Is it okay to use hydrocortisone (hydrocortisone) on large areas of the body, including the chest, back, neck, arms, and legs?

From the Guidelines

No, it is not recommended to use hydrocortisone on large areas of the body such as the chest, back, neck, arms, and legs due to the increased risk of systemic absorption and potential side effects. Hydrocortisone cream or ointment is typically intended for small, localized areas of skin inflammation or irritation. When applied to extensive body surfaces, there is an increased risk of systemic absorption of the medication through the skin, which can lead to side effects similar to those experienced when taking oral steroids, such as thinning of the skin, stretch marks, increased susceptibility to infections, and potential suppression of the body's natural cortisol production 1.

Some of the potential risks and harms associated with topical corticosteroid use include:

• Local skin adverse effects, such as skin atrophy, striae, folliculitis, telangiectasia, and purpura 1
• Exacerbation of acne, rosacea, perioral dermatitis, and tinea infections 1
• Contact dermatitis and rebound effects from abrupt withdrawal of topical corticosteroids 1
• Systemic effects, such as hypothalamic-pituitary-adrenal axis suppression, increased intraocular pressure, glaucoma, and cataracts, especially with use around the eye 1

For large body areas, it's better to consult with a healthcare provider who might recommend alternative treatments or a different formulation with lower potency that's safer for extensive use. If you have a widespread skin condition requiring treatment, your doctor might prescribe a different medication altogether or suggest non-steroidal alternatives that are safer for larger surface areas. Regular clinical review and supervised use of topical corticosteroids are essential to minimize the risks associated with their use 1.

From the FDA Drug Label

Warnings For external use only do not use more than directed unless told to do so by a doctor

The FDA drug label does not answer the question.

From the Research

Use of Hydrocortisone on Large Areas of the Body

• The use of hydrocortisone on large areas of the body, including the chest, back, neck, arms, and legs, may increase 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.
• When using topical corticosteroids, including hydrocortisone, on large areas of the body, it is essential to follow the prescribed dosage and application instructions to minimize the risk of adverse effects 2.
• The quantity of corticosteroid prescribed depends on the duration of treatment, the frequency of application, the skin location, and the total surface area treated 2.

Application and Dosage

• Correct patient application is critical to successful use, and patients may be taught application using the fingertip unit method, where one fingertip unit is the amount of medication dispensed from the tip of the index finger to the crease of the distal interphalangeal joint and covers approximately 2% body surface area on an adult 2.
• Topical corticosteroids, including hydrocortisone, are 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 2.
• There is no specified time limit for low-potency topical corticosteroid use, but it is crucial to follow the prescribed dosage and application instructions to minimize the risk of adverse effects 2.

Safety and Efficacy

• Hydrocortisone has been shown to be effective in reducing inflammation and improving symptoms in various skin conditions, including atopic eczema 3 and sunburn 4.
• However, long-term use of hydrocortisone can lead to adverse effects, such as toxicity to articular cartilage and numerous systemic side effects, including increases in blood glucose levels, a reduction in immune function, and an increased risk of infections 5.
• The risk of hypothalamic-pituitary-adrenal (HPA) axis suppression is a potential systemic risk of topical steroid use, but physiologic adrenal suppression is unlikely to be associated with clinical signs or symptoms of HPA axis suppression 6.