From the Guidelines
Overuse of hydrocortisone can lead to several concerning side effects, including skin atrophy, striae, folliculitis, telangiectasia, and purpura, as well as systemic effects such as adrenal suppression, osteoporosis, and increased risk of infections. The most common local skin adverse effects of topical corticosteroid use include skin atrophy, striae, folliculitis, telangiectasia, and purpura, especially in areas such as the face and intertriginous areas, as well as chronically treated areas 1. Prolonged or excessive use of topical hydrocortisone may also cause acne, rosacea, perioral dermatitis, and tinea infections, and may occasionally cause contact dermatitis.
When considering the use of hydrocortisone, it is essential to weigh the benefits against the potential risks and harms. The risks of overuse include increased infection risk, osteoporosis, suppression of the hypothalamic-pituitary-adrenal axis, diabetes, weight gain, and cardiovascular disease 1. Furthermore, there is evidence of increased mortality in patients on long-term steroids, highlighting the need for careful management and monitoring of hydrocortisone use.
Key Considerations
- Limit use of topical hydrocortisone to 1-2 weeks for acute conditions and follow prescribed guidelines
- Avoid abrupt withdrawal of topical corticosteroids to prevent rebound effects
- Never adjust dosage of oral or injectable forms without medical supervision
- Be aware of the potential for systemic effects, including adrenal suppression and increased risk of infections
Potential Side Effects
- Skin atrophy
- Striae
- Folliculitis
- Telangiectasia
- Purpura
- Acne
- Rosacea
- Perioral dermatitis
- Tinea infections
- Contact dermatitis
- Adrenal suppression
- Osteoporosis
- Increased risk of infections
- Diabetes
- Weight gain
- Cardiovascular disease
It is crucial to prioritize the single most recent and highest quality study when making a definitive recommendation. In this case, the 2021 study published in the Journal of the American Academy of Dermatology provides the most up-to-date guidance on the management and treatment of psoriasis with topical therapy and alternative medicine modalities 1. By following the recommended guidelines and being aware of the potential side effects, healthcare providers can help minimize the risks associated with hydrocortisone use and optimize patient outcomes.
From the FDA Drug Label
Warnings For external use only ... do not use more than directed unless told to do so by a doctor ... Stop use and ask a doctor if condition worsens, symptoms persist for more than 7 days or clear up and occur again within a few days, and do not begin use of any other hydrocortisone product unless you have asked a doctor rectal bleeding occurs
The side effects of overuse of hydrocortisone are not explicitly stated in the label. However, it does mention to stop use and ask a doctor if condition worsens or if rectal bleeding occurs. This implies that overuse could lead to:
- Worsening of the condition
- Rectal bleeding It is recommended to use as directed and consult a doctor if unsure about the usage of hydrocortisone 2.
From the Research
Side Effects of Overuse of Hydrocortisone (Cortisol)
- Hypertension and severe hypokalemia can occur due to the ingestion of topical hydrocortisone cream 3
- Systemic toxicity, including Cushing's syndrome and hypothalamic-pituitary-adrenal suppression, can result from prolonged or excessive use of potent topical steroid preparations 4
- Adrenal insufficiency can be a rare systemic side effect of topical corticosteroid use 5
- Tachyphylaxis and contact allergy are potential problems in clinical practice with topical corticosteroid use 6
- Systemic side effects of corticosteroids include:
- Growth suppression in children
- Osteoporosis
- Osteonecrosis
- Adrenal insufficiency
- Cushing syndrome
- Hypertension
- Glucose intolerance
- Diabetes
- Gastritis
- Gastroesophageal reflux
- Peptic ulcer disease
- Weight gain
- Emotional lability
- Behavioral changes
- Opportunistic infections
- Cataracts
- Glaucoma
- Myopathy
- Myalgia
- Dysaesthesia
- Pseudotumor cerebri
- Hyperlipidemia
- Malignancy
- Thrombosis
- Skin atrophy
- Sleep disturbance
- Rebound flaring 7