Is 1% hydrocortisone (corticosteroid) safe to use on an infant with a rash?

1% Hydrocortisone for Infant Rash

1% hydrocortisone cream is safe and appropriate for treating mild to moderate rashes in infants when used correctly for short periods, but should be limited to small body surface areas and avoided on the face unless specifically directed by a healthcare provider. 1, 2

Safety Profile and Appropriate Use

When to Use 1% Hydrocortisone

• For mild to moderate inflammatory rashes covering less than 10% of body surface area
• For short-term treatment (generally less than 7 days)
• For non-infected rashes that require anti-inflammatory treatment

Application Guidelines

• Apply a thin layer to affected areas 1-2 times daily
• Avoid occlusive dressings unless specifically directed
• Use Class V/VI corticosteroids (like hydrocortisone 2.5%) for facial application if necessary 1
• Avoid application near eyes, mucous membranes, or in the diaper area if there are open wounds

Precautions and Risks

Potential Side Effects

• Skin thinning (atrophy) with prolonged use
• Adrenocortical suppression is possible, especially in infants with severe skin disease 3
• Risk increases with:
  • Larger body surface area treated
  • Prolonged duration of treatment
  • Use of occlusive dressings
  • Application to inflamed or damaged skin

When to Avoid

• Do not use for:
  • Fungal infections
  • Viral infections (like herpes)
  • Bacterial infections without appropriate antibiotic treatment
  • Perioral dermatitis 1
  • Open wounds or ulcerations

Monitoring and Follow-up

When to Discontinue

• If condition worsens
• If symptoms persist beyond 7 days
• If the area clears and then recurs shortly after stopping treatment 2

Signs of Adverse Effects

• Increased redness or irritation
• Skin thinning
• Stretch marks
• Signs of systemic absorption (growth retardation, cushingoid features)

Alternative Treatments

For Mild Rashes

• Emollients and moisturizers (fragrance-free)
• Gentle cleansers and soap substitutes 1
• For diaper rash specifically, breast milk has shown similar efficacy to 1% hydrocortisone in one study 4

For Moderate to Severe Rashes

• Consider referral to dermatology for persistent or severe rashes
• For atopic dermatitis, newer non-steroidal options may be considered under specialist guidance 5

Common Pitfalls to Avoid

1. Overuse: Using for longer than necessary increases risk of side effects
2. Incorrect diagnosis: Treating fungal or bacterial infections with steroids alone can worsen condition
3. Too potent formulation: Using higher potency steroids than needed
4. Inadequate follow-up: Not reassessing the rash after a few days of treatment
5. Abrupt discontinuation: For longer treatments, gradual tapering may be needed

Remember that 1% hydrocortisone is the mildest topical steroid available and is generally safe for short-term use in infants when used appropriately, but caution is still warranted due to infants' increased risk of percutaneous absorption and potential systemic effects 6, 3.