Corticosteroid use is complicated.
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There are both annual and lifetime limits on cortisone injections & treatments, as the effect ends up being both cumulative and very physically damaging (tendon weakening & rupture, osteoporosis, bone death, bone infection, immune system suppression, thinning of membranes, & nerve damage). So even very low dose and localized injections are considered very carefully & cautiously between short term relief and long term health problems.
Cortisone is both a metabolite & precursor to cortisol.
Which means that, as an athlete / former athlete with an active lifestyle, my doctors don’t want me within 10 miles of cortisol, or its precursors.
My orthopedic surgeon says to consider cortisone & cortisol treatment as palliative care to moving... meaning that I’ve given up being active, or living an active lifestyle, and my body being shredded for short term pain relief is an acceptable loss... as I’m not using it, anyway, and have no intention of using it in the future.
Hydrocortisone / hydrocortisol, meanwhile, is the topical version of cortisone (because cortisone doesn’t absorb through the skin but hydrocortisone does). The long term health effects are the same as oral/injected steroids, but it takes a LOT longer to happen, because it really doesn’t absorb through the skin very well, even though it can absorb some unlike cortisone itself. Hence it’s common use as a rash ointment... it treats the surface problem, by absorbing into the skin enough to treat the rash, without being much absorbed into the body to wreak havoc.
All corticosteroids have similar side effects, but the health risk varies a great deal between them, and even between types (like oral pills, localized injections, or topical ointment of cortisone all have very different expected outcomes). Fluticasone is a commonly used bronchial dilator, whose risks are so comparatively minimal it can be taken daily with very little negative effect, meanwhile dexamethasone & prednisone carry a lot of bone risk, but unlike cortisone not a lot of connective tissue risk. Bone heals itself very, very, very well (unlike connective tissue), so while an asthma or influenza or pneumonia patient can be taking daily dex or pred for months, and have accompanying bone damage it’s fairly easy to moderate (if patients listen, and treat their osteoporosis, rather than doing nothing or making it worse... but even then, expect a lot of thin bone fractures, like the ones in your hands and feet from doing nothing more strenuous than rolling over in bed at night or shifting your weight causually, whilst standing) . Thyroid patients, meanwhile, have to follow very strict medication regimens for life... as well as recovery regimens. Because while they are clearly deficient (no thyroid = no thyroid hormones = supplementing necessary), we cannot reproduce the distribution throughout the body via pills or injections that the gland does, which means serious side effects, if not as serious as not having the hormones supplemented at all.
Like I said, corticosteroid use gets complicated. In its simplest form, they all have similar side effects, but the timeline and degree that they affect different systems vary.
Cortisol & cortisone carry some of the highest risk, and fastest timelines. The cost benefit relationship is very steep... and if there are ANY reasonable alternatives, it’s not usually considered worth the risk except as a one off dose to treat an acute injury.
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Standard caveat : I’m just a chick on the Internet, I am not a doctor, and this is not medical advice. Just sharing acquired information / my knowledge of corticosteroid use through personal experience & education... all of which can be easily verified -if your interested, and should be verified- through reliable medical & scientific sources.
