From the Guidelines
Hydrocortisone 1% cream is a suitable option for treating mild to moderate eczema on the face, but its use should be limited to short periods due to potential side effects. According to the British Association of Dermatologists and the Research Unit of the Royal College of Physicians of London, topical corticosteroids, such as hydrocortisone, are the mainstay of treatment for atopic eczema and can be used safely if certain precautions are taken 1. The key principle is to use the least potent preparation required to keep the eczema under control, and when possible, the corticosteroids should be stopped for short periods.
Some key considerations for using hydrocortisone 1% cream on the face include:
- Applying a thin layer to affected areas 1-2 times daily for short periods, typically 7-14 days
- Avoiding longer use due to the risk of side effects like skin thinning, telangiectasia, and hypopigmentation
- Using it even more sparingly and for shorter durations in children
- Avoiding contact with eyes and discontinuing use if irritation develops
It's essential to note that hydrocortisone 1% cream works by suppressing inflammatory pathways and reducing immune responses in the skin, making it effective for flare-ups but not ideal for long-term management. If symptoms persist beyond two weeks, consulting a healthcare provider may be necessary to explore alternative treatments, such as topical calcineurin inhibitors, which do not cause skin thinning with prolonged use.
From the Research
Eczema Treatment with Hydrocortisone 1% Cream
- Hydrocortisone 1% cream is a low-potency topical corticosteroid, which can be used to treat eczema 2.
- The use of topical corticosteroids, including hydrocortisone 1% cream, on the face should be approached with caution due to the risk of adverse effects such as atrophy, striae, rosacea, telangiectasias, purpura, and other cutaneous and systemic reactions 2.
- The risk of adverse effects increases with prolonged use, large area of application, higher potency, occlusion, and application to areas of thinner skin such as the face and genitals 2.
Comparison of Topical Corticosteroid Potencies
- Studies have compared the effectiveness of different potencies of topical corticosteroids, including moderate- versus mild-potency, potent versus mild-potency, potent versus moderate-potency, and very potent versus potent 3.
- Moderate-potency topical corticosteroids probably result in more participants achieving treatment success compared to mild-potency topical corticosteroids 3.
- Potent topical corticosteroids probably result in a large increase in the number achieving treatment success compared to mild-potency topical corticosteroids 3.
Application Frequency and Duration
- Applying potent topical corticosteroids only once a day probably does not decrease the number achieving treatment success compared to twice daily application 3.
- There is no specified time limit for low-potency topical corticosteroid use, such as hydrocortisone 1% cream 2.
- Weekend (proactive) therapy with topical corticosteroids probably results in a large decrease in the likelihood of a relapse compared to no topical corticosteroids/reactive application 3.