Hydrocortisone Cream - An Effective Steroid Medication for Eczema

Overview

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.

For Patients

What Is Eczema?

Eczema, a common skin condition, results in the skin becoming dry, itchy, and developing bumpy patches. This condition compromises the skin's protective barrier function, which is responsible for retaining moisture and safeguarding the body from external elements. Eczema falls under the category of dermatitis, a group of conditions that induce skin inflammation. The most common type is atopic dermatitis, also known as atopic eczema. The term "atopic" implies an increased likelihood of developing allergic conditions such as asthma (breathing difficulty) and hay fever (allergic cold).

What Is Hydrocortisone Cream?

Hydrocortisone cream is a smooth white cream designed for skin application. It contains Hydrocortisone, which is categorized as a corticosteroid medication. This cream is utilized to mitigate inflammation in various inflammatory skin conditions, including:

• Mild to moderate eczema.

• Dermatitis resulting from irritants or allergens.

• Reactions to insect bites.

Hydrocortisone cream, a medicated lotion, ointment, or solution, is employed to address eczema and other skin conditions characterized by swelling, redness, itching, and rashes. It belongs to the group of topical steroids and functions by reducing inflammation in the skin.

How Should the Patient Use Hydrocortisone Cream?

To use Hydrocortisone cream for eczema:

1. Follow the doctor's instructions carefully; do not use more than prescribed to avoid side effects or skin irritation.

2. Apply the cream only on the skin, avoiding contact with the eyes, cuts, scrapes, or burns. Rinse with water if accidental contact occurs.

3. Use the cream solely for the skin conditions the doctor is treating. Do not use it for suspected skin infections or severe burns without consulting the doctor.

4. When applying:

• • Wash hands with soap and water before and after use.
  • Gently massage a thin layer onto the afflicted area.
  • Shake the lotion well before use.
  • Use an occlusive dressing only if advised by the doctor.

5. Measure the amount of cream in fingertip units. This is usually enough for both hands.

6. For infants and children, follow the doctor's or pharmacist's guidance on the appropriate amount and apply Hydrocortisone topically to the affected area one to four times a day.

7. Hydrocortisone comes in different strengths and forms (lotion, cream, ointment, spray). Adhere to the doctor's recommendations for the prescribed product and strength.

What Are the Things to Inform the Doctor Before Taking Hydrocortisone Cream?

Before using Hydrocortisone cream for eczema, please inform the doctor of the following:

• Any allergies, especially if allergic to Hydrocortisone or other corticosteroids like Prednisone and Triamcinolone.

• Any existing health problems, and consult the doctor or pharmacist for guidance.

• If experiencing itching of the outer female genitals with vaginal discharge, consult the doctor before using this product.

• Do not use the cream if there is an infection or a sore in the area to be treated, as skin infections can worsen with this medication. If redness, swelling, or irritation does not improve, inform the doctor promptly.

• If considering using Hydrocortisone cream on children, be aware that they may be more sensitive to the effects of excessive corticosteroid medication. Consult the doctor for more specific information.

• During pregnancy, use this medication only if it is clearly necessary, and discuss the potential risks and benefits with the doctor.

• If breastfeeding, it is uncertain whether this drug passes into breast milk when applied topically, as similar medications can pass into breast milk when taken orally. To ensure safety, consult the doctor before breastfeeding.

What Are the Side Effects of Hydrocortisone Cream?

Common side effects of Hydrocortisone cream include:

• Redness.

• Burning.

• Itching.

Long-term use may cause:

• Thinning of the skin.

• Increased susceptibility to fungal infections.

In rare cases, especially with prolonged use or in children, Hydrocortisone cream may be absorbed into the bloodstream, resulting in side effects associated with excessive corticosteroid levels. These potential side effects include:

• Vision problems.

• Signs of serious infection (for example, fever, persistent sore throat).

With this medication, severe allergic reactions are uncommon. However, if any of the following signs of a severe allergic reaction manifest, get help right away:

• Rash.

• Itching or swelling (especially of the face/tongue/throat).

• Severe dizziness.

• Trouble breathing.

Mild Hydrocortisone treatments are generally safe. Most people do not experience side effects when used for less than four weeks. Some people may feel a burning or stinging sensation for a few minutes upon application, but this usually diminishes after a few days.

Serious side effects are more likely with the use of strong Hydrocortisone treatments or when applied to a large skin area for an extended duration. Prolonged use of Hydrocortisone can result in:

• Skin thinning.

• Development of stretch marks (likely permanent but often fading over time).

How Should the Patient Store Hydrocortisone Cream?

Store Hydrocortisone cream as follows:

• The medication should be stored at room temperature in a closed container away from heat, moisture, and light. Avoid freezing.

• Ensure it is kept out of the reach of children.

• Do not retain outdated or no longer needed medicine.

• Additionally, refrain from storing it above 25 degrees Celsius. Place it in the original package and keep the tube in the outer carton.

• Avoid using Hydrocortisone Cream after the expiry date, which is indicated on the tube or carton.

For Doctors

Indication and Usage:

The use of Hydrocortisone cream is recommended for the short-term management of symptoms related to conditions that respond to corticosteroids, both acute and chronic. This includes minor skin irritations, itching, and rashes stemming from various sources, such as eczema, dermatitis (including rashes caused by cosmetics and jewelry), psoriasis, anogenital pruritus, and sunburn.

Dosage and Administration:

For adults and children aged two years and older, the cream should be applied to the affected area not exceeding three to four times daily. However, for children under two years of age, its use should be avoided, and consultation with a healthcare professional is advised. As symptoms subside, the frequency of applications can be reduced. Importantly, Hydrocortisone cream should not be applied under bandages or dressings unless under the guidance of a medical professional.

Clinical Pharmacology

1. Mechanism of Action: When Hydrocortisone is administered topically, it permeates cell membranes and forms complexes with specific cytoplasmic receptors. These complexes then enter the cell nucleus, attach to DNA (deoxyribonucleic acid), and stimulate the transcription of messenger RNA (ribonucleic acid). This, in turn, leads to the synthesis of enzymes responsible for anti-inflammatory effects, such as inhibiting swelling, fibrin deposition, capillary dilation, and the movement of phagocytes. Furthermore, later stages of inflammation, including capillary production, collagen deposition, and the formation of keloids, are also hindered.

2. Pharmacodynamics: Hydrocortisone interacts with the glucocorticoid receptor, resulting in subsequent outcomes, including the suppression of phospholipase A2, NF-kappa B (Nuclear Factor-kappa B), and various other inflammatory transcription factors, as well as the activation of genes associated with anti-inflammatory properties.

3. Pharmacokinetics:

• Absorption: Hydrocortisone is absorbed through the skin, facilitating penetration into deeper layers. The degree of absorption is more pronounced in inflamed skin and in the presence of skin conditions such as eczema and psoriasis. Enhanced absorption is also observed in areas like the ear, scrotum, axillae, face, and scalp. The use of occlusive dressings assists absorption by hydrating the skin. Once absorbed, the pharmacokinetics closely resemble those of systemic steroids.

• Distribution: Upon topical application, Hydrocortisone diffuses through the skin via both transfollicular and transepidermal routes. The extent of absorption varies based on the anatomical site of application, ranging from one percent (forearm skin) to 26 to 29 percent (mucous membranes). Factors affecting penetration include concentration, vehicle, anatomical site, age, skin condition, and occlusion. The plasma concentration of Hydrocortisone decreases to 50 percent of its initial level within 90 minutes, with a biological half-life of eight to 12 hours. Biotransformation primarily occurs in the skin and, for any systemically absorbed amount, in the liver. Following topical application of C-14 radiolabeled Hydrocortisone to normal skin, 0.2 to one percent of Hydrocortisone appears in the urine over a 10-day period.

• Biotransformation: Hydrocortisone undergoes metabolism in the liver, primarily involving the reduction of the 5,6 double bond and the C3 and C20 keto groups. The resulting hydroxy derivatives are subsequently conjugated with glucuronic acid. Cortisone, an 11-keto-steroid, is produced from Hydrocortisone; the 11-ketosteroids are then reduced and conjugated to form glucuronide metabolites. A minor portion of Hydrocortisone is converted into the 17-keto-steroid, with the C21 hydroxyl group conjugated with sulfate.

• Elimination: When intravenously administered radioactive-carbon, ring-labeled steroids are injected into humans, the majority of the radioisotope is excreted in the urine within 72 hours. Biliary and fecal excretion holds little quantitative significance in humans. It is estimated that the liver metabolizes at least 70 percent of the secreted Hydrocortisone.

Usage In Specific Populations:

Pediatric Population: The risk of systemic absorption and, consequently, systemic toxicity is higher in children due to their larger skin surface relative to body weight compared to adults. The use of this preparation is generally discouraged in children under two years of age except when recommended by a physician.

Fertility: No data is available concerning its effects on fertility.

Pregnancy: Hydrocortisone falls under Category A, indicating that it has been used by a significant number of pregnant women and women of childbearing age without any confirmed increase in the incidence of birth defects or other direct or indirect harmful effects on the developing fetus.

Lactation: Whether there is sufficient absorption of topical corticosteroids to be excreted in breast milk remains uncertain. The potential benefits of use during lactation should be carefully considered in light of potential risks to the breastfeeding infant.

Effects on Driving and Machinery Operation: It is presumed to be safe and unlikely to impair one's ability to drive or operate machinery.

What Are the Contraindications of Hydrocortisone Cream?

Contraindications for Hydrocortisone cream include an allergic reaction to Hydrocortisone acetate. It is not to be applied on acne-prone areas and should not be used near the eye. Additionally, as with all topical corticosteroids, this cream is strictly contraindicated in the presence of skin infections and infestations, including conditions such as chickenpox, herpes, and other viral infections. This medication should not be used on diaper rash.

Adverse Effects of Hydrocortisone Cream

Adverse effects associated with Hydrocortisone cream may include a mild stinging sensation, which is usually temporary and tends to dissipate after multiple applications. It is crucial to note that the cream should not be applied under bandages or dressings without medical guidance. Intolerance to occlusive dressings, potentially leading to miliary eruptions and folliculitis, may occur, similar to other corticosteroids. In such instances, the use of occlusive dressings should be discontinued, and consideration should be given to reducing or discontinuing steroid application due to the possibility of local skin atrophy and striae. In long-term treatment of extensive skin areas with occlusive dressings, healthcare professionals should be mindful of the potential inhibition of adrenal function and monitor adrenal function accordingly.

Additional adverse effects related to topical steroids include burning, itching, irritation, skin atrophy, secondary infections, dryness, acneform eruptions, and hypopigmentation. If these adverse effects manifest, symptomatic treatment is typically recommended, and the use of steroids should be discontinued.

Warnings and Precautions:

This medication should be used externally only. Under no circumstances should Hydrocortisone be applied in the genital area, especially if the patient presents with vaginal discharge. In such instances, it is strongly advised to consult a doctor before use. Furthermore, when administering this product, healthcare professionals should emphasize the significance of avoiding contact with the eyes. It is essential to stress that patients must not exceed the recommended usage unless explicitly directed to do so by a healthcare provider. Patients should also be cautioned against direct rectal application using fingers, any mechanical device, or applicator.

Drug Interactions of Hydrocortisone Cream

At present, there are no identified drug interactions linked to the topical use of Hydrocortisone.

Overdose and Toxicity:

Overdose and toxicity related to Hydrocortisone cream may result from excessive percutaneous absorption of corticosteroids, notably in occlusive conditions. In such cases, the risk of experiencing adverse effects such as burning, itching, irritation, skin atrophy, secondary infections, dryness, acne-like eruptions, and hypopigmentation may be heightened.

In the event of a potential overdose, the approach to treatment should predominantly focus on addressing the symptoms that arise. Discontinuation of the steroid's administration is a key measure in managing toxicity and adverse reactions effectively.

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 good therapeutic agent with an excellent safety profile for a variety of steroid-responsive dermatoses in the patient population in India.

Study 2:

In a double-masked, placebo-controlled, randomized study, the efficacy, safety, and tolerability of Hydrocortisone buteprate 0.1 percent cream in the treatment of atopic dermatitis was investigated. One hundred ninety-four 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 the side effects were reported to be 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.