What is the use of Hydrocortisone (corticosteroid) cream?

From the Guidelines

Hydrocortisone cream is a mild topical corticosteroid that can be used to treat various inflammatory skin conditions, but its efficacy for psoriasis is generally lower compared to more potent topical corticosteroids, with efficacy rates ranging from 41% to 83% for the least potent to midstrength classes of topical corticosteroids 1.

Key Considerations

• Hydrocortisone cream is typically used for mild skin conditions, and its use should be limited to a short period, usually up to 7 days, to minimize the risk of side effects such as skin thinning, discoloration, or increased infection risk.
• For psoriasis treatment, more potent topical corticosteroids or combination therapies with vitamin D analogues may be more effective, with studies showing that combination treatments can achieve clear or almost clear status in 69% to 74% of patients 1.
• When using hydrocortisone cream, it is essential to follow proper application guidelines, including washing hands before and after application, applying only to affected areas, and avoiding use on broken skin, face, groin, or underarms without medical advice.

Efficacy and Safety

• The efficacy of hydrocortisone cream for psoriasis can vary widely, and its use may not be sufficient for more severe cases, which may require more potent topical corticosteroids or other treatments.
• Studies have shown that combination treatments with vitamin D analogues and potent topical corticosteroids can be more effective than either agent alone for the treatment of psoriasis, with no serious adverse events observed over a 52-week treatment period 1.
• Ultraviolet A (UVA) radiation can decrease the concentration of calcipotriene on the skin, and thick layers of calcipotriene can block ultraviolet B (UVB), thereby increasing the minimal erythema dose, which should be considered when using vitamin D analogues in conjunction with phototherapy 1.

Recommendations

• For most cases of psoriasis, a combination treatment with a vitamin D analogue and a potent topical corticosteroid is recommended, as it has been shown to be more effective than either agent alone 1.
• Hydrocortisone cream can be used for mild skin conditions, but its use should be limited to a short period, and patients should be advised to follow proper application guidelines to minimize the risk of side effects.
• Patients with psoriasis should be closely monitored, and treatment should be adjusted as needed to achieve optimal results and minimize the risk of adverse events.

From the FDA Drug Label

Warnings For external use only Do not use in the genital area if you have a vaginal discharge. Consult a doctor. for the treatment of diaper rash. Consult a doctor. When using this product avoid contact with eyes do not use more than directed unless told to do so by a doctor do not put directly into the rectum by using fingers or any mechanical device or applicator Stop use and ask a doctor if condition worsens, symptoms persist for more than 7 days or clear up and occur again within a few days, and do not begin use of any other hydrocortisone product unless you have asked a doctor rectal bleeding occurs Keep out of reach of children.If swallowed, get medical help or contact a Poison Control Center right away.

The hydrocortisone cream should not be used in the genital area if there is a vaginal discharge, and a doctor should be consulted for the treatment of diaper rash 2.

• Avoid contact with eyes
• Do not use more than directed unless told to do so by a doctor
• Do not put directly into the rectum
• Stop use and ask a doctor if condition worsens or symptoms persist for more than 7 days 2.

From the Research

Hydrocortisone Cream

• Hydrocortisone cream is a type of topical corticosteroid used to treat inflammatory skin conditions such as psoriasis and atopic dermatitis 3
• Topical corticosteroids are classified by strength and the risk of adverse effects, with higher potency increasing the risk of adverse effects such as atrophy, striae, and rosacea 3
• The quantity of corticosteroid prescribed depends on the duration of treatment, frequency of application, skin location, and total surface area treated, with correct patient application critical to successful use 3

Application and Usage

• Topical corticosteroids can be applied once or twice per day for up to three weeks for super-high-potency corticosteroids or up to 12 weeks for high- or medium-potency corticosteroids 3
• There is no specified time limit for low-potency topical corticosteroid use, and they can be used safely and effectively in patients who are pregnant or lactating 3
• Potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids in treating eczema, primarily in moderate or severe cases 4
• Applying potent topical corticosteroids only once a day probably does not decrease the number achieving treatment success compared to twice daily application 4

Safety and Adverse Effects

• Local adverse events, such as abnormal skin thinning, are increased with higher-potency topical corticosteroids, but the frequency is low overall 4, 5
• Biochemical adrenal suppression is a potential risk with topical corticosteroid use, particularly with very potent corticosteroids, but effects are reversible when treatment ceases 5
• Skin thinning is not increased with short-term use of any topical steroid potency, but long-term safety data are limited 6, 5

Treatment of Eczema

• Topical corticosteroids are the first-line treatment for atopic dermatitis flare-ups, with pimecrolimus and tacrolimus as alternative options 7
• Ultraviolet phototherapy is a safe and effective treatment for moderate to severe atopic dermatitis when first-line treatments are not adequate 7
• Potent topical steroids, Janus kinase inhibitors, and tacrolimus 0.1% are consistently ranked as among the most effective topical anti-inflammatory treatments for eczema 6