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Cortisone and the skin CORTISONE AND THE SKIN
The various cortisone creams are the most common preparations recommended by the medical profession to be used on the skin. They are known as topical corticosteroids: 'topical' because they are applied rather than taken by mouth; 'corticosteroids' (sometimes known simply as steroids) because they are derived from the natural hormone produced by the adrenal gland known as adrenal corticosteroids. Their history goes back a quarter of a century to 1952, when Dr Sulzberger, in the United States, first used hydrocortisone. Since then, various molecular changes have been made, often by the addition of fluorine to the basic structure. This has resulted in the increased activity, or the increased efficacy, of the subsequent preparation.
As a result of intense research, many topical corticosteroids have been developed which have remarkable beneficial effects. Their ability to affect various skin conditions depends, as mentioned, on their precise chemical structure. This is termed their potency. Other factors, however, are also relevant to their effectiveness. These include the vehicle or base in which the corticosteroid is carried. For example, ointments appear to be better absorbed than creams. Likewise, creams tend to be more effective than lotions, and so forth.
The age of the patient is also most important, determining, as it does, the absorption capacity of the skin. The relative thinness of the infant's or young child's skin, combined with its large surface area in relation to body weight, tends to enhance the preparation's absorption capacity considerably. Similarly, in the elderly, the thinner, more fragile skin tends to absorb wore freely than does the thicker skin of the middle age-groups.
There is also variation of absorption potential over the body's skin area. For instance sites which have thinner skin—as do the eyelids—absorb better than areas of thicker skin such as the soles of the feet. The vascularity or blood supply of the area involved is also important in facilitating absorption. Consequently, the scrotum or face absorbs very freely. Opposing skin surfaces such as are found in the armpits or the groin area likewise increase the absorption potential of the preparation used.
The frequency of application is also critical, optimal results being usually achieved with two or perhaps three applications daily. If the preparation is applied too frequently, or for too long a period, there is a slowing down of responsiveness to it. Hence it is wise to change the type of preparation used fairly frequently, as the skin may become accustomed to, and subsequently resistant to, the frequent application of the same corticosteroid.
The topical application of corticosteroids has made possible the relief of much discomfort and disfigurement from chronic skin disease. As with all treatment, there are possible side-effects. These are, however, easily outweighed by the tremendous benefit their judicious use can offer.
These preparations achieve their effect by a strong anti-inflammatory action, whether the cause of the skin disorder be mechanical, chemical, microbiological, or immunological. They also have a strong immunosuppressive action, and consequently diminish local anti-body production. Finally, they have an antimitotic effect on human skin. This accounts for their effect of slowing down the abnormal cell formation in the various scaling skin disorders.
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