What Is Hydrocortisone Cream?
Hydrocortisone is an FDA (Food and Drug Administration)-approved drug used to treat skin irritation and inflammation linked to corticosteroids. It is available in both over-the-counter, lower-dose formulations and stronger prescription versions. Hydrocortisone is a low-potency corticosteroid that is believed to work by inhibiting immune system activity. It belongs to the category of steroids, or corticosteroids, which are effective in reducing inflammation, not only in the skin but also in other parts of the body.
When certain chemicals are released into the skin as a result of an allergic reaction or irritation, blood vessels enlarge, and the affected area becomes red, swollen, itchy, and painful. This is known as skin inflammation. Hydrocortisone skin treatments target skin cells to prevent the release of these chemicals, thereby alleviating symptoms like swelling, redness, and itching.
Hydrocortisone cream is a smooth, white cream used on the skin. It is used to reduce swelling and irritation in different skin problems, such as:
• Mild to moderate eczema.
• Dermatitis caused by irritants or allergens.
• Insect bite reactions.
Hydrocortisone cream is available as a lotion, ointment, or solution.
Is Hydrocortisone Approved by the FDA?
Yes, Hydrocortisone was approved by the FDA (Food and Drug Administration) in 1952 for the treatment of inflammatory skin conditions.
For Patients
What Is Eczema?
Eczema is a type of inflammatory skin condition that causes dryness, itching, and rough skin with small, raised areas. It damages the skin’s natural barrier, which normally keeps moisture in and protects against irritants. It is a type of dermatitis, a group of skin conditions that cause inflammation.
How Should the Patient Use Hydrocortisone Cream?
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To use Hydrocortisone cream for eczema: Follow the doctor’s advice carefully. Do not use more than prescribed, as it may cause side effects or skin irritation.
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Apply only to the skin. Avoid eyes, cuts, wounds, or burns. Wash with water if it comes into contact with these areas by accident.
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Use it only for the condition being treated. Do not apply it to unknown infections or serious burns without asking the doctor.
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When applying:
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Wash your hands before and after use.
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Gently rub a thin layer on the affected area.
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Shake the lotion well before use.
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Use a covering bandage only if the doctor advises.
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Measure the amount in fingertip units. This amount is usually enough for both hands.
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For babies and children, follow the doctor’s or pharmacist’s advice about how much to use. It is usually applied one to four times daily.
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Hydrocortisone comes in different strengths and forms. Always follow the doctor’s instructions for the prescribed type and strength.
What Should Be Told to the Doctor Before Using Hydrocortisone Cream?
Before using Hydrocortisone cream for eczema, tell the doctor about:
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Any allergies, especially to Hydrocortisone or other steroids like Prednisone or Triamcinolone.
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Any existing medical conditions. Ask the doctor or pharmacist if unsure.
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Itching in the outer genital area with vaginal discharge. Talk to a doctor before using this medicine.
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Do not apply it to infected areas or open wounds, as it may worsen the infection. If redness or swelling does not get better, tell your doctor.
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Children can absorb more medicine through their skin, so always check with a doctor before using it on them.
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If you are pregnant, use it only when truly necessary and discuss the possible risks and benefits with your doctor first.
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During breastfeeding, it is not fully known if the medicine passes into breast milk when applied to the skin. Ask the doctor before use.
What Are the Side Effects of Hydrocortisone Cream?
Common side effects include:
• Redness.
• Burning.
• Itching.
Long-term use may cause:
• Thinning of the skin.
• Higher risk of fungal infections.
Rarely, especially with long use or in children, some medicines may enter the bloodstream and cause steroid-related effects such as:
• Vision problems.
• Signs of serious infection, like fever or long-lasting sore throat.
Severe allergic reactions are rare. Get medical help immediately if there is:
• Rash.
• Swelling of face, tongue, or throat.
• Severe dizziness.
• Difficulty breathing.
Mild Hydrocortisone products are usually safe. Most people do not have side effects when used for less than four weeks. A mild burning feeling may occur after applying, but it usually settles in a few days. Serious side effects are more likely with strong products or long use over large areas.
Long-term use can cause:
• Skin thinning.
• Stretch marks, which may fade but can be permanent.
How Should Hydrocortisone Cream Be Stored?
• Store at room temperature in a closed container away from heat, moisture, and light. Do not freeze.
• Keep out of reach of children.
• Do not keep expired or unused medicine.
• Do not store above 25 degrees Celsius. Keep it in the original carton.
• Do not use after the expiry date mentioned on the tube or carton.
For Doctors
Indication and Usage:
Hydrocortisone cream is recommended for short-term treatment of conditions that respond to corticosteroids, both sudden and long-standing. These include mild skin irritation, itching, and rashes due to eczema, dermatitis (including cosmetic or jewelry reactions), psoriasis, anogenital itching, and sunburn.
Dosage and Administration:
For adults and children over 2 years old, apply to the affected area 3 to 4 times daily. Avoid use in children under two years unless advised by a doctor. Reduce frequency once symptoms improve. Do not use underdressings unless directed by a healthcare professional.
Clinical Pharmacology
Mechanism of Action:
Topical Hydrocortisone passes through cell membranes and binds to receptors inside cells. The complex moves into the nucleus, binds to DNA, and increases messenger RNA production. This leads to the formation of proteins that reduce inflammation, swelling, capillary widening, and immune cell movement. Later stages, like collagen formation and keloid development, are also reduced.
Pharmacodynamics:
Hydrocortisone works by binding to specific receptors in the body’s cells. It then blocks chemicals that cause redness, swelling, and itching. At the same time, it helps the body produce substances that calm inflammation. This is how it reduces skin irritation.
Pharmacokinetics:
• Absorption: When you apply hydrocortisone to the skin, some of it passes through the skin and enters the body. More medicine is absorbed if the skin is thin, damaged, or inflamed. Areas like the face, scalp, armpits, ears, and scrotum absorb more. Tightly covering the area with a bandage can also increase absorption. If a large amount enters the bloodstream, it can act like other steroid medicines in the body.
• Distribution: The medicine spreads through the outer layer of the skin and through hair follicles. The amount absorbed varies depending on the body part. About 1% is absorbed through the forearm, while 26–29% may be absorbed through mucous membranes. The level in the blood decreases by half in about 90 minutes. Its biological half-life is around 8 to 12 hours, and it is mainly broken down in the skin and liver.
•Biotransformation: It is metabolized in the liver by reduction and by conjugation with glucuronic acid. Cortisone and other metabolites are produced and then further processed.
• Elimination: Most of the medicine leaves the body through urine within 72 hours. Very little is removed through bile or stool. About 70% of the drug is broken down in the liver before it is excreted.
Usage in Particular Populations:
• Pediatric: Children are at higher risk of absorbing more medicine into the body because their skin surface area is large compared to their body weight. Do not use it in children under two years of age unless a doctor advises it.
• Fertility: There is no clear information available about how this medicine affects fertility.
• Pregnancy: Category A. It has been widely used without proven harm to the fetus.
• Lactation: It is not known whether enough of the drug is absorbed to pass into breast milk. Use only if the benefits outweigh the risks.
Driving and Machinery: Unlikely to affect ability.
Contraindications
Do not use it in patients allergic to Hydrocortisone acetate. Avoid acne-prone areas and the area around the eyes. Contraindicated in skin infections like chickenpox, herpes, and other viral diseases. Do not use diaper rash.
Adverse Effects
Mild stinging may occur and usually reduces with repeated use. Avoid occlusive dressings without medical advice. Prolonged use under occlusion may cause folliculitis, skin thinning, or stretch marks. Long-term extensive use may suppress adrenal function. Other possible effects include burning, itching, irritation, thinning, infections, dryness, acne-like eruptions, and lightening of skin. Stop treatment if severe reactions occur.
Warnings and Precautions
For external use only. Do not apply to the genital area if vaginal discharge is present without medical advice. Avoid eye contact. Do not exceed the recommended dose. Do not insert anything rectally, including fingers or devices.
Drug Interactions:
No known drug interactions with topical Hydrocortisone.
Overdose and Toxicity:
Overuse, especially under occlusion, may increase absorption and side effects. Treatment involves stopping the steroid and managing symptoms.
Clinical Studies:
Study 1
A study was done to evaluate the efficacy and safety of Hydrocortisone aceponate (0.127 percent) lipophilic cream in Indian patients with steroid-responsive dermatoses. The research included 415 patients who applied the cream as directed. The results indicated a positive outcome, with a substantial proportion of patients experiencing cleared lesions, excellent results, and good responses. According to the study's findings, Hydrocortisone aceponate lipophilic cream (0.127 percent) is a very effective therapeutic agent with an excellent safety profile for a variety of steroid-responsive dermatoses in the Indian patient population.
Study 2
In a double-masked, placebo-controlled, randomized study, the efficacy, safety, and tolerability of Hydrocortisone buteprate 0.1% cream in the treatment of atopic dermatitis were evaluated. 194 adults were randomized to receive either the cream or a placebo, with assessments at various time points. Patients treated with Hydrocortisone buteprate demonstrated significant improvements in lesion scores and overall improvement compared to those receiving a placebo. The majority of side effects were mild to moderate, with burning being the most common. The treatment was found to be more tolerable. Patients considered both Hydrocortisone buteprate and the placebo cosmetically acceptable for daily use.
