What is the difference between mometasone and hydrocortisone 2.5 for treating skin conditions like eczema or dermatitis?

From the Guidelines

Mometasone is preferred over hydrocortisone 2.5% for treating severe or stubborn skin conditions like eczema or dermatitis, due to its higher potency and faster efficacy, as demonstrated in a study published in the British Journal of Dermatology 1. When considering the treatment of skin conditions such as eczema or dermatitis, the choice between mometasone and hydrocortisone 2.5% depends on the severity and location of the condition.

• Mometasone is a medium-to-high potency steroid, making it more suitable for severe or stubborn conditions.
• Hydrocortisone 2.5%, on the other hand, is a low potency option, often used for mild to moderate eczema or dermatitis, and is suitable for sensitive areas like the face and for children. The guidelines for the management of contact dermatitis suggest the use of topical corticosteroids, with mometasone furoate being an option for chronic hand eczema 1. Additionally, a study published in the Journal of the American Academy of Dermatology provides efficacy rates of different classes of topical corticosteroids, including mometasone and hydrocortisone, for the treatment of psoriasis 1. However, it's essential to use the lowest potency steroid that effectively controls symptoms and to follow up with a healthcare provider if the condition doesn't improve within the recommended treatment period, to minimize the risk of side effects such as skin thinning, stretch marks, and adrenal suppression.
• The recommended usage for hydrocortisone 2.5% is to apply it thinly to affected areas twice daily for up to two weeks.
• Mometasone, being more potent, should be used for shorter periods (5-7 days) and is generally not recommended for facial use, thin skin areas, or long-term treatment.

From the Research

Comparison of Mometasone and Hydrocortisone

• Mometasone and hydrocortisone are both topical corticosteroids used to treat skin conditions like eczema or dermatitis 2, 3, 4, 5, 6.
• Mometasone is a moderate-potency steroid, while hydrocortisone 2.5 is a low-potency steroid 6.
• A study comparing mometasone furoate 0.1% cream and hydrocortisone 1.0% cream in the treatment of childhood atopic dermatitis found that mometasone produced significantly greater improvement than hydrocortisone 6.
• The difference in therapeutic response was particularly evident in patients with involvement of more than 25% of their body surface area 6.
• Morning plasma cortisol levels were assayed before treatment, after 1 week of therapy, and at the end of the clinical trial, and plasma cortisol levels were transiently suppressed in one child who was treated with hydrocortisone and in none of the children treated with mometasone 6.

Potency and Efficacy

• Potent and moderate topical corticosteroids are probably more effective than mild topical corticosteroids, primarily in moderate or severe eczema 5.
• However, there is uncertain evidence to support any advantage of very potent over potent topical corticosteroids 5.
• Effectiveness is similar between once daily and twice daily (or more) frequent use of potent topical corticosteroids to treat eczema flare-ups 5.

Safety and Adverse Events

• Adverse events were not well reported and came largely from low- or very low-certainty, short-term trials 5.
• In trials that reported abnormal skin thinning, frequency was low overall and increased with increasing potency 5.
• Local adverse events, such as rosacea-like eruption, perioral dermatitis, atrophy, and telangiectasia, have been reported with the use of topical hydrocortisone 4.