Hydrocortisone for skin

Hydrocortisone for skin is a topical corticosteroid used to relieve inflammation, itching, and redness caused by various dermatologic conditions such as eczema, dermatitis, and insect bites. It is considered a mild steroid and is often the first-line corticosteroid for treating sensitive skin areas (e.g., face, groin, children’s skin). It is available both over-the-counter (OTC) in lower strengths and by prescription in higher concentrations or specialized formulations.

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Classification and Formulations

• Pharmacological Class: Mild topical corticosteroid

• ATC Code: D07AA02

• Active ingredient: Hydrocortisone (often as hydrocortisone acetate)

• Available Strengths:

  • OTC: 0.5% and 1%

  • Prescription: 2.5% or in combination with antimicrobials

• Forms:

  • Cream (water-based; for moist or weepy skin)

  • Ointment (greasier; for dry, thickened skin)

  • Lotion, solution, foam (for hairy areas)

  • Gel or scalp application (alcohol-based; dries quickly)

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Mechanism of Action

Hydrocortisone reduces skin inflammation by:

• Inhibiting phospholipase A2, thereby reducing prostaglandins and leukotrienes

• Suppressing local immune cell activity (e.g., T-cells, mast cells)

• Decreasing capillary permeability, leading to less redness and swelling

• Reducing itching by dampening cytokine-driven irritation

These effects help alleviate symptoms in both acute flares and chronic inflammatory skin conditions.

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Indications

Primary Uses

• Atopic dermatitis (eczema)

• Contact dermatitis (allergic or irritant)

• Seborrheic dermatitis

• Insect bites and stings

• Nappy rash (with caution)

• Mild psoriasis (limited use)

• Pruritus ani (perianal itching)

• Intertrigo (friction rash in folds)

• Heat rash (miliaria)

Off-label / Adjunctive Use

• Post-inflammatory erythema

• Mosquito bite allergy

• Minor burns (if non-infected and inflammation is the key symptom)

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Dosage and Administration

• Apply thinly to the affected area 1–2 times daily

• Once symptoms improve, reduce to once daily or alternate days

• Duration: Up to 7 days OTC, longer under medical supervision

• Apply after moisturizing, and before barrier creams (e.g., zinc oxide)

• Use the Fingertip Unit (FTU) rule:

  • 1 FTU = amount squeezed from the tip to first crease of adult index finger ≈ 0.5 g

  • Face/scalp/hand = 2.5 FTUs

  • Arm = 3 FTUs

  • Leg = 6 FTUs

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Contraindications

• Untreated bacterial, viral (e.g., herpes), or fungal skin infections

• Acne, rosacea, perioral dermatitis (may worsen)

• Broken skin or ulcerated lesions

• Hypersensitivity to hydrocortisone or formulation excipients

• Use in or near the eyes unless specifically formulated for ophthalmic use

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Precautions

• Use with caution on the face, genitals, and skin folds—these areas absorb more

• Do not use under occlusion (e.g., bandages) unless instructed by a healthcare provider

• Do not apply to large areas of the body unless medically advised

• Long-term use may cause skin thinning (atrophy), telangiectasia, or striae

• Avoid prolonged use in children—risk of adrenal suppression

• Pregnancy and breastfeeding:

  • Safe for short-term use in low doses

  • Avoid nipple area if breastfeeding

• Use in infants and young children: only with medical supervision and for short durations

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Side Effects

Common (local)

• Burning, stinging or itching after application (usually temporary)

• Dryness or irritation if used excessively

• Skin thinning (atrophy) with prolonged use

• Perioral dermatitis, acneiform eruptions

• Hypopigmentation (especially in darker skin tones)

• Allergic contact dermatitis (rare)

Rare but Serious

• Systemic absorption leading to:

  • Adrenal suppression

  • Cushing’s syndrome features (moon face, central obesity)

  • Growth suppression in children

  • Hyperglycemia

• Worsening of undiagnosed skin infections

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Drug Interactions

Topical hydrocortisone has minimal systemic absorption when used appropriately, so systemic drug interactions are rare. However, caution is advised if:

• Used with other topical medications: Apply hydrocortisone first and allow it to absorb

• Concurrent use with photosensitizing agents: May increase skin irritation

• Immunosuppressants (systemic): May compound the immunosuppressive effect on the skin

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Comparison with Other Topical Steroids

• Hydrocortisone is least potent (Class VII US; mild potency UK)

  • Safer for use on face, children, and sensitive skin areas

• Moderate-potency steroids (e.g., clobetasone) are more effective for thicker or resistant lesions

• Potent and very potent steroids (e.g., betamethasone, clobetasol) reserved for:

  • Psoriasis

  • Severe eczema

  • Lichen simplex chronicus

• Hydrocortisone may be used to taper down from more potent corticosteroids during remission

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Use in Children

• Avoid in infants <1 year unless supervised

• Limit use to 5–7 days for nappy rash or eczema

• Prefer 1% formulations

• Monitor for growth and signs of systemic absorption if used frequently or long-term

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Practical Application Tips

• Do not overuse – apply a thin layer only

• Do not share topical corticosteroids

• If used with moisturizers: apply moisturizer first, wait 20–30 minutes, then apply hydrocortisone

• Do not apply to infected or broken skin

• Inform clinicians if hydrocortisone was used before diagnosis—can mask infections

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Brand Names (Examples)

• Generic hydrocortisone cream/ointment 0.5% or 1%

• Hc45®

• Dermacort®

• Mildison®

• Anusol HC® (combined with local anesthetics for hemorrhoids)

• Canesten HC® (with clotrimazole) for fungal infections

• Fucidin H® (with fusidic acid) for infected eczema

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Storage and Stability

• Store at room temperature (15–25°C)

• Avoid exposure to direct sunlight or heat

• Replace tube after expiration date or if contaminated