From the Guidelines
Hydrocortisone can be safely used on the face, but with caution and under strict limitations to minimize potential side effects. When considering the use of hydrocortisone on the face, it's crucial to weigh the benefits against the risks, particularly the risk of local skin adverse effects such as skin atrophy, striae, folliculitis, telangiectasia, and purpura, as highlighted in the joint AAD-NPF guidelines of care for the management and treatment of psoriasis with topical therapy and alternative medicine modalities for psoriasis severity measures 1. The face and intertriginous areas are at the greatest risk to develop these adverse effects due to the thinner skin, which makes it more susceptible to corticosteroid side effects. Key considerations for safe use include:
- Using low-strength hydrocortisone (0.5-1%) for short-term periods, typically 1-2 weeks, to treat mild conditions like eczema, contact dermatitis, or insect bites.
- Applying a thin layer only to affected areas once or twice daily as directed by a healthcare provider.
- Avoiding prolonged use to prevent side effects such as skin thinning, increased blood vessel visibility, acne-like eruptions, and rebound inflammation when stopped.
- Never using higher-potency prescription corticosteroids on the face unless specifically instructed by a dermatologist, due to the increased risk of systemic toxicities like hypothalamic-pituitary-adrenal axis suppression, as noted in guidelines of care for the management of psoriasis and psoriatic arthritis 1. Children and elderly individuals should use even lower strengths and for shorter durations due to their more delicate skin. If the facial skin condition doesn't improve after a week of hydrocortisone use or worsens at any point, it's essential to discontinue use and consult a healthcare professional for alternative treatments.
From the FDA Drug Label
Warnings For external use only When using this product avoid contact with eyes
The FDA drug label does not answer the question.
From the Research
Safety of Hydrocortisone on the Face
- Hydrocortisone is a topical corticosteroid used to treat inflammatory skin conditions such as psoriasis and atopic dermatitis 2.
- The risk of adverse effects from topical corticosteroids, including hydrocortisone, 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 used on the face, it is essential to use lower potencies and shorter durations to minimize the risk of adverse effects 2.
- There is no specified time limit for low-potency topical corticosteroid use, but high-potency corticosteroids should be used for up to three weeks, and medium-potency corticosteroids for up to 12 weeks 2.
Precautions and Considerations
- Patients should be taught correct application techniques, such as the fingertip unit method, to ensure safe and effective use 2.
- The quantity of corticosteroid prescribed depends on the duration of treatment, frequency of application, skin location, and total surface area treated 2.
- Other studies have focused on the treatment of acne and psoriasis, but do not provide direct information on the safety of hydrocortisone for use on the face 3, 4, 5, 6.