen atoms into the steroid framework, converting progesterone into 11-dehydrocorticosterone.
  • Final conversion: The last step involves the oxidation of 11-dehydrocorticosterone to cortisone.

This synthesis allows for large-scale production of cortisone for medical use.

How Hydrocortisone is Produced

Hydrocortisone production in the pharmaceutical industry usually follows a similar pathway but focuses on ensuring the product is bioactive immediately upon administration:

  • Synthesis from sterols: Starting from cholesterol, which undergoes several biochemical transformations.
  • Enzymatic reactions: Specific enzymes help to hydroxylate positions on the steroid nucleus, enhancing the compound’s activity.
  • Refinement: The final product is purified to ensure high potency and purity for therapeutic use.

Mechanisms of Action

Cortisone’s Effect on the Body

Cortisone acts mainly by suppressing the immune system and reducing inflammation. Once converted into its active form, cortisol, in the liver, it:

  • Reduces cytokine production: Cytokines are proteins important in cell signaling during immune responses.
  • Inhibits white blood cell action: This limits the body’s inflammatory response to pathogens or irritants.
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Hydrocortisone’s Mode of Action

As the active form of cortisone, hydrocortisone works by:

  • Binding to glucocorticoid receptors: This leads to changes in the transcription of specific genes that control inflammation.
  • Rapid response initiation: Its actions are immediate, helping to quickly reduce swelling and pain.

Medical Uses

Therapeutic Applications of Cortisone

Cortisone is used extensively in the treatment of:

  • Chronic joint diseases: Such as rheumatoid arthritis.
  • Allergic reactions: Helps in managing severe allergies by reducing the body’s immune response.

Hydrocortisone in Medical Treatments

Hydrocortisone finds its applications in:

  • Adrenal insufficiency: Supplements natural hydrocortisone when the body cannot produce enough.
  • Skin conditions: Effective in treating conditions like eczema and psoriasis due to its anti-inflammatory properties.

Side Effects and Risks

Common Side Effects of Cortisone

Cortisone, like all medications, carries the potential for side effects, which can vary widely among individuals. Common reactions include:

  • Weight gain: Often due to water retention and increased appetite.
  • Mood swings: Patients may experience emotional instability or changes in mood.
  • High blood pressure: Due to fluid retention and changes in metabolism.
  • Skin thinning: Prolonged use can lead to fragile skin that bruises easily.

Patients are advised to monitor for these effects and consult healthcare providers if they become problematic.

Potential Risks of Hydrocortisone Use

While hydrocortisone is effective in treating inflammation and adrenal insufficiency, its long-term use comes with risks:

  • Adrenal suppression: Can occur with prolonged use, leading to dependency on the medication.
  • Osteoporosis: Increased risk due to decreased bone density.
  • Immune suppression: Heightened susceptibility to infections.
  • Glucose intolerance: Potential worsening of diabetes.

Awareness and management of these risks are crucial for patients undergoing long-term treatment.

Dosage and Administration

Recommended Dosages for Cortisone

The dosage of cortisone varies based on the condition being treated:

  • Oral dosages: Typically range from 5 to 25 mg per day.
  • Injection: 25 to 300 mg injected directly into the affected area, depending on the severity of the condition.

Dosage must always be personalized by a medical professional to minimize side effects.

Administration Guidelines for Hydrocortisone

Hydrocortisone is administered in several forms, each requiring specific guidelines:

  • Topical applications: Creams or ointments applied to affected skin areas not more than twice daily.
  • Oral administration: Tablets taken with food to reduce gastrointestinal upset.
  • Injectable solutions: Administered in hospital settings for severe conditions.

Proper administration is key to maximizing effectiveness and minimizing side effects.

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Comparative Analysis

Direct Comparisons of Effectiveness

Cortisone and hydrocortisone are both effective in their respective uses, but their effectiveness can vary based on the condition:

  • Cortisone is often more effective for joint inflammation when administered via injection.
  • Hydrocortisone is generally more suitable for topical application on skin conditions due to its potent anti-inflammatory properties.

Situational Preferences in Medical Practice

Medical professionals prefer one over the other based on clinical scenarios:

  • Acute flare-ups: Hydrocortisone due to its rapid action.
  • Chronic conditions: Cortisone for its prolonged effect when converted into its active form.

These preferences help tailor treatment plans to patient needs, enhancing therapeutic outcomes.

Patient Considerations

Who Should Use Cortisone?

Cortisone is particularly suited for patients:

  • With chronic inflammatory conditions: Such as rheumatoid arthritis.
  • Requiring intermittent pain relief: Especially for joint-related ailments.

Ideal Candidates for Hydrocortisone

Hydrocortisone is ideal for:

  • Patients with skin conditions: Like eczema or psoriasis.
  • Those requiring immediate cortisol replacement: Such as individuals with adrenal insufficiency.

Selecting the right medication involves a thorough evaluation of the patient’s overall health and specific medical condition.

Recent Research

Latest Studies on Cortisone

Recent research on cortisone has explored its broader immunological impacts, finding potential for:

  • Reduced complications in autoimmune therapies: Enhancing the management of autoimmune diseases.
  • Improved formulations: Leading to slower release and reduced side effects.

New Findings on Hydrocortisone

Hydrocortisone studies have focused on:

  • Enhanced topical formulations: Improving absorption and efficacy.
  • Long-term effects on children: Particularly those using hydrocortisone for adrenal insufficiency.

Frequently Asked Questions

What is cortisone used for?

Cortisone is primarily used to treat inflammation and pain associated with various conditions such as arthritis, lupus, and other autoimmune disorders. It is administered in an inactive form that the body converts as needed, making it a versatile choice for long-term management of chronic conditions.

How does hydrocortisone work?

Hydrocortisone works by mimicking the effects of cortisol, a natural hormone produced by the adrenal glands. It reduces inflammation by suppressing the immune system and is commonly used in both topical and systemic forms to treat allergic reactions, skin disorders, and adrenal insufficiency.

Are there risks associated with long-term use of cortisone?

Long-term use of cortisone can lead to several potential side effects, including osteoporosis, increased risk of infections, and possible adrenal suppression. It is crucial to manage dosage and duration under medical supervision to mitigate these risks.

Can hydrocortisone be used for everyday skin problems?

Yes, hydrocortisone creams and ointments are often used to treat everyday skin problems such as eczema, psoriasis, and insect bites. However, it should be used as directed by a healthcare provider to avoid potential skin thinning and other side effects.


Cortisone and hydrocortisone serve as cornerstone treatments in the field of medicine, each playing a pivotal role in managing an array of health issues. The choice between these two steroids should be informed by their specific characteristics and the individual needs of the patient. As research advances and our understanding of their mechanisms improves, medical professionals continue to optimize their use to maximize benefits and minimize risks.

In conclusion, while cortisone and hydrocortisone are similar, their distinct properties make them suitable for different therapeutic purposes. A deep understanding of their differences not only enhances treatment efficacy but also safeguards against the potential complications associated with their use.

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