1. Introduction
Hydrocortisone is a mild topical corticosteroid commonly used to treat skin conditions associated with inflammation and itching. It works by suppressing inflammatory responses in the skin, reducing redness, swelling, and itching.
2. Indications
- Approved Indications:
- Eczema (atopic dermatitis).
- Contact dermatitis (e.g., irritant or allergic).
- Psoriasis (limited, mild cases).
- Insect bites and stings.
- Rash due to heat or allergies.
- Seborrhoeic dermatitis.
- Off-Label Uses:
- Localised skin inflammation caused by lupus erythematosus or lichen planus.
3. Dosage
- Adults and Children (≥12 years):
- Apply a thin layer of cream or ointment to the affected area 1–2 times daily.
- Children (<12 years):
- Use sparingly and for short durations (up to 7 days). Only apply as directed by a healthcare provider.
- Infants (<1 year):
- Not recommended unless prescribed by a doctor.
4. Administration
- Wash and dry the affected area before application.
- Apply a thin layer of cream or ointment and gently rub into the skin.
- Avoid use on broken skin, near the eyes, or on large areas unless instructed by a doctor.
- Do not cover the treated area with occlusive dressings unless directed.
5. Forms Available
- Creams: 0.5%, 1%, 2.5%.
- Ointments: 0.5%, 1%.
- Lotions: 1%.
6. Side Effects
6.1. Common Side Effects
- Skin thinning (prolonged use).
- Burning or stinging sensation after application.
- Mild irritation or redness.
6.2. Less Common Side Effects
- Skin discolouration or hypopigmentation.
- Worsening of untreated skin infections.
6.3. Rare but Serious Side Effects
- Allergic contact dermatitis.
- Systemic absorption leading to adrenal suppression (with prolonged use on large areas or under occlusion).
7. Warnings
- Overuse Risks: Prolonged use may cause skin thinning, striae (stretch marks), or systemic absorption.
- Infection: Avoid use on infected skin unless prescribed in combination with an antimicrobial agent.
- Face and Sensitive Areas: Use sparingly and only for short durations on the face, groin, or armpits to minimise side effects.
8. Precautions
- Avoid long-term use, especially on sensitive skin areas.
- Do not use to treat rosacea, acne, or perioral dermatitis, as it may worsen these conditions.
- Use caution in patients with pre-existing skin atrophy or broken skin.
9. Interactions
- Drug-Drug Interactions:
- Rare for topical hydrocortisone due to minimal systemic absorption.
- Drug-Food Interactions:
- None reported.
10. Monitoring Parameters
- Improvement in skin condition (e.g., reduced redness, itching, swelling).
- Watch for signs of side effects like thinning skin, irritation, or discolouration.
11. Use in Children
- Safe for short-term use in children aged ≥2 years under medical supervision.
- Avoid prolonged use, particularly on large areas, to prevent systemic absorption.
12. Use in Pregnancy
- Category C: Topical use is considered safe for short-term use and small areas. Avoid prolonged or widespread application unless directed by a healthcare provider.
13. Use in Elderly
- Safe for elderly patients. However, prolonged use should be avoided to prevent skin thinning, which may already be present due to ageing.
14. Use in Kidney Disease
- Safe as minimal systemic absorption occurs with topical use.
15. Use in Liver Disease
- Safe for use, as hydrocortisone metabolism is not significantly affected in mild to moderate liver disease.
16. Patient Counselling Points
- Apply a thin layer of hydrocortisone cream only to the affected area, avoiding healthy skin.
- Do not use for longer than 7 days unless instructed by a doctor.
- Avoid using hydrocortisone for acne, rosacea, or other conditions it is not prescribed for.
- Report any worsening of symptoms, such as redness or signs of infection, to your healthcare provider.
- Wash hands after applying the cream, unless the hands are the treatment area.
17. Table of Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Price (USD) |
---|---|---|
Cortizone-10 | Chattem Inc. | $5–10 (28 g, 1%) |
Lanacort | AmWINS | $8–15 (30 g, 1%) |
Generic Hydrocortisone | Various manufacturers | $2–8 (30 g, 1%) |
18. FAQs (15 Questions)
- What is hydrocortisone cream used for?
It is used to treat skin inflammation, redness, itching, and swelling associated with conditions like eczema, dermatitis, and insect bites. - How does hydrocortisone cream work?
It suppresses inflammation by reducing the production of inflammatory mediators in the skin. - How long can I use hydrocortisone cream?
It is typically safe for up to 7 days. Prolonged use should only occur under medical supervision. - Can hydrocortisone cream cause side effects?
Yes, possible side effects include skin thinning, irritation, and discolouration. - Can I use hydrocortisone on my face?
Yes, but only under medical advice and for short-term use, as the skin on the face is sensitive and prone to thinning. - Is hydrocortisone cream safe during pregnancy?
Yes, it is considered safe for small areas and short durations. Consult your doctor before use. - Can children use hydrocortisone cream?
Yes, it is safe for children aged ≥2 years for short-term use under supervision. - Can hydrocortisone treat acne?
No, it is not recommended for acne and may worsen the condition. - Can hydrocortisone cream be used for insect bites?
Yes, it can reduce itching and swelling caused by insect bites. - What should I do if I miss a dose?
Apply it as soon as you remember, but skip it if it is close to the next dose. Do not overapply. - How should hydrocortisone cream be stored?
Store at room temperature, away from direct sunlight and moisture. - Can I use hydrocortisone for fungal infections?
No, it is not effective against fungal infections and may worsen them unless combined with an antifungal agent. - Can hydrocortisone cream cause skin thinning?
Yes, prolonged use can lead to thinning of the skin, particularly in sensitive areas. - How should hydrocortisone be applied?
Apply a thin layer to the affected area, avoiding unnecessary application to healthy skin. - Can hydrocortisone cream be used with moisturisers?
Yes, apply the hydrocortisone first, wait a few minutes, and then apply a moisturiser.