What is the effect of hydrocortisone cream on acne?

Hydrocortisone Cream is Harmful for Acne and Should Be Avoided

Hydrocortisone cream should not be used for acne treatment as it can worsen acne and cause adverse effects including steroid acne, skin atrophy, and rebound phenomenon. 1, 2

Mechanism of Action and Harmful Effects

Hydrocortisone cream, a topical corticosteroid, works by suppressing inflammation but does not address the underlying causes of acne, which include:

• Abnormal follicular hyperkeratinization
• Excessive sebum production
• Proliferation of Cutibacterium acnes
• Inflammation 3

When applied to acne, hydrocortisone may:

1. Temporarily reduce redness and inflammation - creating a false impression of improvement
2. Promote follicular occlusion - worsening comedone formation
3. Cause skin atrophy - even low-potency hydrocortisone 1% can cause epidermal thinning after just 2 weeks of use 4
4. Lead to steroid-induced acne - characterized by monomorphic papules and pustules 2
5. Cause rebound phenomenon - worsening of acne after discontinuation 5
6. Induce telangiectasia - especially in sensitive areas like the face 2

Evidence Against Hydrocortisone for Acne

Research has shown that even potent topical corticosteroids produce no short-term improvement in patients with moderate acne 6. More concerning, chronic application of 1% hydrocortisone has been documented to cause:

• Rosacea-like eruptions
• Perioral dermatitis
• Skin atrophy
• Telangiectasia 2

Recommended Acne Treatments

According to current guidelines from the American Academy of Dermatology, first-line treatments for acne should include:

For Mild Acne:

• Topical retinoids (tretinoin, adapalene, tazarotene) + benzoyl peroxide (2.5-5%) 1, 3

For Moderate Acne:

• Topical retinoid + benzoyl peroxide + topical antibiotic (clindamycin 1%)
• Consider adding systemic antibiotics (doxycycline 100mg 1-2 times daily) if topical therapy is insufficient 1, 3

For Severe Acne:

• Systemic antibiotics + topical retinoid + benzoyl peroxide
• Consider isotretinoin (0.25-0.4 mg/kg/day) for resistant cases or those with scarring 1, 3

For Hormonal Acne in Women:

• Combined oral contraceptives or spironolactone in addition to topical therapy 1, 3

Limited Appropriate Uses of Corticosteroids in Acne

The only appropriate use of corticosteroids in acne management is:

1. Intralesional corticosteroid injections for large inflammatory nodules (triamcinolone acetonide 2.5-10 mg/mL) 1
2. Short-term oral corticosteroids for severe inflammatory acne while initiating standard treatments 1

Conclusion

Hydrocortisone cream should be avoided for treating acne. Instead, patients should use evidence-based treatments targeting the multiple pathogenic factors of acne, including topical retinoids, benzoyl peroxide, and appropriate antibiotics as recommended by current guidelines. Using hydrocortisone cream for acne can lead to worsening of the condition and additional skin complications that may be difficult to treat.