Hydrocortisone

I do not remember that I ever had the itch; and yet scratching is one of nature's sweetest gratifications, and nearest at hand; but the smart follows too near. I use it most in my ears, which are often apt to itch.--Michel de Montaigne, French essayist (1533-92), from "Of Experience," Book 3, Chapter 13, Essays (1588)

If you've ever had an itch that scratching didn't stop, topical hydrocortisone--either prescribed or over the counter--might have done the trick. If inflammation (swelling, heat, redness, and pain) is your problem, hydrocortisone can be injected into a large muscle (such as your buttock or hip), directly into your vein, or added to an intravenous fluid that will drip through a needle or catheter placed in your vein. Oral hydrocortisone, on the other hand, may be prescribed to treat certain forms of arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders; severe allergies; and asthma. Hydrocortisone is also used to treat certain types of cancers, such as leukemia, lymphoma, and multiple myeloma.

Hydrocortisone, the generic name for 17-hydroxycorticosterone, is a corticosteroid or glucocorticoid. It occurs naturally and can be prepared synthetically. This drug is a jack-of-all-trades. Corticosteroids are applied to the skin to treat mild to severe inflammation and itching that results from conditions such as diaper rash, insect bites, allergic reactions, eczema, and psoriasis. They are combined with antibiotics to treat ear infections, eye infections, and skin infections caused by bacteria. They are also combined with antifungal agents to treat fungal and yeast infections of the ear and skin.

Hydrocortisone lessens the body's response to an allergen, reducing swelling, redness, itching, and other symptoms. One way in which it decreases inflammation is by preventing infection-fighting white blood cells from traveling to the area of swelling in the body. In the process, however, it also reduces the body's ability to fight infection.

WHEN YOU APPLY a hydrocortisone cream or lotion, you inevitably absorb some of the medication through your skin and into the bloodstream. Too much absorption can lead to unwanted side effects elsewhere in the body. To keep this problem to a minimum, you should avoid using large amounts of hydrocortisone over extensive areas and should not cover the area with airtight dressings such as plastic wrap or adhesive bandages unless specifically told by a doctor to do so.

Any research into corticosteroids--whether via the Internet, medical books, or journal articles--uncovers warnings that these drugs are strong medicines. Side effects can be numerous and range from increased appetite to facial puffiness, mood changes, unusual weight gain, and even rash.

Why, then, would anyone take such medications? The body naturally produces certain cortisone-like hormones that are necessary to maintain good health. If the body doesn't produce enough, a corticosteroid medication can help make up the difference. "The effects of the corticosteroids are numerous and widespread. They influence carbohydrate, protein, and lipid metabolism; electrolyte and water balance; and the functions of the cardiovascular system, the kidney, skeletal muscle, the nervous system, and other organs and tissues" (Alfred Goodman Gilman et al., "The Pharmacological Basis of Therapeutics," 7th Ed., New York: Macmillan Publishing Co., 1985).

Type "hydrocortisone" as an active ingredient into the Food & Drug Administration's Center for Drug Evaluation & Research website, and 93 drug names come up. More than 37 companies produce or have produced these drugs.

According to Victor H. Witten in "Topical Corticosteroids" (Basel: Karger, 1992), "The use of hydrocortisone was not an accidental or chance discovery, but rather the result of painstaking efforts based on a knowledge of ongoing medical events and a recognition of their possible application to dermatologic therapy."

As early as the 1930s, chemists recognized the structural similarity of a large group of natural substances, including the cortical hormones of the adrenal glands: the steroids. The medicinal value of these compounds quickly became obvious, but extracting sufficient quantities was prohibitively expensive. Thus, chemists looked to create these substances synthetically and later to make them safer and more effective as drugs. Actually, 1952 is viewed by many as the pinnacle year for dermatologic therapy because of the introduction of topical hydrocortisone.

Although the 1950 Nobel Prize in Physiology or Medicine was won by Philip S. Hench, Edward C. Kendall, and Tadeus Reichstein "for their discoveries relating to the hormones of the adrenal cortex, their structure and biological effects," many names are associated with the isolation and synthesis of steroids: Lewis H. Sarrett, H. L. Mason, Sylvia A. Simpson, Randall G. Sprague, Joseph von Euw, N. L. Wendler, O. Hechter, A. Zaffaroni, Percy L. Julian, Carl Djerassi, Gilbert Stork, Robert B. Woodward, and George Rosenkranz.

De Montaigne was born too soon. In the 16th century, he may have been able to apply the herb Arnica montana; nutmeg oil; herbs such as sage; aloe vera, if accessible; or tarthuth to relieve an itch. But he would have had to wait until the 1950s to apply the healing benefits of topical hydrocortisone.

Hydrocortisone

Name
◾ (11β)-11,17,21-Trihydroxypregn- 4-ene-3,20-dione

CAS Registry
◾ 50-23-7

Other Names
◾ Cortisol; 4-pregnene-11β,17α ,21-triol-3,20-dione
◾ 17-hydroxycorticosterone
◾ anti-inflammatory hormone
◾ Kendall's compound F
◾ Reichstein's substance M

Introduced
1952, Upjohn Co

Did you know that the earliest recorded mention of the adrenal gland is Bar tolomeo Eustachio's 1563 copper-etched depiction of "glandulae Renibus incumentes"? Several centuries later, in 1849, Thomas Addison published his description of a lethal clinical syndrome resulting from destruction of the adrenal glands, thereby providing the stimulus for subsequent modern physiological investigations of the adrenal cortex.