Hydrocortisone cream

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 NameManufacturerPrice (USD)
Cortizone-10Chattem Inc.$5–10 (28 g, 1%)
LanacortAmWINS$8–15 (30 g, 1%)
Generic HydrocortisoneVarious manufacturers$2–8 (30 g, 1%)

18. FAQs (15 Questions)

  1. 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.
  2. How does hydrocortisone cream work?
    It suppresses inflammation by reducing the production of inflammatory mediators in the skin.
  3. How long can I use hydrocortisone cream?
    It is typically safe for up to 7 days. Prolonged use should only occur under medical supervision.
  4. Can hydrocortisone cream cause side effects?
    Yes, possible side effects include skin thinning, irritation, and discolouration.
  5. 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.
  6. Is hydrocortisone cream safe during pregnancy?
    Yes, it is considered safe for small areas and short durations. Consult your doctor before use.
  7. Can children use hydrocortisone cream?
    Yes, it is safe for children aged ≥2 years for short-term use under supervision.
  8. Can hydrocortisone treat acne?
    No, it is not recommended for acne and may worsen the condition.
  9. Can hydrocortisone cream be used for insect bites?
    Yes, it can reduce itching and swelling caused by insect bites.
  10. 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.
  11. How should hydrocortisone cream be stored?
    Store at room temperature, away from direct sunlight and moisture.
  12. 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.
  13. Can hydrocortisone cream cause skin thinning?
    Yes, prolonged use can lead to thinning of the skin, particularly in sensitive areas.
  14. How should hydrocortisone be applied?
    Apply a thin layer to the affected area, avoiding unnecessary application to healthy skin.
  15. Can hydrocortisone cream be used with moisturisers?
    Yes, apply the hydrocortisone first, wait a few minutes, and then apply a moisturiser.